Right to Medical Aid Under Article 21 – A Case Study of Parmanand Katara v. Union of India
In the case of Parmanand Katara v. Union of India, the Supreme court interpreted the right to medical aid as an essential part of the right to life under Article 21 and held that no accident victim could be denied treatment at hospitals simply because the hospital did not handle medico-legal cases. It was the constitutional right of… Read More »
In the case of Parmanand Katara v. Union of India, the Supreme court interpreted the right to medical aid as an essential part of the right to life under Article 21 and held that no accident victim could be denied treatment at hospitals simply because the hospital did not handle medico-legal cases. It was the constitutional right of accident victims to get life-saving treatment and this right could not be taken away by any enactment.
Introduction
The medical profession is considered an honourable and noble profession because the medical professionals exercise their expertise, skill, knowledge, and caution to save lives. People look up to doctors and consider them as the only ray of hope for a person hanging on a tightrope between death and life.
Apart from having a noble side, the medical profession also has an undesirable side where people are refused treatment solely on the basis that the hospital and the doctors do not want to get involved in a legal quagmire of formalities, police questioning, court summons, and cross-examinations. Unfortunately, there have been instances where doctors have refused treatment to injured patients simply because they were not handling medico-legal cases.
Countless lives have been lost to delay and non-cooperation of hospitals to treat accident cases just because they involved a medico-legal question. It is this question that was brought up before the Supreme Court of India for its consideration in Parmanand Katara v. Union of India[1] through a Public Interest Litigation (PIL).
Background of the Case
Human life holds paramount value in the world. Protection of humanity is one of the several aspirations which governments across the globe strive to achieve and safeguarding the health of people is an aspect of the same. Article 21 of the Constitution of India protects the right to life of people, but hospitals and medical practitioners across the country had been refusing treatment to accident victims solely because they were not authorized to handle medico-legal cases or simply because they did not want to handle a police case. This lack of sensitivity shown by the hospitals was costing many accident victims their life, amounting to a violation of their right to protection of life under Article 21.
Therefore, in 1989 in Parmanand Katara v. Union of India, the question came before the Supreme Court for its consideration in the form of a PIL filed by petitioner Parmanand Katara. The apex court interpreted the right to medical aid as an essential part of the right to life under Article 21 and held that no accident victim could be denied treatment at hospitals simply because the hospital did not handle medico-legal cases. It was the constitutional right of accident victims to get life-saving treatment and this right could not be taken away by any enactment.
Facts of the case
A medico-legal case is one wherein in any case of injury, the attending doctor after performing a clinical examination and taking the history of the patient considers whether the investigation by law enforcement agencies is necessary to ascertain the circumstance and to fix responsibility for the said injury according to the law.[2]
The petitioner, Parmanand Katara, had filed a writ petition before the Supreme Court under Article 32 of the Constitution, making the Union of India the respondent. The petitioner was a human rights activist fighting for the causes in the general public’s interest. The petition was based on a newspaper report published in the Hindustan Times titled – “Law Helps the Injured to Die”.
The newspaper report claimed that a scooterist was hit by a speeding car. The injured scooterist was picked up from the road by a person and taken to a nearby hospital. On reaching the hospital, the doctors refused to treat the injured scooterist as the hospital was not authorized to handle medico-legal cases and asked the person to take the injured scooterist to another hospital twenty kilometres away which was authorized to treat such cases.
The good citizen lost no time to take the scooterist to the other hospital, but owing to the delay in availing of medical treatment, the victim succumbed to the injuries on the way.
Provisions referred to in the case
Article 21 of the Constitution of India, 1950, was referred to in the case along with clauses 10 and 13 of the Code of Medical Ethics, 1970.
Issues Raised
The issue raised by the petitioner before the Supreme Court was of utmost importance. It was: Whether an accident victim could be allowed treatment by a hospital without the hospital having to comply with several legal formalities before giving medical aid to the person?
Arguments
Ordinarily, the contending parties raise arguments that favor their case best and usually have opposing arguments to counter the other. However, in this case, the arguments of the respondent were in line with the arguments raised by the petitioner.
The petitioner contended that a direction should be given to the respondent stating that every injured person brought to a hospital for treatment should be given the necessary medical care to preserve the life of that person. Further, the petitioner prayed that to avoid death caused by negligence, only after medical treatment had been given to that person should the procedural criminal code be allowed to operate.
If such direction is breached then appropriate compensation must be awarded to the victim, apart from any action that might be taken for negligence. Consequently, The Secretary, Ministry of Health and Family Welfare of the Government of India, the Medical Council of India, and the Indian Medical Association were added as respondents to the petition.
The respondent, The Secretary of the Medical Council of India, drew the court’s attention to clauses 10 and 13 of the Code of Medical Ethics, 1970. Clause 10 of the 1970 Code stated that a physician is not bound to treat everyone who seeks his/her service except in case of emergencies for the sake of preserving life and that they should assist in treating the sick and should always remember that the lives of others are entrusted to his/her skill, care, and attention.
Clause 13 of the said Code stated that a medical practitioner is free to choose whom they will treat, but should always render his/her skills for assisting in emergency cases. Once the medical practitioner has undertaken a case, they should not neglect the patient and should not withdraw from the case without giving notice in advance to the patient, the patient’s relatives, or friends. The clause further states that a medical practitioner should not wilfully commit negligence that might deprive the patient of medical care.
The respondents, the Medical Council of India, argued that it was expected of medical professionals to look after the injured at once and to avail them timely medical care irrespective of whether the victim was in an accident or otherwise, and that any legal formalities given in any law should not prevent a medical practitioner from treating injured patients. Any legal formalities to be completed must be undertaken after giving primary care to the patient.
Further, they stated that it was their view that the government should amend all the provisions in existing laws and if required then make provisions that allow medical practitioners to offer instant medical assistance to the injured person without any delay and without waiting for legal formalities to be completed before the police. They also requested that the medical practitioners should be indemnified against any action which may be brought against them for not completing the legal formalities before treating the patients since they would only be performing their duty and abiding by the oath undertaken by them.
The Council further requested that doctors working in public, as well as private hospitals, should be free from fear of being prosecuted for not fulfilling legal formalities before giving treatment. Doctors should not be encumbered while extending medical care to patients in such cases fearing they would be hassled by the police or taken to the court. They also requested that the Evidence Act of 1872, should be amended so that the doctor’s diary which has all the details of accident cases should be accepted as evidence in the court without requiring the physical presence of the doctors themselves to prove the same.
The Ministry of Health and Family Welfare apprised the honorable Supreme Court of the meeting held by it on behalf of the Union of India and highlighted the essential decisions taken in the meeting. First, whenever a medico-legal case arrived at the hospital, the medical practitioner should inform the name, gender, and age of the patient, and place and time of occurrence of the incident to the police constable on duty and start the required treatment of the patient without waiting for completion of legal formalities or arrival of the police.
The constable must inform the concerned police station or superiors about the same. A full medical report of the case should be prepared by the medical practitioner and should be handed over to the police after the treatment has been given to the patient.
Second, the zonal classification of cities for medico-legal cases would apply only to those cases which were brought by the police. The medico-legal cases coming to the hospitals on their own should not be refused treatment, nor referred to other hospitals, even if the case occurred in the area of another zonal hospital.
Irrespective of whether a case was medico-legal or otherwise, all the government hospitals and medical institutes should provide instantaneous treatment to all the patients. The practice of refusing patients simply because it is a medico-legal case is unacceptable. After providing primary care, the patient could be referred to another hospital if the expertise or facilities required for further treatment of the patient are not available at the hospital.
The Union of India and the Medical Council of India also submitted that there was no law justifying the conduct of the doctors and that none of the laws prevented medical professionals from attending to an accident victim immediately, before the arrival of the police, or before the completion of legal formalities. On the contrary, it was the duty of medical professionals to treat the patients as soon as they were brought to the hospital. It was the doctor’s paramount obligation and duty to save human life. However, despite all this, the problem of refusing accident patients continues in the hospitals and clinics across the country.
Judgment
Both the judges, honorable Justice Ranganath Misra and Justice G. L. Oza gave concurring judgments.
- The Supreme Court recognized that the preservation of human life and its value came before all else and it was the necessary duty of medical professionals to save the life of any patient who came to them for treatment.
- The medical professionals must treat all patients, whether an innocent citizen or a criminal liable to be punished by the law, so that the life of the innocent citizen could be saved and the crime of the offender could be punished because social laws do not see death by negligence as equal to legal punishment.
- Article 21 of the Constitution says that “No person shall be deprived of his life or personal liberty except according to procedure established by law”, and puts an obligation on the state to preserve life. Hence, a doctor serving at government hospitals, or at private hospitals, or otherwise has a professional obligation to exercise their skill, knowledge, and due expertise to save and protect life. Therefore, no laws or state action can interfere in the discharge of this paramount obligation cast upon medical professionals, and shall hence give away.
- No doctor contravenes any law of the land when they treat an injured victim brought to the hospital. Everyone connected with the case, be it a medical professional, a police officer, or a normal citizen, should give paramount consideration to saving the life of the person.
- Medical professionals should not be harassed for interrogation, should not be called to the police station again and again for investigation and for other legal formalities. It should be avoided as much as possible.
- The courts should not summon medical professionals to give evidence unless the evidence is extremely necessary. Whenever summoned to the court, attempts should be made to not keep them waiting for long. In cases where the facts are clear, medical professionals should not be harassed by adjournments and cross-examination, and as far as possible both should be avoided so that no fear or apprehension is created in their minds while discharging their duties as medical practitioners.
- When a patient, who would be given better treatment at another hospital as whatever assistance the medical professional might give will not be sufficient to save that person’s life, is brought to the hospital, it is still the duty of the medical professional to offer all the help they can and to see to it that the patient reaches the other hospital as soon as possible.
- Zonal classifications cannot act as an impediment to the treatment of victims irrespective of whether rules demand otherwise. The court also ordered that the 1985 guidelines of the Tenth Meeting of the Standing Committee on Forensic Medicine be set up by the Union Ministry of Home Affairs, which had decided to make all upgraded primary healthcare centers eligible to provide medico-legal facilities, should become operative.
- The Supreme court also directed all journals which publish Supreme Court decisions, all national media, and Doordarshan and All India Radio to give wide publicity to the decision, highlighting all its essential points, so that every doctor practicing in India would become aware of the same. A copy of the judgment was also to be supplied to every medical college affiliated to the Medical Council of India, to every State Government and to every High Court in the country which would in turn supply a copy to every session Judge within their jurisdiction, with directions to widely publicize the order.
Analysis
Article 21 of the Constitution of India is a guardian of the pivotal right to life and personal liberty. It encompasses the right to life, right to personal liberty, right to free legal aid, right to privacy, right against custodial violence, right to a healthy environment, and right to medical aid among others.
By interpreting it positively, the Supreme Court has cast an obligation upon the state to ensure a better quality of life, human dignity, and personal liberty for the people. Hence, the right to medical aid is seen as a significant facet of Article 21.
In Parmanand Katara v. Union of India, the Supreme Court has given clear-cut orders that no hospital, whether public or otherwise, can refuse treatment to an injured victim solely because they were not authorized to handle medico-legal cases. It has ordered that it is an essential duty of medical professionals to give the required treatment to patients first hand and then complete the legal formalities.
Thus, giving primary care and treatment to patients is a paramount duty of the healthcare professionals which cannot be curtailed by any law or regulation. The Apex Court has thereby recognized the people’s right to health and medical aid as a fundamental right under Article 21 of the Constitution and interpreted the Constitution to ensure the greater welfare of the public at large.
Conclusion
The Supreme Court has time and again reiterated that the Constitution envisages the establishment of a welfare state and the government has to secure the welfare of all people. An essential part of this obligation is to provide the people of the country with sufficient medical facilities and to safeguard their right to life to which they have a fundamental right under Article 21 of the Constitution. This is so because the preservation and protection of human life have always been and will remain paramount.
Therefore, all public hospitals are duty-bound to provide medical aid to people in need and any violation of the same would be a violation of Article 21. Whatever happens, the state is bound by the Constitution to provide treatment to the patients. Hence, neither financial constraints nor non-availability of beds nor on the ground of it being a medico-legal case can a hospital refuse medical treatment.
[1] Parmanand Katara v. Union of India, AIR 1989 SC 2039.
[2] Medicolegal Issues: Guidelines to Medical Officers, National Health Centres Resource System, Available here