Case T-209/99

This joint appeal involved two cases wherein mentally ill individuals were released from psychiatric hospitals into the care of their families.

In File 152.647, Jorge Sandro Hernandez Tacuri had been repeatedly admitted into psychiatric hospitals because he suffered from a variety of mental psychosis, including schizophrenia and epilepsy. After treatment in the psychiatric hospital, Jorge Sandro’s medical experts agreed that he should be transferred to his house because his epileptic episodes and levels of violence had decreased and his treatment could be satisfactorily continued on an outpatient basis.

In File T-154.23, Sergio Iriarte Polanco was a patient suffering from schizophrenia who had been in and out of mental hospitals since he was a child. After a continuous 4 year stay in a hospital, he was released to his family after his medical experts determined that his treatment no longer required psychiatric hospitalization.

The mothers of both patients had contested their sons’ release into the family’s care. Jorge Sandro’s mother stated that he would not take his medicine which intensified his mental problems and resulted in aggression with his relatives and himself. She also argued that, due to her responsibilities as head of the household, she did not have time to take care of his illness and that, as her son was a beneficiary on her insurance, the Social Security Institute was required to assume comprehensive patient care.  Sergio’s mother also claimed that at home Sergio was aggressive with both his relatives and himself and that he had attempted suicide.

The mothers each claimed that the release of thir sons, respectively, threatened, among other things, the fundamental rights to health, physical integrity, and life in dignified conditions of each son, of each mother, and of the other family members.

The courts of first instance for both cases each denied the protection requested by mothers, which judgments were upheld by the courts of second instance, resepctively.

The Court first reaffirmed the importance of the right to health within Colombian jurisprudence and noted that such right covers a broad state of mental, physical and social well-being. The Court also noted that the right to health implies particular care be given to the mentally-ill as vulnerable person and that medical care should be provided to individuals not just at the most critical stages of mental disease. The Court confirmed the “clear connection” between the right to health and dignity.

The Court determined that, in order for the right to health guarantees to be satisfied, various public and private entities (such as the family unit) must contribute to the well-being of a patient. Citing to the principle of social solidarity (i.e., the duty “imposed on any person by the mere fact of belonging to the social conglomerate, consisting of the binding of one's own efforts and activity to the benefit or support of other associates or in the collective interest”) grounded in the Colombian Constitution, the Court confirmed that protection of fundamental rights, especially in the case of vulnerable people like the mentally ill, can become the constitutional responsibility of individuals.

The Court therefore held that, based on definition of the right to health, respect for human dignity and the exercise of the principle of social solidarity, the family should be involved in the treatment of the disease suffered by a family member. However, such obligation of family members did not allow the state to abnegate its responsibilities and the assistance to be rendered by the family must take into account their resources.

The two verdicts that denied the appeal for legal protection requested by the mothers were confirmed. Additionally, the Court ordered, inter alia, that Institute of Social Security provide medical assistance to the patients and their family, continue providing outpatient assistance and allow readmission of the patients if necessary.

“This is a proposition that in health field acquires specific dimensions. Health is a legal right that must be protected by the State and society, -either the family or other communities-, that are obliged to assist ill persons, guaranteeing their harmonious and integral development and the full exercise of their rights.

It cannot be forgotten that 'health is like an extension of the right to life…it participates in the dimension in which the human dignity unfolds, and thus, all the country forces are engaged to protect the person against the contingencies that compromise health'. In this vein, not only the State is responsible for protecting the life and health of the associate; these guarantees, as well as all fundamental rights, must also be safeguarded by private citizens, and thus become their constitutional responsibility. It can be said then, 'the protection to the humans is guaranteed in the acts or omissions both from the state as well as the private citizens'.

And it could not be otherwise, because as the foundation of the structure of our law, the Constitution of 1991 grounded the principle of social solidarity as a way to meet with the state purposes and ensure the acknowledgement of the rights of all the community members.” Section 4.3

“Esta es una proposición que en el campo de la salud adquiere dimensiones concretas. La salud es un bien jurídico que debe ser protegido por el Estado y por la sociedad, -ya sea la familia u otras comunidades-, que tienen la obligación de asistir al enfermo, garantizándole su desarrollo armónico e integral y el ejercicio pleno de sus derechos.

No se puede olvidar que “la salud es como una prolongación del derecho a la vida... participa de la dimensión en la que se desenvuelve la dignidad humana, y por tanto, todas las fuerzas del país se encuentran comprometidas en la protección de la persona contra las contingencias que vulneran la salud”. En este orden de ideas, no solamente el Estado es responsable de proteger la vida y la salud de los asociados; estas garantías, como todos los derechos fundamentales, deben también ser resguardadas por los particulares, y se convierten por ello en su responsabilidad constitucional. Puede decirse entonces, que “la protección a la persona humana se concreta frente a los actos u  omisiones tanto del estado como de los particulares”

Y no podría ser de otra forma, puesto que en la base de la estructura de nuestro ordenamiento jurídico, el Constituyente de 1991 fundó el principio de solidaridad social como una forma de cumplir con los fines estatales y asegurar el reconocimiento de los derechos de todos los miembros de la comunidad.”Sección 4.3

“Then, it is not possible to state that family is not involved in the disease treatment process that one of its members suffers; powerful reasons that, as we have seen, are grounded in the definition of the right to health, in respect for human dignity and in the exercise of the principle of solidarity, prevent the responsibility of this social body in the assistance and protection of ill from being eluded.” Section 4.4

“No es posible decir entonces, que la familia no está involucrada en el proceso de tratamiento de la enfermedad que sufre uno de sus integrantes; poderosas razones que como hemos visto, se sustentan en la definición del derecho a la salud, en el respeto de la dignidad humana y en el ejercicio del principio de solidaridad, impiden que se eluda la responsabilidad de este organismo social frente a la atención y protección de los enfermos.”Sección 4.4

“It is unthinkable that an absolute and inconsiderate obligation is intended to be established. The assistance rendered by the family regarding its ill members must be established in relation to the sickness presented, and taking into account the economic and logistic resources available. As such, whether a hospitalized patient or someone that can stay at home, means suitable for the relatives to be able to contribute to the process of relief must be found, together with the conventional medical therapy. Then, it will be necessary to coordinate efforts for the individuals to have the assistance and information required in order to contribute effectively to the improvement or stabilization of the ill person. The family enjoys certain rights that must also be ensured.” Section 4.4

“Pero, no puede pensarse que se procura establecer una obligación absoluta y desconsiderada. La asistencia que se predica de la familia respecto de sus miembros enfermos, debe ser establecida de cara a la naturaleza de la enfermedad que se enfrenta y teniendo en cuenta los recursos económicos y logísticos de que se disponga. De este modo, ya sea que se trate de un paciente hospitalizado o de alguien que puede permanecer en su hogar, han de buscarse los medios adecuados para que, junto con la terapia médica convencional, los familiares puedan contribuir al proceso de alivio. Será entonces necesaria la coordinación de esfuerzos para que los particulares cuenten con la asesoría e información necesarias que permitan contribuir eficazmente a la mejora o estabilidad del enfermo. La familia goza de ciertos derechos por los cuales también ha de velarse.” Sección 4.4

“Lastly, and to sum up: the existence of a chronic mental pathology does not mean that there must be disinterest and disaffection of the people close to the patient. It cannot be solved –and so does modern medicine advise-, by unnecessarily and indefinitely confining the ill in the premises of a medical center. The fears and reluctance in situations that we cannot understand –such as the example of mental diseases-, cannot be avoided by arguing embarrassment or discomfort. The affection, and bonds that are born from family life, and that are expressed in multiple and varied manners in the law –e.g. solidarity, decent life, health-, require that we overcome our perplexities and actively participate fostering well-being for others.” Section 5

“Por último, y a manera de síntesis: la existencia de una patología mental crónica, no puede encontrar como respuesta el desinterés y desafecto de las personas cercanas al paciente; tampoco puede solucionarse -y así lo aconseja la medicina moderna-, a través del innecesario e indefinido confinamiento del enfermo en las instalaciones de un centro médico. Los temores y reticencias frente a situaciones que sobrepasan los límites de nuestro entendimiento y de nuestra experiencia vital -de los cuales los males mentales son un típico ejemplo-, no pueden evadirse argumentando desconcierto o incomodidad. La propia naturaleza humana, el cariño, y los lazos nacidos de la convivencia familiar, que se expresan de múltiples y concretas maneras en el ordenamiento jurídico -v.g. solidaridad, vida digna, salud-, exigen que nos sobrepongamos a nuestras perplejidades y participemos activamente propiciando el bienestar de otros.” Sección 5