36 irrelevant to the assessment of the violation of her personal integrity and/or her reproductive rights. In addition, it considered that a surgical procedure or an invasive medical treatment, without the patient’s consent, constituted a violation of the right to personal integrity, which was related to other rights recognized in the Convention. 120. The representative endorsed the arguments of the Commission. 121. The State considered that, asserting the inexistence of consent was disproportionate, in view of the fact that, during the surgical procedure, the attending physician in the presence of his team, decided to consult I.V. about the possibility of performing the tubal ligation as a result of the clinical picture observed during the caesarean section. In response to this consultation and advice, I.V. had given her free, voluntary and spontaneous consent. The State concluded that the surgical procedure performed on I.V. was characterized as a high-risk obstetric procedure and, consequently, the actions of the instructing physician were only aimed at safeguarding her life and integrity. Thus, in an exceptional emergency situation, reducing the need to obtain this consent to a mere formality consisting in a consent form signified jeopardizing the immediate need for the surgical procedure. The State indicated that the alleged violation of I.V’s personal integrity in relation to her condition as a woman, who was poor, Peruvian and a refugee in Bolivia, and the presumed continuity of this violation, was unwarranted in this specific case, because it concerned a sterilization procedure performed with I.V.’s prior and free consent. Therefore, the State could not assume any responsibility. A.2 Arguments on the right of access to information (Article 13(1) of the American Convention) A.2.a Access to information and informed consent 122. The Commission considered that the right of access to information and informed consent are essential instruments to ensure other rights such as personal integrity, autonomy, sexual and reproductive health, the right to decide freely on maternity and to raise a family, as well as to give free and informed consent to any measure that may affect the reproductive capacity, and these are all interrelated. In addition, it established that the right of access to information protected the right of a patient to receive from the State, previously and formally, relevant, comprehensible information to be able to take free well-informed decisions on intimate aspects of her health, body and personality, and required that the State obtain this consent prior to any health procedure. The Commission noted that, as tubal ligation was a permanent method of contraception, the controls to ensure free and informed consent needed to be more rigorous. In this regard, the Commission concluded that: (i) there was no record that the presumed victim received complete information on her health situation and the nature of the clinical diagnosis based on which the tubal ligation procedure was recommended, nor that the relevant person had provided her with a detailed description of the nature, risks and consequences of the procedure; (ii) in addition, it appeared that the patient had not been advised about alternative treatments to safeguard her life in the case of a future pregnancy, such as the use of non-permanent contraception methods; (iii) a situation of medical emergency did not exist that would have required the tubal ligation to save I.V.’s life during her surgery; to the contrary, it was an elective procedure that could be performed at any other moment, so that there was no justification for the patient not to have obtained timely and accessible information on contraception methods, and (iv) I.V. should not have been consulted about the sterilization during the caesarean section, because she was under epidural anesthesia, and it is reasonable to consider that she was in a state of surgical stress, so that her consent could not be truly free. The Commission indicated that, even if I.V. had been given information verbally, as argued by the State, that did not meet the necessary requirements and conditions to have enabled her to give her informed consent. It also indicated that there was no real and immediate danger to her life that would have excluded the need for her express consent.