Sheer Volume Of NEET Cases In Supreme Court Indicates Need For Reforms In Medical Education : CJI DY Chandrachud

Chief Justice of India DY Chandrachud has observed that a larger number of cases related to NEET and medical admission reach the Supreme Court and this is indicative of the need for reforms in medical education.

While delivering the 19th Sir Ganga Ram Oration on the topic "A prescription for Justice: Quest for fairness and equity in healthcare", CJI said :

"Several cases challenging National Medical Commission's decisions or cases relating to NEET have found their way to my bench at the Supreme Court. Often, courts cannot enter policy domain and it is the duty of the state to listen to the representations made by the students. However, whenever injustice is done, it becomes our bounden duty to intervene. The sheer volume of litigation of NEET cases is indicative of the hopes and aspirations of millions of students. It is proof that medicine is one of the most sought-after professions in India. Yet, the litigation is also symbolic of the need for reforms in medical education in India".

It may be noted that Supreme Court has been considering several cases related to postponement of NEET exams, counselling, fixation of quotas, admission disputes etc over the past several years. Presently also, several such cases are pending in the Supreme Court.

The CJI said that the principles of justice underlay the practice of both law and medicine and both the fields are concerned with fairness, equality and the well-being of communities and individuals. He cited the struggle of LGBTQ+ community as one of the examples where health and justice coincided. One of the first steps to decriminalize homosexuality was initiated by an NGO called AIDS Bedhbhav Virodh Andolan in 1994 out of a growing concern over male sexual health.

The CJI addressed the issues of inequalities in access to health care. Growing socio-economic inequalities in India disproportionately affect health outcomes of marginalised groups.

“People belonging to marginalised communities are perpetually faced with barriers in accessing health care. Social determinants of health, i.e. factors outside the healthcare system such as class, caste, gender, regional location often determine health status of an individual. Injustice in healthcare becomes evident when one looks at the people not merely by the means of a stethoscope but by understanding their social determinants to health.”

What amounts to justice in healthcare?

The CJI said that one way of understanding justice in healthcare is that there should be 'health equity'. This means that each person has a fair, just and equal opportunity to be healthier. Another component of healthcare justice includes the ethical principles that govern the interaction between medical professionals and patients, with a view to give primacy to patient care and a patient's bodily integrity and autonomy. Ultimately, the goal is to achieve fairness, promote dignity, and ensure people have similar capabilities to lead healthy lives and contribute to the society.

CJI also addressed the issue of violent reactions by public when a person loses life during treatment and lamented that such instances put the lives of health professionals at risk.

“This dehumanization of healthcare has often resulted in violent confrontations between the citizens and hospitals, with medical professionals being caught in the crossfire. This puts the lives of medical professionals at risk and creates a hostile environment for them to work in. The violence ends up hampering the delivery of medical services, which can have serious consequences for patients.”

Increasing diversity in recruitment of staff members can be an important step towards healthcare equity

To make healthcare more accessible to disadvantaged groups, it might be beneficial that culturally cognizant environments are created to cater to these groups, CJI opined.

"Increasing diversity in recruitment of staff members can be an important step towards healthcare equity. Sensitivity to different cultures, patient-centered care and community engagement spearheaded by the senior medical professionals would go a long way".

In this context, he referred to the judgment authored by him in the case Neil Aurelio Nunes which recognized the importance of diversity in medical education, by reconceptualizing the meaning of 'merit'. The Court observed that "merit cannot be separated from the function of the existing inequalities in society".

"Special provisions (including reservations) are methods to ameliorate the structural inequalities. Fortitude required to uplift oneself from conditions of deprivation is reflective of individual merit and calibre", he said.

"The need of the hour is for healthcare providers, community leaders, lawmakers and policymakers to work together to identify possible initiatives and solutions that promote equitable access to healthcare", CJI added.

CJI Chandrachud also lauded the efforts taken by doctors as frontline warriors during the COVID-19 pandemic times. Before concluding, CJI emphasized the need for medical professionals to cultivate 'rest-ethic' in their lives.

"Just like every doctor present here must have prescribed “plenty of rest” to their patients, I hereby order everyone gathered here today to pause, take a break and cultivate a ‘rest ethic’ in your professional lives. Caring for ourselves and providing the space for our juniors to self-care is a sign of strength. It is my hope that we are able to make those much needed structural and institutional changes to implement this unenforceable order".

He concluded his address with a quote of Dr. Rudolf Virchow, also Known as the father of modern pathology

"Should medicine ever fulfil its great ends, it must enter into the larger political and social life of our time; it must indicate the barriers which obstruct the normal completion of the life cycle and remove them."