In spite of having a comprehensive legal and regulatory system for doctors, several policy measures based on ethical & emergency healthcare are still required to streamline ethics in private and public healthcare systems.

Under the obligation of the Hippocratic oath, which was laid down 2500 years ago, health care providers are supposed to be committed to eliminate suffering and to uphold the primacy of life. Respecting a patient’s autonomy, non-maleficence, beneficence and justice are the four main ethical pillars of the practice of medicine.

However, when there is a medico-legal case, most doctors especially in private hospitals, tend to direct the patients to Government hospitals, which can lead to delay in treatment. The doctors find the legal process daunting, time-consuming often involving long waiting periods. Taking these into consideration, most doctors shun away from the paramount responsibility of ‘saving lives’.

Refusal to treat critical patients, which may lead to death, complications, extensive hospitalisation, and financial losses, is against the core moral-ethical principles of the medical profession.

Litigations related to Emergency Care in India

Denial or delay in emergency care by public healthcare institutions for accidents

In the first case, the patient had a motor vehicle accident, in the second case, a fall from the train, and in the third case an emergency cardiac problem. In all these cases, patients were denied care as no beds were available in the hospital. In the first case the victim died and in the other 2 cases, the patients were admitted to private hospitals where they had to pay exorbitant amounts of money.

Private Hospitals: Medical negligence and refusal of treatment

In the first case, the patient, who was the son of a doctor, was getting operated for a fracture in the left femur. The patient died after the surgery due to an inadequate dose of anaesthesia. In the second case, a doctor filed a case on the hospital staff for discontinuing treatment for their 20-year-old son because they were not able to deposit Rs 15000 immediately. The man died while being taken to another hospital.

Emergency care for people involved in railway accidents

Earlier, the railways provided emergency care only when authorised passengers had been a victim of accidents. Emergency life-saving measures were not considered in railway accidents in which people crossing the railway tracks or those who travelled ticketless were affected. The above case was a written petition stating that emergency medical care must be provided to all people involved in railway accidents.

Ill-treatment and lack of medical care in police custody

In the first case, the accused who was beaten up by a mob for an alleged robbery, was tied to a cycle rickshaw by the police and taken to the police station. The accused was not given any medical treatment and he died. In the second case, the person met with an accident due to drunken driving. The patient did not receive any medical care while in custody and he finally died.

These cases reflect the deterioration of ethics in the medical profession and the gaps in the provision of healthcare in India.

Emergency care- law & ethics

The Supreme court of India has established that the ethical duty to save or preserve life is an undeniable principle. The ‘right to life’ is considered as the most important. The state and the medical professionals must be committed to it.

The law also directs the courts not to summon the doctors as witnesses for evidence unless necessary as they are not supposed to wait and waste their time.

Implications of violating the ‘duty of care’

Under article 21 of the constitution, it is a stated that ‘duty of care’ is a total, absolute, and paramount principle that is applicable for all medical professionals in both public and private healthcare systems. Failure to provide timely medical attention for the people in need is a violation to the right to life.

This statement played an important role in bringing medical professions under the Consumer Protection Act (CPA) in 1986.

Nonetheless, such legal and ethical provisions have still not been able to achieve desirable healthcare for people from disadvantaged and vulnerable communities. Patients belonging to such communities seldom have health insurance, and when they go to private hospitals to seek care (due to lack of services in government hospitals), they are at a high risk of becoming poorer due to the burden of medical expenditures.

The private medical sector in India must realise the right to healthcare for all. The NCDRC explains that though a doctor is not compelled to treat every patient under normal circumstances, he/she is bound to treat a patient who needs emergency care. The doctor cannot delay treatment for reasons such as non-payment or delay in payment of fees.

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Medicine is a noble profession, but the vast number of litigations against the healthcare system in India is a clear proof that the medical professionals are far from altruistic in their motives. Medical professionals must take the initiative to restore the ethical goals of medical profession related to patient care and reduction of suffering. More focus is needed to provide sensitive and equal healthcare to the socially disadvantaged communities.

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Adapted from:

1. Edward Premdas Pinto. The jurisprudence of emergency medical care in India: an ethics perspective. Indian Journal of Medical Ethics. Oct-Dec 2017; 2(4).

2. Peters DH, Muraleedharan VR. Regulating India’s health services: to what end? What future? Soc Sci Med. 2008;66(10):2133-44.