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November 17, 2022 2:56PM EST

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A Positive Move to Support People

with Disabilities
The Buenos Aires Commitment Reinforces Autonomy
and Choice
Published in: Los Angeles Times

Carlos Ríos Espinosa

Senior Researcher and Advocate,
Disability Rights Division
@espinosa_rios

As someone with a physical disability that requires

intense forms of support, I can easily relate to the
stories shared by other people with disabilities about
their struggles when they lack access to quality support
and care systems that foster independence and the
ability to make choices about their own lives.

There was good news in this regard on November 11,

when the 15th session of the Regional Conference on
Women in Latin America and the Caribbean, organized
by the Economic Commission for Latin America and
the Caribbean (ECLAC), adopted the Buenos Aires
Commitment. All member states of the Commission,
46 in total, agreed to “recognize the importance for
persons with disabilities of their individual autonomy
and independence, including the freedom to make their
own choices.”

Reading accounts like Mark O’Brien’s in his book “How

I Became a Human Being” about the abuses he endured
while being forced to live a state hospital for two years
really makes you shiver. On one occasion, a nurse
feeding Mark was bored and in a hurry, so she started
stuffing food into his mouth, causing him to cough and
gag. The nurse called another nurse for help, and they
decided he had problems swallowing and ordered the
hospital’s kitchen to only provide him with pureed
meals. This decision was taken without asking for his
consent, let alone his opinion. Because of the nurse’s
neglectful behavior, he lost control over the type of
food he wanted to eat.

Abuses like this don’t just happen in hospitals and

institutions for people with disabilities. Unfortunately,
they also happen within families. During my research
for a 2020 report on family violence in Mexico, I spoke
with people who were made entirely dependent on
their families for care and support. Like Mark, they
were denied any say in basic decisions about their lives.
Javier (not his real name), 27, who has cerebral palsy,
told me his mother wanted to completely control him.

“When I go to school, I need to ride in a van for some

time, and I cannot hold my urine,” he said. “I have
asked her to put a diaper on me in order not to wet
myself, but she refuses, and if I wet my pants, she
punishes me by not letting me come to school, which is
…the only time when I’m away from home.” Javier’s
lack of other options left him financially dependent on
his family and feeling, in his words, “trapped.”

These accounts illustrate how, both in an institution or

at home, people with disabilities are disempowered,
deprived of any control over the support and care they
need, and at risk of violence. Many people with
disabilities around the world have no recourse but to
accept how precarious their situation is. Human Rights
Watch has documented abuses caused by
institutionalization in numerous countries, including
Brazil, India, and Russia.

Care systems often fail to recognize everybody's

capacity to act on their own behalf--most obviously the
people who receive care, but also people, mostly
women, who provide support. Such systems are
inconsistent with international human rights law.
Instead, any sound policy response aimed at providing
support and care services should empower both
providers and recipients while treating recipients as
agents of their own development and well-being, not
passive objects.

The lack of comprehensive national systems for

support and care, as documented by many studies
worldwide, forces some family members to provide
care 24/7, at the expense of their own well-being and
personal and economic development.

For countries to live up to the Buenos Aires

commitment, they would need to create and implement
policies, services, and accessible infrastructure to
protect people with disabilities’ right to provide and
receive care and to self-care, considering their specific
needs. While the resolution does not itself have the
force of law, all members of the Commission in the
Americas have ratified the Convention on the Rights of
Persons with Disabilities, which establishes binding
obligations.

Policymakers and other stakeholders worldwide need

to have close consultations with organizations of
people with disabilities and include them in ongoing
discussions around designing and implementing
support and care systems. The Committee on the
Rights of Persons with Disabilities has developed
standards and directives on international obligations
for states that have ratified the UN disability rights
treaty.

These core obligations of international disability law

include the right of people with disabilities to make
choices about their lives. The Buenos Aires
Commitment is a great start to advancing the
autonomy and rights of people with disabilities. As
such, it provides key guidance for the design of the
national support and care systems underway in many
countries in the Americas.

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