Just last week, the National Consumer Dispute Commission observed a doctor can be booked for medical negligence even if the situation doesn’t turn life threatening but reasonable degree of care is not taken while deciding on the course of treatment or while treating the patient. It’s finally happened. The once-equated-to-God doctor saab today falls squarely in the ambit of the Consumer Protection Act (1986). Today, a medical practitioner’s act of negligence or oversight can be examined in the purview of the Consumer Protection Act and relief can be obtained for any loss incurred. Not that there wasn’t a law to help address issues as such. It’s just that the going’s become a lot smoother for the patient who can obtain relief and avail justice without the usually long-winded legal tangle and can completely avoid courts, lawyers and all-related bother.

BY LAW: According to the Act, a Consumer is “any person who hires or avails of any services for a consideration, and includes any beneficiary of such service other than the person who hires or avails of the service, when such services are availed of with the approval of the first mentioned person.”

Service means “service of any description which is made available to the potential users, but does not include rendering of any service free of charge or under a contract of personal service.”

And, Deficiency “means any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance, which is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise in relation to any service.”

It was following the landmark judgement in the Indian Medical Association vs V. P. Shanta that the Supreme Court of India laid down the law relating to professional negligence under Consumer Protection Act, 1986 and enunciated certain principles under which medical practitioners, government hospitals and private hospitals and nursing homes are covered under the consumer law.

DOCTORING PROFITS: Today, a lot of medical practitioners face flak for putting patients through undue tests and examinations as well as opting for surgical intervention even when not necessary. The reason being, doctors make a quick buck through commissions paid to them through chemists, laboratories, technicians and specialists for referrals. And, when there is a profit-motive involved in the practice, it makes for perfect sense to rope them into the Consumer Protection Act that aims to protect the consumer patient.

LONG-WINDED RELIEF: Usually, in the absence of the Consumer Protection Act, it was the Indian Penal Code’s Section 304-A that provided the relevant provision under which a complaint against a medical practitioner for alleged criminal medical negligence could be registered. Section 304-A provides that whoever commits culpable homicide not amounting to murder shall be punished for life or imprisonment for a term up to 10 years and fine as well. 

Also, Section 337 of the IPC deals with hurt caused by an act endangering life or personal safety of others.  And, Section 338 of the IPC relates to grievous hurt by an act endangering life and personal liberty of others. However, lack of care attracts only civil liability.  Therefore, only civil negligence may not be enough to hold a medical professional criminally liable.

HOLDING DOCTORS LIABLE: Doctors can be held responsible for:

* Liability in respect of diagnosis;

* Liability in relation to doctor’s duty to warn the patient about the risks involved, and

* Liability in relation to the treatment to be carried out.35

The Supreme Court held that the duty of a doctor will include (a) a duty of care in deciding whether to undertake a case and (b) a duty of care in deciding what treatment to give or a duty of care in administration of that treatment. Any breach of these duties gives a rise of action for negligent acts towards the patient.

BREACH OF ‘DUTY OF CARE’: The laws of negligence apply to ascertain whether or not the defendant has been in breach of a duty of care towards the victim who has died. If such breach of duty is established, the next question is whether that breach of duty caused the death of the victim. If so, the jury must go on to consider whether that breach of duty should be characterised as gross negligence and therefore, a crime. This will depend on the seriousness of the breach of duty committed by the defendant in all the circumstances in which the defendant was placed when it occurred.

The Supreme Court of India in a classic judgment said that in every mishap or death during medical treatment, the medical man cannot be made criminally liable for punishment. In the absence of adequate medical opinion, putting guilt on the medical man would be doing great harm or disservice to the medical community at large. “Every mishap or misfortune in the hospital or clinic of a doctor is not a gross act of negligence to try him for an offence of culpable negligence.”

The rights available to patients are basically indirect rights which arise from the performance of duties of health care professionals. However, the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 does provide some safety and rights to patients. Sadly, the basic rights such as right to correct information about his condition, right to participate in treatment decisions, right to have discussion with the doctor(s) are relegated to textbooks and treatises instead of actual practice.

- By Gajanan Khergamker

,text-align: justify; text-justify: inter-ideograph; line-height: 150%

‘Illegal’ use of force is widely considered a literal antithesis of democracy while ‘free’ opinion remains the constant goal of like-minded individuals who continuously persist with tweaking situations and statute to satisfy majority needs. 

The deliberations over euthanasia’s bonafide applicability in states in question too pivot on the same principal. It’s this ‘illegal’ use of force – at times, replaced with coercion, undue influence or plain mistake - to obtain consent from a dying person, that baffle the very basis of euthanasia. The use of force can be legitimised through democratic means. ‘Democratic Means’ include legislation fetched by a like-minded electorate whose religious sentiments can be manipulated through one sweeping attempt, as the state of Washington did. But, when it comes to those diverse in their reasoning and swayed by different religious compulsions, the electorates are starkly divided in opinion and nearly impossible to rein in by any single, however overwhelming, force.

Religion plays a huge influence on psyche since birth and value-systems generated by peer and socio-cultural influence imbibed throughout life strategically affect our decisions for years to follow, till death too and its influence cannot be discounted.

One could presume a physician possesses skills to practise a line of medical treatment. But to presume that s/he is legally qualified to corroborate a dying patient’s consent as ‘free’ and immune of ‘undue influence, coercion, mistake, fraud and so on and forth’ seems illogical.

In India, the practice of euthanasia in varied forms continues almost without prejudice. Like: The killing of an ailing calf in Sabarmati Ashram, at Mahatma Gandhi’s instance which caused much commotion as he received some angry letters on the subject too back in October 1928 as mentioned in Gujarati weekly Navjivan.

“A calf, having been maimed, lay in agony in the ashram and despite all possible treatment and nursing, the surgeon declared the case to be past help and hope. The animal’s suffering was very acute.

“In the circumstances, I felt that humanity demanded that the agony should be ended by ending life itself. The matter was placed before the whole ashram. Finally, in all humility but with the cleanest of convictions I got in my presence a doctor to administer the calf a quietus by means of a poison injection, and the whole thing was over in less than two minutes,” had said Bapu.

“Would I apply to human beings the principle that I have enunciated in connection with the calf? Would I like it to be applied in my own case? My reply is yes. Just as a surgeon does not commit himsa when he wields his knife on his patient’s body for the latter’s benefit, similarly one may find it necessary under certain imperative circumstances to go a step further and sever life from the body in the interest of the sufferer.”

And then, among Jains, Santhara a philosophical concept of attaining ‘Samadhi’ dating back to over 2,000 years is a common practice. In Jainism, Santhara stands for spiritual withdrawal from worldly existence. Accordingly, a person deciding to attain Santhara first prays, meditates and practices fasting every day. Then, the person gradually gives up solid food, confines oneself to a bed and finally relinquishes even liquid-diet.

According to evidence present at Ahmedabad-based LD institute of Indology, the first recording of Santhara deaths began between 250 B.C. and 700 A.D when a total of 24 such deaths were recorded on manuscripts and Jain scriptures. Apparently, between 700-1650 AD over 35 deaths were recorded, while during1800-1992 there were 37 cases of Santhara.

Among Hindus, Prayopavesa, or fasting to death, is considered an acceptable way to end one’s life in certain circumstances. Starkly different from a rather sudden suicide, Prayopavesa is a gradual process, giving ample time for the patient to prepare himself and those around him for his death.

In November 2001, a California-born Hindu leader Satguru Sivaya Subramuniyaswami gave up his life by Prayopavesa after finding that he had untreatable intestinal cancer. The Satguru meditated for several days and then announced he would accept pain-killing treatment only and would undertake Prayopavesa - taking water, but no food. He died on the 32nd day of his self-imposed fast; and, without the fanfare of lofty legislation to help desist force and acknowledge ‘free’ consent.

(Readers may write in to This email address is being protected from spambots. You need JavaScript enabled to view it. or call DraftCraft’s chief media legal consultant Gajanan Khergamker on 022-32010593 for any assistance on RTI or to have their findings / issue featured on this page)

                   

Water besides being a precious commodity is guaranteed by the Constitution of India to ensure a wholesome life as laid down in Article 21 which ensures Right to Life for Indian citizens. In a case that’s subjudice in the Supreme Court, the court has given a notice to the union ministry of health on the quality of water sources in villages. The litigant has asked the court to enforce quality water in sources for drinking water and the argument is that non-safe water is a violation of Right to Life. 

The Supreme Court has ruled, “The Right to Life includes the right to live with human dignity and all that goes with it, namely, the bare necessaries of life such as adequate nutrition, clothing and shelter and facilities for reading, writing and expressing oneself in diverse forms, freely moving about and mixing and mingling with fellow human beings.

The magnitude and components of this right would depend upon the extent of economic development of the country, but it must, in any view of the matter, include the bare necessities of life and also the right to carry on such functions and activities as constitute the bare minimum expression of human self.”

Back in 2002, the Supreme Court validated the Sardar Sarovar dam project on Narmada in 2000 interpreting the right to life as right to water.

“Water is the basic need for the survival of human beings and is part of the right to life and human right as enshrined in Article 21 of the Constitution of India and can be served only by providing source of water where there is none.”

Two years later, in 2004, giving a verdict on a PIL on the fast depletion of groundwater in Delhi, the apex court ruled that groundwater is a social asset. It further said that people have the right to use air, water and earth interpreting the Article 21vii. It even observed that in groundwater use, domestic and irrigation needs must be prioritised.

In Mumbai in July 2010, a Right to Information plea went on to reveal there were about one lakh points of water leakages, and about 19,000 connections unauthorised. In all, there were 3,44,253 authorised water connections in the city. Of the 3,400 million litres water the BMC supplied per day, 20 per cent water goes down the drain due to leakages and theft.

RTI activist Milind Mulay’s queries revealed there were 97,747 leakages and 18,944 unauthorised water connections across the city. To make things worse, RTI activist Aziz Amreliwala’s query revealed that despite having launched a drive to install digital water meters across the city for equitable distribution and conservation of water, many of Brihanmumbai Municipal Corporation (BMC) own offices, including the headquarters, are yet to install even the conventional analog meters.

Incidentally, in the case of an unmetered connection, the exact quantity of water consumption cannot be calculated and bills are charged on average usage, which only encourages the incidence of water theft throughout the city.

It was also revealed that while the hydraulic department advocates use of alternative water sources — including drawing water from bore wells, tube wells and rain water harvesting — to reduce dependence on drinking water supply, not a single ward office had taken any such initiative.

There, undoubtedly, is a sinister nexus between slum-dwellers, the water mafia, politicians and bureaucrats. That apart, when asked, civic officials across the nation insist that action against illegal connections is being taken routinely. Water is pilfered from many points and sold at a high rate in slums across the nation who land up paying 30 times more than BMC?charges.

Political representatives and their henchmen run virtual water mafias in slums and sell water connections in connivance with the civic authorities and the police despite right to water being an extension of right to life.

(Readers may write in to This email address is being protected from spambots. You need JavaScript enabled to view it. or call DraftCraft’s chief media legal consultant Gajanan Khergamker on 022-32010593 for any assistance on RTI or to have their findings / issue featured on this page)