Guachalá Chimbo et al. v Ecuador
The Inter-American Court of Human Rights affirmed that disability is a category protected by the American Convention and established general obligations to eliminate all disability-based discrimination and to promote full integration of persons with disabilities into society. The Court found that, due to the failure of the State to provide adequate accessible medical treatment and the public hospital to obtain informed consent from Mr. Chimbo, who disappeared during his custody at the hospital, the State violated his rights to recognition of juridical personality, life, integrity, personal liberty, dignity and privacy, access to information, and health. The court also held that the State violated the rights to judicial guarantees and protection and the right of personal integrity of his family.
Luis Eduardo Guachalá Chimbo, aged 23 years old at the time of his disappearance, suffered from epileptic seizures since childhood. As of January 21, 2004, he was diagnosed with with a psychosocial disability. Due to insufficient income to cover Mr. Chimbo’s and his family’s basic needs, he was unable to consistently afford the medicines needed to treat his epileptic seizures.
On January 10, 2004, Mr. Chimbo was hospitalized and received treatment at a public psychiatric hospital with consent given by his mother, Ms. Zoila Chimbo Jarro. Between January 10 and 17, Ms. Chimbo visited the hospital once and called multiple times but was unable to find or contact her son, with hospital staff acting dismissive or evasive of her attempts. On January 17, the hospital recorded that Mr. Chimbo had left the hospital and that a search was made but he was not found. After Ms. Chimbo inquired about her son’s condition on January 18th, only then did the hospital inform that her son had reportedly left the hospital, that the hospital had searched its grounds to no avail and informed the police; she was directed by the hospital to seek assistance from the police.
Following Mr. Chimbo’s disappearance in 2004, Ms. Chimbo,filed a complaint with the National Judicial Police Directorate of Pichincha. The case was dismissed after not shedding light on Mr. Chimbo’s whereabouts. Concurrently, Ms. Chimbo filed a complaint with the Ombudsman addressed to the National Directorate for Defense of the Rights of the Elderly Persons and Persons with Disabilities that resulted in a communication finding total responsibility of the hospital for the disappearance. Next, Ms. Chimbo filed a writ of habeus corpus before the Mayor of Quito. After no response, Ms. Chimbo filed suit before the Constitutional Tribunal. The Constitutional Court ruled an investigation must continue until Mr. Chimbo was located, but no meaningful investigative actions took place following the ruling.
The family filed a petition with the inter-American human rights system, represented by the Centro de Derechos Humanos de la Pontifícia Universidade Católica de Ecuador (CDH-PUCE) led by the Dean of the Faculty of Jurisprudence Mario Melo.
In its judgment, the Inter-American Court of Human Rights examined the right to equality and non-discrimination under Articles 1(1) and 29 of the American Convention. The Court affirmed that disability is a category protected by the American convention and accordingly no law, act, or practice may discriminate based on a person’s real or perceived disability or reduce or restrict their rights based on their disability. As a result, the Court found that States have general obligations to adopt, to the maximum extent of their available resources, the necessary legislative, social, educational, labor, or any other measures to eliminate all disability-based discrimination and to promote full integration of persons with disabilities into society. Supported by the Convention on the Rights of Persons with Disabilities (CRPD) and the Ecuadorian Constitution in effect at the time, the Court also established that discrimination based on disability occurs when reasonable accommodations are either denied or not provided.
The Court noted that the State hospitalized Mr. Chimbo without his informed consent, failed to make any efforts to support Mr. Chimbo so he could provide informed consent, and unduly attempted to justify the lack of informed consent on the basis of his disability. The Court further noted that the State failed to provide accessible and adequate medical treatment because Mr. Chimbo was unable to afford the treatment to manage and prevent his disability and did not receive quality medical care while hospitalized. The State was also found negligent due to its inability to locate Mr. Chimbo while in its custody. Accordingly, the Court held that under Articles 1(1), 4, 24 and 26 of the American Convention and under the Inter-American Convention on the Elimination of All Forms of Discrimination Against Persons with Disabilities, the State violated Mr. Chimbo’s rights to recognition of juridical personality, life, integrity, personal liberty, dignity and privacy, access to information, and health and discriminated against him based on his disability.
Specifically, the Court found that the lack of informed consent and failure to take any measures to meaningfully support Mr. Chimbo to provide informed consent, even if he was in crisis, constituted a denial of his autonomy as a person and his capacity to make decisions concerning his rights to health, recognition of juridical personality, dignity, privacy, personal liberty, and access to information. The State’s failure to comply with its obligation to provide acceptable and quality medical care violated his right to health, which encompasses the principles of availability, accessibility, acceptability, and quality. The State’s negligence in locating Mr. Chimbo who was in its custody violated his rights to life and to personal integrity, in relation to the right to health. The Court also found that the State has formal and substantive obligations to ensure equality for persons with disabilities, including adopting a supported decision-making model and providing reasonable accommodations. Here, the State failed to provide support for and receive informed consent from Mr. Chimbo, failed to provide reasonable accommodations in the form of free medical treatment and supervision, and unduly sought to justify the lack of informed consent and support on the basis fo Mr. Chimbo’s disability. These failures constituted discrimination based on disability under the right to health and to equality.
The Court also examined the investigative administrative and judicial proceedings following Mr. Chimbo’s disappearance. Mr. Chimbo’s disappearance from a public hospital meant the State had an obligation to immediately open an investigation into his disappearance ex officio but did not do so. The State also failed to immediately comply with the Constitutional Court ruling to continue to investigate the disappearance until Mr. Chimbo was found. The Court found that the State violated the rights to judicial guarantees and judicial protection in violation of Articles (7)(6), (8)(1), and 25(1) in relation to Article (1)(1) of the American Convention.
Finally, the Court recognized that, because of Mr. Chimbo’s disappearance and the subsequent investigative administrative and judicial proceedings, Mr. Chimbo’s mother and sister suffered profound suffering and anguish. The Court concluded that this suffering and anguish violated the right to personal integrity of the family members under Articles Article (1)(1) and (5)(1) of the American Convention.
The Court ordered the State to conduct a diligent investigation within a reasonable time to determine what happened to Mr. Chimbo; identify, prosecute and hold accountable, as appropriate, those responsible; and continue its search for Mr. Chimbo and provide any support to the family participating in the search. The Court also ordered pecuniary and non-pecuniary damages to Mr. Chimbo, his mother, and his sister. The State must also conduct a public act to acknowledge its international responsibility in the case and regulate its international obligation to provide support to persons with disability to give informed consent to ensure the right to health without discrimination. This includes adopting permanent education and training programs for medical students, professionals, and personnel on the issues of informed consent and the necessary support for people with disabilities to make informed medical decisions.
While Ecuador continues to investigate the disappearance of Mr. Chimbo, advocates note that the investigative measures have been conducted in a non-technical, unsystematic manner and that the State has not been diligent in their efforts. Further, as of April 2022, Ecuador had not made the required payments for damages or mental health treatment to Mr. Chimbo’s mother or sister. On January 20, 2022, the Ministry of Public Health of Ecuador (MSP) posted a public apology through an image on Twitter; the image did not name Mr. Chimbo or his mother as victims. The MSP also posted a short statement on the case with a link to the ruling on Twitter, but this publication fails to comply with the judgement that requires the posting be on the home page of the website and accessible to the public. In February 2022, Ecuador published two documents on the Ministry of Health website that summarized the judgement. But Ecuador did not coordinate this publication with the injured parties, Mr. Chimbo’s mother and sister, and it was published two months after the deadline. On September 15, 2022, Ecuador has made public act of acknowledgment of international responsibility and apology to the family.
This was the Court’s first case to involve the psychiatric hospitalization of a person with disability since the adoption the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in 2006. Guachalá Chimbo et al. v Ecuador establishes the right of a person with disabilities to provide informed consent in relation to the right to health and requires the provision of the necessary supports to obtain free and informed consent. This standard applies even if a patient is in crisis. If no advance planning measures are in place and significant efforts have been made to obtain consent, then the State must determine the best interpretation of the patient’s will and preferences.
For their contributions, special thanks to ESCR-Net members: the Program on Human Rights and the Global Economy (PHRGE) at Northeastern University.