This case was brought before the Inter-American Commission on Human Rights (“IACHR”) by three family members (“Petitioners”) of Mr. Vinicio Antonio Poblete Vilches (“V”) against Chile, regarding V’s death at Sótero del Río Public Hospital (“Hospital”). The petition alleged that V’s death was caused by the attending doctors’ negligence, as they performed a major operation on V without the requisite informed consent. The doctors then forged the authorization form and discharged him while he was still in a serious condition and had open, infected wounds. When V was promptly re-admitted to the hospital in need of urgent medical care, he was denied access to such treatment due to the lack of available beds in the hospital’s intensive care unit. The petitioners received contradictory and unclear information regarding the cause of V’s death and the hospital denied their autopsy request.
Following this, the Petitioners’ initiated a criminal complaint alleging culpable homicide against the hospital doctors responsible for V’s care in 2001. From 2001-2008, this complaint bounced between the First Civil Court (“Civil Court”) and the Court of Appeal of San Miguel. During the Civil Court proceedings, the police report and the report of the forensic physician concluded that V died due to the seriousness of his medical complications, and not from medical oversight.
In 2005, one of the petitioners initiated a second criminal complaint against unnamed persons for V’s death. In 2006, the Legal Medical Service Report also failed to find any medical oversight in V’s treatment and eventual death. The petitioners also applied to the Supreme Court of Justice four times between 2011 and 2015, and each time the Supreme Court denied their request to examine the case, stating that it was unable to intervene in “concluded proceedings.”
The petitioners argued that the investigation into V’s death was unnecessarily prolonged and delayed and that they were discriminated against based on economic grounds, since they did not have the resources to afford a lawyer to represent their interests against the experienced lawyers the doctors hired. They argued that they experienced serious harm as a direct result of V’s “passive euthanasia,” including significant pain and suffering, as well as severe health problems, and their eventual descent into poverty.
The IACHR found that the State of Chile violated the rights to life, humane treatment, access to information on health, judicial guarantees, and protection, guaranteed under Articles 4, 5, 8, 13, and 25 of the American Convention on Human Rights (“Convention”).
The IACHR drew upon its own jurisprudence as well as that of the European Court of Human Rights and international standards to define informed consent. The IACHR stated firmly that Article 13 of the Convention (freedom of thought and expression) includes the right to access information and that this right is imperative to ensure individuals can make “free and reasoned decisions with respect to intimate aspects of his or her health… including decisions on medical procedures or treatments.” The IACHR further noted that informed consent requires that individuals understand all available facts and treatment options. The IACHR indicated that informed consent consists of:
a. Information about the nature of the procedure, treatment options, and reasonable alternatives (analyzing the plausible risks and benefits) of the proposed procedure. Such information must be “complete, accessible, reliable, timely, and diligent.” It must be “culturally and otherwise acceptable to the person consenting” (i.e. must be appropriately translated, where the need arises) and must be provided timely, prior to the application of the procedure.
b. Ensuring that the person comprehends the information furnished, taking into account requirements an individual may have (i.e., the information was explained to the persons consenting in language that they were able to understand);
c. Ensuring that free and voluntary consent is given. Such consent must be granted free from any coercion or manipulation and although it can be given orally or in writing, “…the State should take measures to ensure that the consent is given in writing.”
The IACHR reiterated that the process of informed consent includes the adoption of “legislative, public policy, and administrative measures” and that such obligation extended to physicians, health professionals, and social workers at public as well as private hospitals.
It further noted that health services must satisfy the criteria of “availability, accessibility, acceptability, and quality” to prevent violations of the rights to life and integrity, established by the Economic, Social, Cultural, Environmental Rights Commit in its General Comment No. 14. The IACHR referred to its previous jurisprudence that recognized the direct and immediate link between the right to life and the right to health, noting that this link was a manifestation of the “interdependence and indivisibility” between civil-political rights and socio-economic rights and, consequently, that the lack of medical treatment may arise in a violation of personal integrity. The IACHR found that these rights had been violated in this case by the Hospital’s decision to discharge V, as well as its failure to provide the intensive care required by his condition on his second admission to the Hospital.
The IAHCR analyzed whether the Hospital obtained informed consent prior to V’s treatment by examining V’s capacity to consent and whether the family provided informed consent, and, if so, whether the family had sufficient information to properly provide it, ultimately finding that the medical staff of the Hospital failed to fulfill their obligations to obtain informed consent prior to treating V. With respect to V’s second hospitalization, the IAHCR also recognized that the Hospital failed to obtain informed consent, noting that the decision to offer V “intermediate” treatment (rather than admitting him to the ICU) was a medical decision based on infrastructural restrictions rather than medical need, yet Petitioners were never informed of possible alternatives, including the option to transfer him to another hospital, in order to make a fully informed decision. Accordingly, the IAHCR found that the Hospital had failed in its duty to ensure that informed consent was obtained from the Petitioners, in violation of Article 13 of the Convention, for which the Chilean government was liable for since the Hospital was public.
The IACHR also found that Chile did not investigate with due diligence or within a reasonable time the complaints the Petitioners filed before domestic courts, thus violating the rights to judicial guarantees and judicial protection under Articles 8 and 25 of the Convention.
Finally, the IACHR found a violation of the right to humane treatment and respect to family members, as guaranteed in Article 5(1) of the Convention. The Court referenced precedent that recognized that the family members of the victim may suffer from a violation of their mental and moral integrity as a result of the victim’s suffering. Based on this precedent, the IACHR found a violation of Article 5(1) in the facts, since the Petitioners did not give informed consent, did not receive basic information about V’s treatment, suffered through long-winded legal proceedings, and the State did not do as much as it could have to ensure that V received the treatment he needed.
The IACHR called for: (1) full reparation to V’s next-of-kin including compensation; (2) that Chile undertake a thorough investigation into the circumstances surrounding V’s death, ensuring effective access to justice for V’s next-of-kin; (3) the establishment of legislative, administrative, budgetary, infrastructural, and other measures in line with the standards of informed consent articulated in the decision; (4) establishment of measures to ensure that the Hospital had adequate resources to provide care; and (5) sufficient training and education measures for judicial officers, to equip them to deal with investigations into deaths alleged to be the result of inadequate health care.