63 sterilization, the Court notes that all the States that had a law in this regard in 2000 required written consent in this case. 200. The Court also notes that, even though the general rule was to obtain informed consent, the laws of some States recognized the existence of exception to this rule, including cases of urgency or emergency in which consent could not be obtained. In 2000, various States regulated these exceptions.262 In the case of female sterilization, however, the Court has corroborated that none of the countries that regulated it, established specific exceptions in this regard. B.2.c Conclusion 201. Based on the foregoing, the Court concludes that, at the time the facts of this case took place, the State had an international obligation to obtain, through its health personnel, the consent of patients for medical procedures and, especially, of women in the case of female sterilizations, and this should have complied with the characteristics of being prior, free, full and informed following a process of informed decision-making. B.3 Determination of the scope of the State’s international responsibility 202. The Court notes that tubal ligation, in particular using the Pomeroy technique, is a surgical contraception method that causes sterilization; that is, it permanently deprives a woman of her biological reproductive capacity. A medical procedure of this type should be performed voluntarily, requiring prior, free, full and informed consent, as developed in the preceding section. Indeed, as expert witness Luisa Cabal indicated, “[s]sterilization is a permanent contraceptive method that should form part of a wide range of contraception methods that everyone has the right to choose or refuse autonomously, in the exercise of their sexual and reproductive rights.”263 203. In light of all the above, the Court must now determine whether the State of Bolivia had a clear regulation in order to prevent the performance of female sterilizations without prior, free, full and informed consent, because the State has argued before this Court that the laws and regulations cited by the Commission and the representative to substantiate the alleged violations, were not applicable in the case of I.V. Nevertheless, the Court will not determine the validity of these norms, because it has not been alleged that Article 2 of the Convention was violated. The Court must also decide whether the tubal ligation procedure performed on I.V. constituted a case of sterilization that was contrary to Bolivia’s international obligations resulting from the parameters defined previously with regard to the obligatory nature of ensuring that patients have given their informed consent based on their autonomy and dignity, in order to verify whether the international responsibility of the State has been generated by the actions of its public officials; in this case, its health care personnel in a public hospital. 204. The Court notes that, although the express prohibition of forced or involuntary sterilization has been established in international criminal law, 264 or in the definition of crimes at the domestic level,265 the absence of informed consent in relation to the deprivation of a woman’s biological Namely: Argentina, Bolivia, Chile, Canada (Ontario), Colombia, Costa Rica, Ecuador, Paraguay, Peru, Uruguay and Venezuela. 262 263 Expert opinion provided by Luisa Cabal by affidavit on April 28, 2016 (evidence file, volume XI, affidavits, folio 3973). See Articles 7(1)(g), 8(2)(b)(xxii) and 8(2)(e)(vi) of the Rome Statute. Forced sterilization was recognized as a war crime in the Nuremberg trials of the perpetrators of acts committed in the context of medical experimentation. 264 Bolivia (2013), Brazil (1996), Ecuador (2014), Mexico (2012) and Venezuela (2007) have criminalized forced sterilization within their jurisdictions as an ordinary offense: forced sterilization in Bolivia and Brazil; forced deprivation of reproductive capacity in Ecuador, and induced sterility in Mexico. 265