This article delves into the complex interplay between medical practice and human rights, shedding light on the challenges faced by doctors in navigating ethical, legal, and societal expectations, emphasising the need for a balanced healthcare system.

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We have traversed a thousand miles in white coat through the dynamic corridors of Indian hospitals, where the air is filled with the poignant supplications of the optimistic and the pungent aroma of antiseptics.

We have seen firsthand how medical jurisprudence and the Hippocratic Oath collide with respect to human rights. We have successfully traversed the maze of moral and legal conundrums that our healers encounter on a daily basis.

You may question why it's necessary for a doctor to understand the nuances of human rights. The explanations are as intriguing as they are complicated.

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The ethical pledge: Beyond words

The Hippocratic Oath is a tribute to the noble ideals that have driven healers throughout antiquity and is a symbol of medical ethics as well as a rite of passage for those wishing to join the field. It is the philosophical strand that unites doctors to a long-standing custom of honour and healing throughout their professional lives. However, what does this hallowed pledge really mean for the contemporary doctor?

Speaking these lines aloud is intended to represent a lifetime dedication to the moral practice of medicine, serving as a compass to help doctors navigate the stormy waters of moral quandaries and clinical ambiguity.

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Frameworks of law managing medical practise

Within the dynamic realm of medicine, physicians must not only manage the complexity of patient care but also the nuances of the legal frameworks that oversee their profession. Human rights and medical responsibilities are intricately entwined; this dance is performed within the confines of legal structures that serve to safeguard both the doctor and the patient.

Over the last few years, one thing has been very evident: Medical professionals are extremely vital to society. On the front lines of the coronavirus epidemic, they have put their lives in danger. It is no secret that India often has inadequate healthcare facilities. It just adds to the difficulty of their duties.

In addition to the International Covenant on Economic, Social, and Cultural Rights, India is a signatory to both of these agreements. The right to the best possible level of physical and mental health is protected by the Indian Constitution. They have many of the same privileges as employees in other industries because of the significance of their line of work.

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Medical practitioners' rights as employees

In general, Indian labour and employment law falls within the purview of Industrial Law. It was created to provide workers' rights with more protection. It includes, in general, the relationships between employees, employers, and the government. It addresses working conditions and terms of employment.

One concern pertaining to the medical field, in particular, is: Is the labour performed by doctors mostly skilled, technical, operational, supervisory, or manual unskilled labour? 'Healthcare professional' is a wide word, to be clear. Doctors, dentists, nurses, chemists, therapists, psychologists, physical therapists, optometrists, paramedics, and other professionals are included. It also covers other people who are authorised or licenced to provide healthcare services.

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Functions and responsibilities

Healthcare professionals, including doctors, are entitled to the same basic personal rights as everyone else. However, because of the nature of their work, they also have obligations as medical professionals.

According to Article 21 of the Constitution, the State is required to protect each person's right to life. Medical personnel have the following duties and obligations in this context:

1. A medical professional's first duty is to provide a patient with the best treatment possible, with the understanding that their health comes first. It is their responsibility to ensure that the patient is protected against hazards and problems.
2. In accordance with guidelines established by the Medical Council of India, all medical professionals are required to keep medical records from the start of therapy.
3. Every medical practitioner should have their registration number issued to them by the State Medical Council / Medical Council of India displayed.
4. They should also have a Register of Medical Certificates. It is the responsibility of a medical practitioner to follow all applicable rules and regulations. Laws such as the Pharmacy Act of 1948, the Narcotic Drugs and Psychotropic Substances Act of 1985, the Drugs and Cosmetics Act of 1940, and others should be known to and followed by them.
5. Information on the patient's medical history, therapy, and personal and family background should all be kept private. This information may only be shared under exceptional situations with agreement.

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Criminal culpability and negligence

A doctor may face criminal charges if they commit professional misconduct or make mistakes in their practice. In a legal court, they may be tried and prosecuted. Doctors are subject to different criminal laws than regular people. Because of the nature of their employment, they may injure people while attempting to stop additional damage from occurring.

Regarding medical professional carelessness, consumers have rights under the Consumer Protection Act of 1986. The inclusion of the medical profession in this Act was first up for discussion. The Supreme Court ruled that it ought to.

The Indian Penal Code and the Code for Criminal Procedure include separate provisions pertaining to criminal responsibilities in the medical field. However, there are three defences available to physicians under criminal law: informed consent, necessity, and good faith.

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The importance of workplace safety

There have been several accounts of physicians and nurses being mistreated and harassed while doing their jobs during the pandemic. Doctors in many states and towns staged rallies and strikes in response, calling for more safety. According to Medical Council of India regulation 2.1.1, physicians are free to choose or reject a patient.

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Medical practitioners are protected from harassment and abuse by several laws:

The Protection From Violence and Property Damage Act applies to Medicare service personnel and Medicare service institutions.

This law has been approved by at least 19 states. It includes both individual practitioners and physicians employed by institutions. Anyone found guilty under this legislation faces up to three years in prison and a ₹50,000 fine.

There are issues with the legislation. Because it lacks the Code of Criminal Procedure (CrPC) and the Indian Penal Code (IPC), it is less effective. As a result, physicians and other healthcare professionals find it difficult to contact the police and make complaints.

Medicare Service Personnel and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act, 2008

There is legislation protecting physicians in Delhi, the National Capital Territory. Here are a few of its crucial elements:

1. It forbids harming medical personnel or causing damage to an institution of higher learning's property.
2. The Act defines medicare service professionals as registered medical practitioners, nurses, nursing assistants, midwives, paramedical workers, ambulance service providers, and others. It defines violence as acts or behaviours that cause harm, injury, intimidation, obstruction, hindrance, or endangerment to the life of a medical professional.

Anyone found guilty under this rule might spend up to three years in jail and/or pay a fine of ₹10,000.

Regulations for the Professional Conduct of Registered Medical Practitioners (NMC) 2023

The Medical Council of India's (MCI) 2002 Code of Medical Ethics will be superseded by the National Medical Commission's (RMP) Professional Conduct Regulations, 2023. The effective date of these new rules is August 2, 2023.

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Right to choose

With the exception of life-threatening emergencies, the laws also provide physicians the authority to choose the patients they will treat.

Physicians have the authority to refuse treatment to patients who are disruptive or violent. In these situations, doctors are instructed to follow a protocol that involves accurately recording and reporting the violence, as well as refusing treatment and referring the patient to another medical facility. This information is outlined in a notification published in the National Medical Commission's (NMC) gazette, which notifies the NMC Registered Medical Practitioner (Professional Conduct) Regulations 2023.

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The rights of doctors vs. societal expectations

An ancient covenant that ties the doctor to the cured, the Hippocratic Oath has long been regarded as a cornerstone of medical ethics. Throughout history, the grave commitment to "do no harm" has reverberated in the sacred corridors of medical facilities all around the globe. However, society—which sometimes forgets that underneath the symbol of their profession, physicians are humans, just like those they treat—moulds the expectations put upon those who wear the white coat in addition to this pledge.

The story of 'Society's Expectations vs. Doctors' Rights' does not depict enemies but rather possible partners in the fight for global health. It's a tale that keeps being told, and we're all involved in influencing it. Let's create a new chapter that respects physicians' rights while we discard outmoded conventions, understanding that doing so elevates the core of medical treatment. A system that genuinely values its people's health is, after all, one that looks out for its carers.

So, the unanswered issue still stands: how can we pursue justice while yet having compassion for both the healer and the healed? As we consider this, let's not forget that providing care for human beings is at the core of healthcare, and in this admirable pursuit, excellence is a goal rather than a certainty. For the sake of everybody, we must work towards a system that not only corrects neglect when it happens but also encourages ongoing advancements in medical practice.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.