'Both Hands Intact' Condition For MBBS Admission Of Persons With Disabilities Arbitrary : Supreme Court

In a significant decision, the Supreme Court today (February 21) held that the eligibility condition prescribed by the National Medical Commission's guidelines that candidates with disabilities must have "both hands intact, with intact sensation and sufficient strength" for admission to MBBS course was arbitrary and antithetical to the Constitution.

The Guidelines regarding admission of students with “Specified Disabilities”, which constitute Appendix H-1 to the Graduate Medical Education Regulations (Amendment), 2019, stated one of the conditions to be as : 

"Both hands intact, with intact sensations, sufficient strength and range of motion are essential to be considered eligible for medical course." 

Finding this condition to be against the Rights of Persons with Disabilities Act, 2016 and also the Constitution, the bench comprising Justice BR Gavai and Justice KV Viswanathan allowed the petitioner, a candidate with disability, to secure admission to MBBS course in the Government Medical College, Sirohi, Rajasthan

The decision authored by Justice Viswanathan, took a stern view on the said condition when assessing the disabilities of candidates covered under the RPwD Act. The Court noted that "flexibility in answering individual needs and requirements is an essential component of reasonable accommodation. There cannot be a “one size fits all” approach." 

Condition Is  Antithetical To RPwD, Article 41 of the Constitution 

The Court held "In our view, this prescription of “both hands intact…” is completely antithetical to Article 41 of the Constitution; the principles enshrined in the United Nations Convention on the Rights of Persons with Disabilities and the salutary provisions of the RPwD Act. It also indicates a classification which is overbroad and glorifies 'ableism'. It propagates that persons with typical abilities and with faculties similar to what the majority may have or somehow superior. This is precisely what the Directive Principles of State Policy, the United Nations Convention and the RPwD Act abhor."  

Notably, Article 41 provides the Right to work, to education and to public assistance in certain cases. It reads: The State shall, within the limits of its economic capacity and development, make effective provision for securing the right to work, to education and to public assistance in cases of unemployment, old age, sickness and disablement, and in other cases of undeserved want.

'Both Hands Intact' Condition Reeks Of Ableism; Cannot Be A Factor Under 'Functional Assessment' : Court Opines 

The Court added that such a condition was contrary to the equality principle and the percept of 'reasonable accommodation' of the PwDs and reinstated the social stigma of 'ableism'- discrimination in favour of able-bodied people. 

"A prescription such as “both hands intact…” reeks of ableism and has no place in a statutory regulation. In fact, it has the effect of denuding the rights guaranteed under the Constitution and the RPwD Act and makes a mockery of the principle of reasonable accommodation." 

The bench held that such a condition cannot be part of the 'functional assessment' of a PwD candidate - which was of intrinsic importance under the RPwD Act. 

"The “both hands intact…” prescription has no sanctity in law as it does not admit of a functional assessment of the individual candidate, a matter which is so fundamental in protecting the rights of persons with disabilities." 

Disability Assessment Of Appellant Contrary To Set Precedents Of Apex Court

In the present case, the bench was hearing a challenge to the Punjab and Haryana High Court which rejected the claim of the appellant suffering from disability to be admitted into MBBS Course. The Assessment Board by its Certificate of 02.09.2024, rendered him ineligible to pursue medical course.

The Appellant suffered from Locomotor disability 50% with Club foot right lower limb with Phocomalia, Left middle ring finger through middle phalanx with right middle index finger through middle phalanx. Further, he has speech and language disability of 20%. The final disability computed was 58%. 

The Top Court then directed a functional assessment by the AIIMs Doctors Committee of 5 members along with Professor Dr. Satendra Singh as a member of the Committee. The Court perused the report of AIIMS Doctors and observed : 

"We have no hesitation in concluding that the report of the five members of the All India Institute of Medical Sciences cannot be the basis to deny the appellant's admission to the MBBS Course."

It reasoned that :

(1) The report does not satisfy the test laid down in the decisions in Omkar Ramchandra Gond and Om Rathod. The functional assessment as contemplated in the said two judgments is not borne out by the report of five members.

In Omkar Ramchandra Gond v. Union of India, the Court held that mere quantification of the disability will not disbar a candidate and the capacity to pursue the course has to be examined by the disability assessment board.  

In Om Rathod Versus The Director General Of Health Services And Ors, the Court stressed the need to give opportunities to PwDs in the medical sector and devise qualitative standards for testing disabilities in the procedure for medical course admissions.

(2) As mandated or required in both Omkar Ramchandra Gond (supra) and Om Rathod (supra), reasons have not been assigned by the five members of the Assessment Board for denying the appellant his right to pursue the MBBS Course. 

(3) The need to assess beyond the quantified disability and the need to opine whether the individual with a disability aided by modern scientific tools and devices can enter the MBBS program has not been fulfilled by the five members of the Board. This is apart from the fact that the five members of the Board have recorded statements in the nature of disclaimers.

Need To Revise NMC Guidelines - An Ignored Caution By The Court 

Referring to the decisions in Omkar Ramchandra Gond and Om Rathod, the bench again flagged the need to revise the NMC guidelines for assessing PwD Candidates.

"We may only add that the need to revise the guidelines as emphasized by the NMC was directed in the 15.10.2024 judgment of Omkar Ramchandra Gond (supra) and reiterated in the 25.10.2024 judgment of Om Rathod (supra). Further in para 26 of Om Rathod (supra) extracted hereinabove the “both hands intact…” requirement has been expressly rejected. We have also held hereinabove that such  an insistence in a statutory regulation is absolutely antithetical to the objectives of Article 41 and the principles set out in the United Nations Convention and the rights guaranteed under the RPwD Act." 

In Om Rathod, at Paragraph 26, the relevant observation states : 

"An assessment for functional competency entails an analysis of the skill set which a person with disability must learn in order to compete and pursue the medical course. This is a marked difference from requiring a specific manner which a candidate must use to achieve the outcome. For example, a functional competency model would require a candidate to effectively communicate with patients but would not require them to have speech or intact hands." 

The bench, while allowing the appeal of the appellant, relied on the approach taken by Professor Satendra Singh- 

"In our considered view, the correct approach is the one that Dr. Satendra Singh has adopted viz.- to not bar a candidate at the threshold but grant the candidate the choice after completing the MBBS Course, to decide whether he whishes to specialize in a non surgical or medical branch or continue as a General Duty Medical Officer. As rightly set out by Dr. Satendra Singh, it will be unfair to presume incompetence at the threshold without first providing an opportunity to the candidate and ensuring the availability of accommodations and assistive products. " 

The Court will now hear the issue on the status of revised NMC guidelines as assured by the National Medical Commission in previous cases in March. 

"Before we part, there is one important aspect which needs to be considered. In the judgment of 15.10.2024 in Omkar Ramchandra Gond (supra) a direction was given to the National Medical Commission to issue revised regulations and guidelines in supersession of the guidelines of 13.05.2019 with regard to admission of students with specified disabilities under the RPwD Act with respect to the MBBS Course. This Court had also directed the NMC to consider the communication of the Ministry of Social Justice and Empowerment dated 25.01.2024. Pursuant to the judgment in Omkar Ramchandra Gond (supra), the National Medical Commission assured this Court during the course of hearing in Om Rathod (supra) that it will constitute a new committee of domain experts to comply with the judgment in Omkar Ramchandra Gond (supra)."

"Noting the assurance of the NMC, this Court directed that the Committee to be so constituted will include persons with disability or one or more experts conversant with the disability rights. A further direction was given that fresh guidelines will be put in place applying the principles set out in the judgments."

"We direct this matter to be posted on 03.03.2025 to consider whether the National Medical Commission has formulated the revised guidelines in accordance with the judgments of this Court, as directed in Omkar Ramchandra Gond (supra) and Om Rathod (supra) and further direct that the NMC shall file an affidavit explaining the current status before the said hearing date."

Case Details : ANMOL v. UNION OF INDIA & ORS| CIVIL APPEAL NO. 14333 OF 2024

Citation : 2025 LiveLaw (SC) 236

Click here to read the judgment