Supreme Court Directs NMC To Issue Fresh Guidelines To Admit Persons With Disabilities Into Medical Courses

In a significant stride towards social recognition of the Rights of Persons with Disabilities (PwDs), the Supreme Court recently 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.

The bench led by CJI DY Chandrachud comprising Justices JB Pardiwala and Manoj Misra in its judgement allowed a candidate suffering from muscular dystrophy to participate in the ongoing counselling for NEET-UG 2024. In doing so, the Court underlined that Persons with Disabilities (PwDs) needed to be perceived not with an element of sympathy but as an essential part of the society we live in today. It is imperative to further the cause of inclusion of the PwDs to achieve the national project of eradicating all forms of discrimination that the Country is scarred with.

“Persons with disability are not objects of pity or charity but an integral part of our society and nation. The advancement of rights for persons with disabilities is a national project along with eradication of all forms of discrimination. A component of this project is the inclusion of persons with disabilities in all pursuits of life.”

The Court emphasised how including PwDs as part of the healthcare workforce would create a more sensitive and welcoming atmosphere for the community of PwDs at large, as the healthcare providers would be someone they could communicate and feel more comfortable with. The Court also scorned upon regulations which restrained PwDs from seeking admission to medical courses.

“When we create avenues for inclusion, we work towards improving systems and institutions. In the context of healthcare, the inclusion of persons with disabilities is a vital component of quality healthcare. The guidelines and recommendations which express concern about "lowering the standard of medical practice" on account of persons with disabilities miss the fact that these standards may not be adequate to begin with.”

The bench was hearing by a candidate facing 88% muscular dystrophy and was disqualified from pursuing MBBS on the ground that the NMC Guidelines require bringing down the disability to less than 80% for those with petitioner's condition to pursue MBBS.

Notably, in Muscular Dystrophy, the individual's body muscles are progressively weakened and face a breakdown, making it difficult to carry out normal physical activities. Since the petitioner's disability could not be brought down to less than 80%, the Bombay High Court had refused to grant any relief.

Earlier on October 3, the Supreme Court had ordered a reassessment of the petitioner by a committee of experts at AIIMS Delhi. However, on perusal of the expert committee report, the Court observed that there existed no definite guidelines to assess the disability with assistive devices as per the Govt. of India gazette guideline which notifes the guidelines for assessing the extent of 'specified disabilities'. A subsequent examination was then done by Dr Satendera Singh who runs an organization by the name of Infinite Ability, which has doctors who personally face disabilities.

Inclusion Of PwDs Into Medical Practice Would Create A Welcoming Healthcare Atmosphere For The PwD Community

Turning to the need to sensitise the medical and healthcare sector towards the potential and difficulties of the PwDs, the Court observed the need to diversify the workforce with the inclusion of PwDs in the practice. It noted that such diversification would hone the values and quality of the healthcare ecosystem.

“The quality of a system is informed by its ability to empathise with and relate to the recipients. A system without adequate number of practitioners who have lived experiences will not be able to fully imagine the obstacles and grievances faced by a diverse population. Diversity of workforce is crucial for a diverse society, so that everyone may have a stake in the system and the system can effectively discharge its duties toward everyone.”

Referring to Section 25 of the RPWD Act which outlines the positive obligation of Government and local authorities to provide healthcare to persons with disabilities, the Court opined that PwDs were entitled to receive 'barrier-free' access to all public and private healthcare institutions. It explained that such a barrier-free environment could only be created when PwDs witness the inclusion of their community on the practising side itself.

“Removal of barriers can only be achieved if persons with disabilities feel comfortable while accessing healthcare. The barriers faced by a person may be physical, psychological and attitudinal. The inclusion of persons with disabilities within medical practice is vital to ensure that the approach of the medical community and of hospitals and other healthcare institutes is humane, sensitive and informed by lived experiences. It strengthens our fraternity. Therefore, the process through which medical aspirants with disability enter the profession must be compatible with constitutional and statutory entitlements and guarantees.”

The Court also highlighted the need for having diversity within key institutions of the Country, and how social discrimination would lead to the nation being deprived of the unique talent and contribution that the excluded individuals may bring to the table. Thus when PwDs are discriminated against, it not affects the individual rights of the person but also adversely affects the integrity and fraternity of the Country.

“No nation can truly progress until all her people realize a stake in their collective outcome. In one sense discrimination excludes the aggrieved from the collective imagination of the nation. In another sense the nation is deprived of the expertise and brilliance of those who are discriminated. We aspire to have institutions and systems which reflect the rich diversity of our country. The aspiration is one rooted in our commitment to the nation. Diverse institutions are vital to ensure the governance of a diverse nation. When persons with disabilities are discriminated against, it not only affects their individual aspirations and dignity - it strikes a blow to the entire nation and the collective goal of integration and fraternity.”

Non-Inclusion And Inaccessibility As The Key Triggers In Bringing Out Social Reforms

The Court analyses that social exclusion and inaccessibility are two key factors which run common across the different types of social movements ranging from the Rights of PwDs to LGBTQ. It is these two elements which act as a catalyst in breaking down the discriminatory and unequal social order.

“What the movement for disability justice shares with other social justice movements - such as the anti-caste movement, feminism and queer and trans justice - is that they call into question the fundamental arrangement of a society which has created prejudicial structures. Inaccessibility and non-inclusion are taken as suspect categories to question the prevalent social order. In doing so these movements invite us to contribute to the national goal of fraternity and integration.”

In a way, the Court credits the role of such social movements in challenging the discriminatory norms of the society and bolstering the constitutional values of integration and fraternity through increased social acceptance and 'intersectionality'

“Far from being interruptive in the national journey - calls for equal access and equal justice postulate a disruption in the order of discrimination and prejudices so that we may carry on the journey of national progress. They do not only champion the group interest of a certain class of citizens but instead advocate for a larger vision of a justice-oriented society. A society where discrimination and exclusion are addressed and eliminated will create a just and equitable system for all persons regardless of their identities.

“To be intersectional is to see the common goals across vectors of identities by eliminating systems of discrimination. It is a call to eschew from simplistic identity reductionism and to imagine meaningful remedies for marginalised groups and persons. It calls for a world with equity and justice where our uniqueness forms part of benign differences among people and lends vibrance to our diversity. The Constitution enables this project of fraternity by guaranteeing rights to life, dignity, freedom, equality and non-discrimination inter alia under Articles 21, 19, 14, and 15.”

Need For Humanistic Reforms In The Approach of Disability Assessment Boards

The Court highlighted the concerns raised by the United Nations Committee on the Rights of Persons with Disabilities. The committee has identified the medical model of disability as a significant issue in India and has recommended adopting a human rights model in assessment guidelines.

“The committee has recommended that the concern be remedied with inter alia reforming guidelines assessing persons with disabilities by adopting a human rights model.”

The Court has pushed for the need to make the Disability Assessment Boards evaluating the PwDs for medical admissions more transparent, fair and sensitive.

“Disability Assessment Boards must comply with rule of law principles by injecting transparency, fairness and consistency in their approach. The Boards must further elaborate on the reasons for the outcome of their assessment, in particular when they opine that the candidate is ineligible.”

The Court also emphasized the need to focus on the functional competence of individuals with disabilities, rather than simply quantifying their disability. Such assessment of functional competence can be done by experts with an experience in disability justice.

“The Disability Assessment Boards must focus on the functional competence of persons with disabilities and not merely quantify the disability. The quantification of disability is a task in need of a purpose within the human rights based model of disability. The functional competency approach to assessment for a medical course is globally recognised. To enable members of the Assessment Boards in effectively applying the functional competency test, they must be adequately trained by professionals and persons with disabilities or persons who have worked on disability justice. These trainings must be with a view to enhance the understanding of the Board members in assessing persons with disabilities and must not pathologize or problematize them.”

The court highlighted the importance of the Unique Disability ID Card. This card shows how much a person's disability affects them. When someone applies for school or a job, this card helps decide if they can get special help. It was observed that if someone thinks their disability has changed, they can ask for a new assessment. This would allow individuals to update their ID cards if needed.

It was additionally suggested that Disability Assessment Boards must have a streamlined evaluation approach specific to the course which the assessee seeks admission in. These boards should focus on what a person can do, not just what they can't do. They should look at the skills needed for the specific course or job the person wants.

“The role of the Disability Assessment Boards must be tailored (with a functional competency approach) only for the course which the candidate seeks to pursue.”

Other observations made by the Court in easing the application procedure in the NEET exams and at the stage of college admissions are follows:

“Further, the journey of a person with disability to apply for the NEET Examination and thereafter pursue medicine at the college must also comply with accessibility norms. The application portal for NEET Examination must outline the accessibility compliances of different colleges to enable prospective students with disabilities in making an informed decision.”

“Once admitted, the Enabling Units established under the directions of the University Grants Commission must act as a point of contact for persons with disabilities to access clinical accommodations. Students must be informed about the Enabling Units and Equal Opportunity Cells through the information booklet circulated for new MBBS students, the college website and the Equal Opportunity Policy under Section 21 of RPWD Act. The second respondent must make appropriate directions in this regard.”

The Court also referred to the suggestions made by Dr. Satendra Singh, Singh's report was sought by the Court to assess whether the petitioner could pursue MBBS with the aid of assistive devices. While answering in affirmative, Dr Singh also made the following suggestions :

(i) rename the Disability Assessment Boards as Ability Assessment Boards to align them better with their intended purpose;

(ii) include a doctor with disability or who is well conversant with disability rights in such Boards;

(iii) use a human rights model of disability for assessment;

(iv) issue guidance on clinical accommodations;

(v) train the Boards in carrying out the disability competency assessment; and

(vi) use the Enabling Units to serve as a contact point for clinical accommodations.

Key Directions Issued To Facilitate PwDs' Inclusion Into Medical Admissions:

1. The second respondent (Secretary, National Medical Commission) shall issue fresh guidelines for admitting persons with disabilities into medical courses. The committee formulating the guidelines must include experts with disability or persons who have worked on disability justice. The guidelines shall comply with the judgments of this Court and contemporary advancements in disability justice;
2. The Disability Assessment Boards shall eschew from a benchmark model to test the functional competence of medical aspirants with disability. The second respondent shall issue appropriate guidelines in this regard;
3. The Disability Assessment Boards shall include a doctor or health professional with disability as per the directions of the first respondent (Director General of Health Services) dated 24 March 2022;
4. The conduct of the Disability Assessment Boards shall be fair, transparent and in compliance with principles of the rule of law. Attention must be paid to ensure that candidates appearing before the Board do not feel uncomfortable on account of physical or attitudinal barriers;
5. Reasonable accommodation is a gateway right to avail all other fundamental, human and legal rights for persons with disabilities. Non-availability of reasonable accommodation amounts to discrimination and violates substantive equality of persons with disabilities;
6. The inclusion of persons with disability in the medical profession would enhance the quality of healthcare and meet the preambular virtue of fraternity and the guarantees in Articles 21, 19, 14 and 15 of the Constitution;
7. Applicants to the NEET examination must be informed about the compliance of accessibility norms and provisions of reasonable accommodation available at colleges. The respondents shall issue appropriate directions to create a database with relevant information on accessibility and reasonable accommodation; and
8. Enabling Units at medical colleges shall act as points of contact for persons with disability desirous of accessing clinical accommodations.

A copy of this Judgment was directed to be transmitted to the Secretaries of all concerned Ministries of the Government of India.

Senior Advocate Shadan Farasat and AOR Talha Abdul Rahman appeared for the petitioner.

Related judgment - Mere Existence Of Benchmark Disability Won't Disqualify Candidate From MBBS Course : Supreme Court

Case Details : OM RATHOD Versus THE DIRECTOR GENERAL OF HEALTH SERVICES AND ORS.SLP(C) No. 21942/2024

Citation : 2024 LiveLaw (SC) 857

Click here to read the judgment