Supreme Court denies nod to woman to terminate her 26-week fetus

Supreme Court denies nod to woman to terminate her 26-week fetus New Delhi, Feb 28 (PTI) The Supreme Court has refused to allow a woman, who is in her 26th week of pregnancy, to abort her foetus on the ground that it suffered from 'down syndrome', saying "we have a life in our hands". The apex court said that as per a report of the medical board constituted to examine the 37-year-old woman, there was no physical risk to the mother in continuation of pregnancy. A bench of Justices S A Bobde and L N Rao observed that though "everybody knows that children with down syndrome are undoubtedly less intelligent, but they are fine people." The bench said as per the report, the foetus is "likely to have mental and physical challenges" but the advice of the doctors does not warrant termination of pregnancy. "With this report, we don't think we are going to allow termination of pregnancy. We have a life in our hands," the bench said. "In these circumstances, as per the present advice, it is not possible to grant permission to terminate the pregnancy," the court said. Down syndrome is a congenital disorder due to a chromosome defect, which causes intellectual impairment and physical abnormalities, which varies from individual to individual. Babies with Down syndrome have an extra copy of chromosome 21. Down syndrome is also referred to as Trisomy 21 (CDC). Down syndrome earlier was a dreaded diagnosis, because of the ensuing difficulties in raising the child. Institutionalization was but an inevitable outcome for such children. But, advances in health care and technology have led to a greater understanding of the condition along with better care facilities for their rehabilitation. As a result, most children with Down syndrome are able to lead healthy ‘normal’ lives and can be integrated into mainstream of society. Over the years, life expectancy for people with Down syndrome has considerably increased, from 25 in 1983 to 60 today. The US National Association for Down Syndrome has this to say, “Most children with Down syndrome have mild to moderate impairments but it is important to note that they are more like other children than they are different.” While children with Down syndrome do experience developmental delays, they possess many skills and abilities, which need nurturing. Parents have the most crucial role in this. They can enlist the help of various Support Groups, organizations such as the “Down Syndrome Federation of India” to bring up their child in a supportive and positive manner where they can make valuable contributions to society. There is a list of people with Down syndrome on Wikipedia (https://en.wikipedia.org/wiki/List_of_people_with_Down_syndrome). They have been actors, singers, writers, disability rights activists. One of the names in the list is Karen Gaffney, from Oregon, USA a woman in her 40s. She also has a science degree, an honorary doctorate, and is a champion swimmer who has crossed the Channel in a team relay event (The Guardian). Prenatal genetic screening raises several ethical dilemmas as the outcome of the test may well be a decision to opt for termination of pregnancy because couples may be overwhelmed by the challenges of raising a child with genetic disorder such as Down syndrome. Health professionals, who handle such cases, should also be educated about how to counsel such parents-to-be as to how they can prepare themselves to raise their child to be a useful member of society. March 21 is observed as World Down Syndrome Day every year to raise public awareness about the condition. Is termination of pregnancy for genetic reasons the answer? No, a diagnosis of a genetic disorders should not automatically be a reason to opt for abortion, though the decision to terminate a pregnancy may be based on the specifics of an individual case. Section 3 of the MTP Act 1971 elaborates the conditions when termination of pregnancy is permitted. “3. When Pregnancies may be terminated by registered medical practitioners.- (1) Notwithstanding anything contained in the Indian Penal Code (45 of 1860), a registered medical practitioner shall not be guilty of any offence under that Code or under any other law for the time being in force, if any pregnancy is terminated by him in accordance with the provisions of this Act (2) Subject to the provisions of sub-section (4), a pregnancy may be terminated by a registered medical practitioner,- (a) where the length of the pregnancy does not exceed twelve weeks if such medical practitioner is, or (b) where the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks, if not less than two registered medical practitioners are. Of opinion, formed in good faith, that,- (i) the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury physical or mental health ; or (ii) there is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped. Explanation 1.-Where any, pregnancy is alleged by the pregnant woman to have been caused by rape, the anguish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman. Explanation 2.-Where any pregnancy occurs as a result of failure of any device or method used by any married woman or her husband for the purpose of limiting the number of children, the anguish caused by such unwanted pregnancy may be presumed to constitute a grave injury to the mental health of the pregnant woman. (3) In determining whether the continuance of pregnancy would involve such risk of injury to the health as is mentioned in sub-section (2), account may be taken of the pregnant woman's actual or reasonable foreseeable environment. (4) (a) No pregnancy of a woman, who has not attained the age of eighteen years, or, who, having attained the age of eighteen years, is a lunatic, shall be terminated except with the consent in writing of her guardian.” The Government of India has drafted the Medical Termination of Pregnancy TP (Amendment) Bill, 2014, which proposes to raise the limit of permitting MTP up to 24 weeks pregnancy from the current limit of 20 weeks. However, currently, the law does not permit termination of pregnancy after 20 weeks.

Public servants cannot show gifts as income from legal sources, says SC

Public servants cannot show gifts as income from legal sources, says SC In its judgement pertaining to the disproportionate assets case against Smt Sasikala Natarajan, the Supreme Court of India has ruled that presents could not be counted as income from lawful sources for public servants, reported Dhananjay Mahapatra in the Times of India, February 16, 2017. The Apex Court stated “Gifts to A1 (Jayalalithaa), a public servant in the context of Sections 161 to 165A IPC now integrated into the Act are visibly illegal and forbidden by law. The endeavour to strike a distinction between “legal” and “unlawful” as sought to be made to portray gifts to constitute a lawful source of income is thus wholly misconstrued." The Bench further said, “With the advent of the 1988 Act, and inter alia consequent upon the expansion of the scope of definition of the “public servant” and the integration of Section 161 to 165A IPC in the said statute, the claim of the defence to treat the gifts offered to A1 (Jayalalithaa) on her birthday as lawful income, thus cannot receive judicial imprimatur.” The defense of the counsel for Selvi J Jayalalithaa was also rejected by the Apex Court, which held that "To reiterate, disclosure of such gifts in the I-T returns of Jayalalithaa and orders of the I-T authorities on the basis thereof do not validate the said receipts to elevate the same to lawful income to repel the charge under Section 13(1)(e) of the PC Act." Accepting gifts has always posed an ethical dilemma for the doctors. They are required to maintain professional boundaries in their relationship with the patients as well as the pharmaceutical industry. Receiving gifts is one aspect of this relationship, which is fiduciary in nature. This judgement is important for doctors as it is also applicable to them, the government doctors in particular. The Medical Council of India has defined guidelines regarding this in section 6.8 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 especially in their relationship with pharmaceutical and allied health sector industry. The MCI has also defined the quantum of punishment for violation of these regulations. a) Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives. • Gifts more than Rs. 1,000/- upto Rs. 5,000/- : Censure • Gifts more than Rs. 5,000/- upto Rs. 10,000/-: Removal from Indian Medical Register or State Medical Register for 3 months. • Gifts more than Rs. 10,000/- to Rs. 50,000/- : Removal from Indian Medical Register or State Medical Register for 6 months. • Gifts more than Rs. 50,000/- to Rs. 1,00,000/- : Removal from Indian Medical Register or State Medical Register for 1 (one) year. • Gifts more than Rs. 1,00,000/-: Removal for a period of more than 1 year from Indian Medical Register or State Medical Register. b) Travel facilities: A medical practitioner shall not accept any travel Facility inside the country or outside, including rail, road, air, ship, cruise tickets, paid vacation, etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME Programme, etc. as a delegate. • Expenses for travel facilities more than Rs. 1,000/- upto Rs. 5,000/-: Censure • Expenses for travel facilities more than Rs. 5,000/- upto Rs. 10,000/-: Removal from Indian Medical Register or State Medical Register for 3 months. • Expenses for travel facilities more than Rs. 10,000/- to Rs. 50,000/-: Removal from Indian Medical Register or State medical Register for 6 months. • Expenses for travel facilities more than more than Rs. 50,000/- to Rs. 1,00,000/-: Removal from Indian Medical Register or State Medical Register for 1 year. • Expenses for travel facilities more than Rs. 1,00,000/-: Removal for a period of more than 1 year from Indian Medical Register or State Medical Register. c) Hospitality: A medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext. • Expenses for Hospitality more than Rs. 1,000/- upto Rs. 5,000/-: Censure • Expenses for Hospitality more than Rs. 5,000/- upto Rs. 10,000/-: Removal from Indian Medical Register or State Medical Register for 3 months. • Expenses for Hospitality more than Rs. 10,000/- to Rs. 50,000/-: Removal from Indian Medical Register or State medical Register for 6 months. • Expenses for Hospitality more than more than Rs. 50,000/- to Rs. 1,00,000/: Removal from Indian Medical Register or State Medical Register for 1 year. • Expenses for Hospitality more than Rs. 1,00,000/-: Removal for a period of more than 1 year from Indian Medical Register or State Medical Register d) Cash or monetary grants: A medical practitioner shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext. Funding for medical research, study etc. can only be received through approved institutions by modalities laid down by law / rules / guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed. • Cash or monetary grants more than Rs. 1,000/- upto Rs. 5,000/-: Censure • Cash or monetary grants more than Rs. 5,000/- upto Rs. 10,000/-: Removal from Indian Medical Register or State Medical Register for 3 months. • Cash or monetary grants more than Rs. 10,000/- to Rs. 50,000/-: Removal from Indian Medical Register or State Medical Register for 6 months. • Cash or monetary grants more than more than Rs. 50,000/- to Rs. 1,00,000/-: Removal from Indian Medical Register or State Medical Register for 1 year. • Cash or monetary grants more than Rs. 1,00,000/-: Removal for a period of more than 1 year from Indian Medical Register or State Medical Register. e) Medical Research: A medical practitioner may carry out, participate in, work in research projects funded by pharmaceutical and allied healthcare industries. A medical practitioner is obliged to know that the fulfillment of the following items (i) to (vii) will be an imperative for undertaking any research assignment / project funded by industry – for being proper and ethical. Thus, in accepting such a position a medical practitioner shall:- (i) Ensure that the particular research proposal(s) has the due permission from the competent concerned authorities. (ii) Ensure that such a research project(s) has the clearance of national/ state / institutional ethics committees / bodies. (iii) Ensure that it fulfils all the legal requirements prescribed for medical research. (iv) Ensure that the source and amount of funding is publicly disclosed at the beginning itself. (v) Ensure that proper care and facilities are provided to human volunteers, if they are necessary for the research project(s). (vi) Ensure that undue animal experimentations are not done and when these are necessary they are done in a scientific and a humane way. (vii) Ensure that while accepting such an assignment a medical practitioner shall have the freedom to publish the results of the research in the greater interest of the society by inserting such a clause in the MoU or any other document / agreement for any such assignment. First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register for a period depending upon the violation of the clause. f) Maintaining Professional Autonomy: In dealing with pharmaceutical and allied healthcare industry a medical practitioner shall always ensure that there shall never be any compromise either with his / her own professional autonomy and / or with the autonomy and freedom of the medical institution. First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register. g) Affiliation: A medical practitioner may work for pharmaceutical and allied healthcare industries in advisory capacities, as consultants, as researchers, as treating doctors or in any other professional capacity. In doing so, a medical practitioner shall always: (i) Ensure that his professional integrity and freedom are maintained. (ii) Ensure that patients interest are not compromised in any way. (iii) Ensure that such affiliations are within the law. (iv) Ensure that such affiliations / employments are fully transparent and disclosed First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register for a period depending upon the violaton of the clause h) Endorsement: A medical practitioner shall not endorse any drug or product of the industry publically. Any study conducted on the efficacy or otherwise of such products shall be presented to and / or through appropriate scientific bodies or published in appropriate scientific journals in a proper way” First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register Dr KK Aggarwal National President IMA and HCFI

Are you being blamed of commercialization?

Are you being blamed of commercialization?

Dr K K Aggarwal, National President IMA

Padma Shri, Dr KK Aggarwal. HCFI, MCI, IMA, National President, HSG, Health, 

Most doctors are honest. It’s only a minority who bring a bad name to the entire profession.

In Samira Kohli vs Dr. Prabha Manchanda and Anr, SCI Appeal (Civil) No. 1949 of 2004, 16.01.2008, the Supreme Court of India has observed:

“27. On the other hand, we have the Doctors, hospitals, nursing homes and clinics in the private commercial sector. There is a general perception among the middle class public that these private hospitals and doctors prescribe avoidable costly diagnostic procedures and medicines, and subject them to unwanted surgical procedures, for financial gain. The public feel that many doctors who have spent a crore or more for becoming a specialist, or nursing homes which have invested several crores on diagnostic and infrastructure facilities, would necessarily operate with a purely commercial and not service motive; that such doctors and hospitals would advise extensive costly treatment procedures and surgeries, where conservative or simple treatment may meet the need; and that what used to be a noble service oriented profession is slowly but steadily converting into a purely business.

28.    But unfortunately not all doctors in government hospitals are paragons of service, nor fortunately, all private hospitals/doctors are commercial minded. There are many a doctor in government hospitals who do not care about patients and unscrupulously insist upon ‘unofficial’ payment for free treatment or insist upon private consultations. On the other hand, many private hospitals and Doctors give the best of treatment without exploitation, at a reasonable cost, charging a fee, which is reasonable recompense for the service rendered. Of course, some doctors, both in private practice or in government service, look at patients not as persons who should be relieved from pain and suffering by prompt and proper treatment at an affordable cost, but as potential income-providers/customers who can be exploited by prolonged or radical diagnostic and treatment procedures. It is this minority who bring a bad name to the entire profession.”