Poblete Vilches and Others v. Chile
The Inter-American Court of Human Rights found violations of the rights to health, life, personal integrity, access to information, and informed consent in a case brought against Chile by the family of Vinicio Poblete Vilches, an older patient who was deprived of adequate emergency medical treatment by a public hospital preceding his death.
On January 17, 2001, Vinicio Poblete Vilches was admitted to the Chilean public Hospital Sotero del Rio with severe respiratory failure. He was 76 years old and was sent to the Intensive Care Unit (ICU), where he was in an unconscious state for several days. He underwent surgery, was discharged and readmitted, and died in the hospital on February 7. The principal questions before the Inter-American Court were whether the state violated: 1) the human rights to health and life of Mr. Poblete Vilches, and 2) the human rights to personal integrity, access to information, and informed consent of both him and his family.
The Court recognized that the right to health is an autonomous right, within the economic, social, cultural, and environmental rights guaranteed by Article 26 of the American Convention of Human Rights (ACHR). Therefore, Chile must adopt immediate measures to protect the right to health, such as guaranteeing non-discrimination in access to health services, as well as progressive measures to “advance in the most expedited and effectively way possible toward the full effectiveness” of the right over time.
The Court reasoned that the progressive duties were not at issue in this case, so it only examined Chile's immediate duties, which it held included the obligation to take steps that are adequate, deliberate, and concrete toward the full realization of the right to health. The Court determined that in the context of emergency medical services, Chile must provide medical services that are, at a minimum, available, accessible, acceptable, and of quality, and must adequately supervise public and private hospitals. In addition, because older individuals are particularly vulnerable, Chile has a heightened responsibility to protect their right to health.
The Court found that Mr. Poblete Vilches was in demonstrably poor health when he was discharged, the care he received on his second hospital stay was inadequate, and he was not provided certain medical services because he was older. These factors—as well as the lack of necessary medical equipment, available ambulances, and sufficient ICU beds—together showed the state's failure to meet its immediate duties, thus violating his autonomous right to health. Because the Court found a strong probability that this failure caused his death, it also violated his rights to life and personal integrity. In addition, because several of Mr. Poblete Vilches' family members experienced severe physical and emotional harm related to his hospitalization and death, including depression, suicidal tendencies, and heart attacks, Chile also violated their right to personal integrity.
Next, the court discussed the right to access information, which is protected under Article 13 of the Convention, as well as in connection to the right to health. The state must provide basic standards of accessibility, which includes access to information about health care. Informed consent is also an element of that access. Under Chile's relevant regulations, when a patient does not have capacity to make decisions, their family or other legally designated representative takes on the responsibility to consent. When Mr. Poblete Vilches was taken to surgery, he was unconscious and unable to consent. Because the hospital did not seek informed consent from his family members before surgery, and later did not provide the family adequate information about the grave state of his health, Chile also violated the family's rights to informed consent, to access to information, and to the related rights to dignity and liberty.
The Inter-American Court also decided Chile had violated its duty of due diligence with respect to the provision of an effective remedy for the human rights violations because the state failed to do an autopsy and to arrest a defendant in the case, even after a warrant had been issued.
The Court ordered a number of remedies, requiring Chile to: 1) publish the judgment and publicly recognize its responsibility; 2) provide specific psychological support to the family members; 3) increase training, improve infrastructure, monitor compliance, and take specific measures to strengthen institutional support for older people; and 4) pay compensation for lost income, medical costs, and emotional distress, as well as attorney's fees and costs. The Court did not re-order the opening of the criminal case because the passage of time limited the state's ability to respond effectively in a punitive process.
As of May 2019, just over a year after the Court’s ruling, the Chilean state had published and publicized the judgment as ordered, but it had yet to comply with the compensatory, non-repetition, and other remedies established.
For the first time, the Inter-American Court declared a violation of the autonomous right to health recognized within the economic, social, cultural, and environmental rights protected by Article 26 of the American Convention. This recognition can contribute to further clarifying state obligations, defining rights more accurately, and providing an avenue to relief for the right to health in the Americas. Furthermore, the Court re-affirmed the rights of patients and their families to informed consent when seeking medical care, noting their relationship with the rights to access information and to health. Finally, the decision establishes a heightened state duty of care concerning the health rights of older persons.
For their contributions, special thanks to ESCR-Net member: the Program on Human Rights and the Global Economy (PHRGE) at Northeastern University.