The right to health is not justiciable in India though the Supreme Court has interpreted it to be a part of Article 21 (protection of life and personal liberty).
The apex court’s judgements and the legal provisions in Drugs and Cosmetic Act, 1940, Consumer Protection Act 1986, Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, and the Clinical Establishment Act, 2010, have helped establish the case of looking at the rights of patients as part of human rights. Drawing upon these judgements and the provisions, the National Human Rights Commission (NHRC) drafted and adopted the Charter of Patient’s Rights.
With increasing cases of irrational and unethical treatment, gross overcharging by hospitals and other violations of patients’ rights, the book Patients’ Rights in India, written by Dr Mohamed Khader Meeran, has come in quite timely.
The book, a compendium on patients’ rights, is a ready reckoner which will make them and activists aware of their legal rights. In the words of the author: “This book has been written with an intention to educate every common citizen about the legal rights they have while visiting any hospital for seeking medical care.”
For instance, as per the Charter, the patient has every right to know the expected cost of his/her treatment and the hospital administration should provide written information about the charges and the expected cost of treatment, including any additional charges that may be levied. Patients also have the right to raise queries and seek clarification from the hospital administration and get defects/doubts in billing (if any) corrected/cleared. However, in most cases, hospitals don’t provide such information, leading to overcharging from patients without their knowledge.
In many cases, doctors perform without informing the patient/caregiver. For example, there have several cases of insertion of intrauterine devices into women without their knowledge, let alone consent. But ‘Patient’s Right to Consent for Examination and Surgery’, envisaged in the Charter, desists medical professionals from any such practice.
The book lays down patients’ rights in an interesting format by giving references to legal cases that eventually led to specific rulings. The content is written in an easy-to-understand language and lucidly takes the reader through various technical details.
The medical field is largely hierarchical in nature with doctors and specialists being at the top rung and patients at the receiving end. Patients have little knowledge about medical technicalities and procedures involved. Therefore, the doctor-patient relationship is inherently unequal.
“The challenges many patients face in accessing healthcare, the concerns about the lack of evidence-based medical practice, the ‘mixed-pathy, the diversity of providers, the decay in many elements of public healthcare provisioning, the increasingly corporatised nature of private healthcare, all serve as important reminders about why we need concerted efforts to delineate patients’ rights in India,” writes Dr Anant Bhan (researcher, Global Health, Bioethics and Health Policy) in his foreword to the book.
Moreover, as the author notes in the preface to the book that the rights of patients “… are not included in medical education curriculum. Hence, doctors do not receive any formal education or training about rights of patients.”
In this situation, a book on patients’ rights by a doctor is noteworthy. As Dr Amar Jesani, editor, Indian Journal of Medical Ethics, writes in the introduction of the book: “A doctor authoring this book is also a testimony to the growing number of healthcare professionals aligning themselves with the people’s interests and rights and committing themselves in the struggle to change the orientation of healthcare services.”
In addition to discussing the rights contained in the Charter, the author also explains the format of various publicly funded health insurance schemes. These include state-level schemes in Maharashtra and Tamil Nadu as also the Pradhan Mantri Jan Arogya Yojana. It takes the reader through a step-by-step process of what the schemes entail and how they can be accessed.
The issue of the right to health and patients’ rights came to the fore strongly during the unprecedented ongoing pandemic. The author is vigilant to include a discussion on the ‘Patients’ Rights during COVID-19 Pandemic’. The NHRC played a constructive role by forming an expert committee that developed an advisory document. The concerned chapter includes the key points from the human rights advisory on right to health in the context of COVID-19 published by the NHRC.
The issue of adverse events following immunisation (AEFI) often made headlines. A chapter is devoted to explaining the concept and enlisting the AEFI—Surveillance and Response Operational Guidelines 2015.
Along with enlisting patients’ rights, the book also enlists the duties of patients and other general instructions they should follow. These are helpful listings for patients and their caregivers which intend to help them go through the maze of medical procedures and documentation more systematically and in an informed manner.
The Charter was adopted by the government in 2018. However, violation of patients’ rights is rampant with no remedy to the aggrieved patient/caregiver in most cases. Unless collective and sustained efforts are made by the medical fraternity, patient groups, activists and civil society organisations, establishing the rights of patients as human rights will be extremely difficult. The book is an enabling step in that direction.