This article has been written by Oishika Banerji of Amity Law School, Kolkata. This article provides a detailed analysis of medical jurisprudence with respect to India. Further, the article also discusses the relationship of medical science with Indian laws from legislative and judicial lenses.
This article has been published by Shoronya Banerjee.
Medical jurisprudence is the branch of law that studies the relationship between medical facts and legal issues. Medical witnesses may testify in front of courts, administrative tribunals, inquests, licencing agencies, boards of inquiry or certification, or other investigative organisations. Doctors in most countries are required by law to certify individuals for workers’ compensation or other national insurance plans, the occurrence of birth or the cause of death, to report any cases of specified infectious diseases to the authorities, and to determine when mentally disturbed individuals need to be detained to protect themselves or others. The most common tasks of medical jurisprudence are these everyday activities. The use of a doctor as a witness is less common, but perhaps more important. When physicians appear in court to testify about what they have seen, they are subjected to the same restrictions that apply to other witnesses. As the discipline evolved, the medical practitioner/doctor gained enormous authority thereby playing a critical role by providing expert opinions in cases. With this authority, however, came enormous responsibility. To mention a few, there is the doctor-patient relationship, medical negligence, ethical behaviours, and professional misconduct. Medical jurisprudence is a very old discipline, but with the advancement of technology and the addition of changes to the legal system, this sector is continually evolving. The present article provides a detailed analysis of medical jurisprudence from an Indian legal perspective.
Turning the pages of history for medical jurisprudence
Medical jurisprudence stretches back to 4000-3000 BC, and the data recorded can be studied from the Materia Medica Imhotep (around 2300 BC), the Egyptian ruler’s personal physician and chief judge, and is regarded as the first medico-legal specialist. While in India, the Charaka Samhita (about 7th century BC) contains necessary regulations for physicians regarding ethics, obligations, privileges, and other matters, other writings like the Manusmriti, Sushruta Samhita, Yajnavalkya Smriti, and others were also important in preserving and regulating medical practice. In medico-legal practice, an autopsy is regarded as the most significant instrument. Dr. Edward Bulkley was the first to do a medico-legal autopsy in India in the 18th century.
When this branch was first introduced in India, it didn’t take long for it to spread in all directions. Calcutta received the country’s first medical school in 1822. This progression continued in the states of Madras and Bombay. Scientific procedures have evolved by a factor of ten in the previous few decades. In Pratap Misra v. State of Orissa (1977), Justice Fazal Ali had observed that medical jurisprudence is not an exact science, and it is difficult for any doctor to say with precision and exactitude when a particular injury was caused, or when the accused may have had sexual intercourse with the prosecutrix. The tests carried out and the findings produced were so accurate that they were used as evidence to prove or refute a defendant. This expansion has resulted in the expansion and diversification of medical law into several small fields.
In forensic medicine, a medical specialty that aids in the identification of crime, law, and medicine come together more harmoniously. Forensic medical experts also help courts, especially the coroner’s court under Anglo-Saxon law, figure out what caused sudden and unexpected deaths. In these circumstances, the primary inquiry conducted by a forensic professional is a postmortem examination of the corpse, which includes a thorough inspection of every organ and its contents, as well as microscopical study of some organs and chemicals along with DNA testing. Forensic medicine includes dramatic tasks such as establishing the size and sex of a body by analyzing just a few bones, identifying a corpse based on its dental pattern, and uncovering signs of rape or unsolved murder. It usually entails determining the timing of a person’s death or analysing the amount of alcohol in a motorist’s blood to determine the degree of impairment in a judgment.
In a hypothetical situation, if a patient dies as a result of a hypersensitive allergic reaction to a medicine that is generally accepted by the general public, is the death to be regarded as the doctor’s fault? The patient’s family may bring a medical malpractice complaint against the practitioner. The attorneys representing the doctor and the patient in the lawsuit should be well-versed in the circumstances surrounding the patient’s tragic death. This is how medical jurisprudence will assist in assessing whether or not the doctor should be held accountable. The following are some of the most common medical jurisprudence cases that come up before the courts:
- Paternity testing.
- Injuries and wounds.
- Death as a result of poisoning.
- Cause of death and manner of death.
- Violent death.
Medical jurisprudence in India
The evolution of medical jurisprudence in the democratic land of India can be better understood by means of judicial decisions where the subject of medical jurisprudence has always been provided with a dignified position.
The case of Ram Kala v. Emperor (1945) that appeared before the Allahabad High Court was one such early case where the Court had referred to Lyon’s Medical Jurisprudence for India by Waddell to understand the ‘signs of recent intercourse’ in cases of rape. Lyon states that if the vagina is covered with a uniform coating of smegma then recent intercourse is indicated. Furthermore, according to Modi’s Medical Jurisprudence, if the accused is not circumcised, the presence of smegma around the corona glandis, which is rubbed off during sexual intercourse, is proof against penetration. If the victim doesn’t take a bath for twenty-four hours, the smegma will accumulate. Even if there are certain flaws in the defence that are not precisely compatible with the accused’s innocence, the prosecution must nonetheless show his guilt beyond a reasonable doubt and in the present case, the prosecution had failed to achieve this goal. The Court held that the accused was not guilty under Section 376 of the Indian Penal Code, 1860, and was therefore acquitted.
The Supreme Court of India while deciding on the case of Mulakh Raj Etc v. Satish Kumar and Others (1992), relied on Taylor’s Principles and Practice of Medical Jurisprudence to decide what asphyxia actually is and whether the death of the deceased victim was a result of the same. In this case, all of the symptoms observed on the deceased’s dead body indisputably revealed that her death was caused by pressure on the neck, and the doctor’s findings during the post-mortem examination and his testimony were compatible with medical jurisprudence. Hence, the respondent was charged under Section 302 of the Indian Penal Code, 1860.
The Delhi High Court while hearing the case of Virender v. the State Of NCT of Delhi (2009), referred to Parikh’s Textbook of Medical Jurisprudence and Toxicology which describes ‘sexual intercourse’ as the tiniest degree of penile penetration of the vulva, with or without semen discharge. As a result, it is quite conceivable to lawfully commit rape without causing any genital harm or leaving any seminal traces. In light of the facts of the case and perspective provided by the aforementioned textbook, it was decided that the finding of guilt of the appellant for commission of the offence under Section 376 of the Indian Penal Code, 1860 was not sustainable.
In Madan Lal v. State (2012), the Rajasthan High Court was considering a rape incident of an adolescent girl, in which the hymen of the victim was not torn. Because of the same, the Court had taken reference from medical jurisprudence along with the contentions of the parties to the case. Medical jurisprudence provides that as the hymen is located more posteriorly in teenage females, rape can occur without the hymen being ripped. On the other hand, if the hymen of an adolescent girl is torn as a result of rape, the penetration must be deep. The Labia Majora are the first organs to be contacted by the male organ, and they are subjected to blunt powerful strikes, depending on the vigour and force employed by the accused and countered by the victim, with bruising visible to the human eye. The most trustworthy evidence in the rape case is the examination of the hymen and their state of harm. In the case at hand, it was evident that the medical evidence about the commission of rape was contradicting the prosecution’s case, hence, the accused was acquitted of the offence under Section 376 of the Indian Penal Code, 1860. The offence of committing assault to outrage the modesty of a woman was made out in this case and the accused was held guilty of offence punishable under Section 354 of the aforementioned Code.
The Gujarat High Court while deciding on the recent case of Bharatbhai Mohanbhai Chavda v. State of Gujarat (2021) had put its reliance on Modi’s Medical Jurisprudence and Toxicology (26th Edition) in order to understand the meaning of the term ‘strangulation’. The mentioned text refers to strangulation as the compression of the neck by a force other than hanging. The Court had concluded that the deceased was murdered in her home by smothering and strangling, and an effort was made to remove her corpse by setting fire to it. After that, close relatives concocted a tale that she committed suicide by hanging herself. The Hon’ble High Court had also observed that the Trial Court in the present case was correct in convicting the accused under Section 302 of the Indian Penal Code, 1860.
Indian laws that are being governed by principles of medical jurisprudence
To comprehend the legal aspect of medical jurisprudence, it is necessary to understand the structure of the Indian judicial system’s classification of laws.
Indian Penal Code, 1860
The prime criminal legislation in India is the Indian Penal Code, 1860. The following provisions are to be taken into account while relating medical jurisprudence with the Indian laws:
- Section 44: This provision provides the definition of injury as any illegal harm to a person’s body, mind, reputation, or property of any kind.
- Section 319: The provision lays down the definition of hurt as bodily pain, disease, or infirmity caused to any person.
- Section 320: This provision defines grievous injury and lays down a list of injuries that comes under the broad head of grievous injury.
- Section 321: This section defines voluntarily causing hurt.
- Section 322: The provision provides for voluntarily causing grievous hurt.
- Section 323: This section lays down punishment for intentionally inflicting harm.
- Section 324: This provision provides punishment for voluntarily causing hurt with a dangerous weapon is up to 3 years in jail, with or without a fine.
- Section 325: The provision lays down punishment for intentionally causing grievous harm. The punishment prescribed is a maximum of 7 years in jail, or/and fine.
- Section 326: The section lays down punishment for intentionally causing grievous harm with a dangerous weapon or means.
- Section 328: The provision lays down the penalty for inflicting harm by means of poison, etc.
- Section 351: This provision defines assault as the threat/attempt to apply force.
Indian Evidence Act, 1872
The Indian Evidence Act, 1872 is an adjective law that comprises a collection of rules governing the admission of evidence in Indian courts of law, as well as related concerns. Sections 45 and 114 A of the 1872 Act needs to be taken into account while attaching the importance of medical jurisprudence with Indian laws.
- Section 45: This provision deals with the opinions of experts. When the Court has to develop an opinion on a point of foreign law, science, or art, or on the identification of handwriting, the opinions of individuals who expertise in the same are considered to be relevant facts. Such individuals are referred to as experts.
- Section 114 A: In a rape case, if the question is whether sexual intercourse occurred without the woman’s consent and she indicates that she did not consent in her testimony, the court shall presume that she had not to consent.
Code of Criminal Procedure, 1973
The Code of Criminal Procedure, 1973 is the procedural law governing criminal proceedings in India. Sections 53 clauses (i) and (ii), 54, 174, and 176 are the provisions that need to be taken into account while talking about medical jurisprudence in India.
- Section 53 (i): At the request of a police officer who is employing reasonable force, an accused may be evaluated by a medical professional.
- Section 53 (ii): When a female accused’s person is to be examined, it must be done by or under the supervision of a female certified medical practitioner exclusively.
- Section 54: A medical practitioner may examine an arrested individual at his/her request in order to find evidence in his/her favour.
- Section 174: Police to enquire and report on suicide, etc.
- Section 176: Inquiry by Magistrate into cause of death.
Indian Medical Council Act, 1956
The Indian Medical Council Act, 1956 is an Act to provide for the re-establishment of the Medical Council of India, the maintenance of a Medical Register for India, and related things. Section 20 A of the statute provides for professional conduct consisting of standards for the same, etiquette, and a code of ethics for medical practitioners, to be prescribed by the medical council. Regulations adopted by the Council under subsection (1) of the aforementioned provision define which infractions may constitute notorious behaviour in any professional respect, that is, professional misconduct, and such provision shall apply notwithstanding anything contained in any law for the time being in force.
Discussion around medical negligence
The idea that ignorance of the law is no excuse for breaking it, is acknowledged by both Indian and other legal systems. The norm can also be represented as a legal presumption that everyone is aware of the law. Every individual owes it to themselves to understand the parts of it that interest them. A doctor, in particular, is definitely considered to know the law and is treated as if they do, because they can and should know it in general. The medical profession varies from other vocations in terms of professional responsibility since it operates in areas where success cannot be guaranteed in every case and when success or failure is frequently dependent on elements outside a medical expert’s control. A medical expert has grown increasingly vulnerable to being sued by a lawsuit of any sort, civil or criminal, as a result of the increased knowledge of a patient’s rights in today’s society. The majority of working doctors in our nation are still unfamiliar with the basis of a medical negligence lawsuit.
The risks involved with medical practice have long been acknowledged by the courts. Because the law presumes that a doctor always works in good faith for the well-being of his/her patient, Sections 88 to 92 of the Indian Penal Code, 1860 shield doctors from criminal culpability. In a medical malpractice case, however, the idea of good faith plays a more difficult role. “Nothing is claimed to be done or believed in ‘good faith’ which is done or believed without appropriate care and attention,” according to Section 52 of the aforementioned Code.
The Supreme Court of India reaffirmed its views in a medical malpractice case, ruling that “the medical practitioner must bring to his duty a fair degree of ability and knowledge and must exercise a reasonable degree of care.” The law does not demand the maximum level of care and competence, nor the lowest level of care and competence, as determined by the facts of each instance. When a scenario arises that necessitates the application of a particular skill or competence, the test is the ordinary/reasonable skill that a man practising and purporting to have that special talent possesses. The “duty of care” is viewed as the complementary principle that applies to medical professionals and healthcare providers.
When it comes to professional negligence, courts have always been quite mindful of medical practice. A clinician has specific responsibilities to his or her patients. A clinician has committed a negligent act if they do something that other clinicians of their standing, standard, and competence would not do, or if they fail to do something that other clinicians would undoubtedly do. A medical expert is supposed to practice with proper care, dedication, and adoption of acknowledged standards of practice while respecting the autonomy of the patient. A medical practitioner must also follow the copy of the Code of Medical Ethics statement issued by the Indian Medical Council at the time of registration.
The Supreme Court of India set the legal basis for the duty of care as a binding ethical and constitutional concept in a ruling declaring the Code of Medical Ethics as the prevailing rule for the medical profession. In a way, this gives medical ethics in India legal support, as in Section 33 of the Indian Medical Council Act, 1860. In a sense, this provides medical ethics with the backing of legal authority in India.
Issues in the existing legal regime
There are several disadvantages to the aforementioned laws, according to the current Indian scenario. Despite its numerous advantages, evidence obtained through medical jurisprudence is still deemed secondary to expert opinion rather than primary evidence. Only in limited circumstances is the report of an autopsy process deemed documented evidence under the Indian Evidence Act of 1872. Doctors are obligated by doctor-patient confidentiality, which frequently puts them in the position of deciding whether or not to share information with the legal system. If the doctor learns that one of his patients has committed a crime (other than suicide), he/she is obligated to report it to the authorities. The doctor may face repercussions if he/she fails to do so. Suggestive reforms for the existing system would be:
- Drafting of legislation that will use medical jurisprudence as a main source of evidence.
- Other scientific test findings must also be regarded as documentary evidence, provided they are done according to standard testing methodology.
- If a patient attempts suicide, the doctor must notify the appropriate authorities. This will assist in addressing the circumstances that may have led to such drastic action by the victim, as well as ensuring the patient’s safety in the near future.
Jurisprudence of emergency medical care in India
In India in the 1980s, emergency medical care jurisprudence, which closely intersected ethical concerns, established the groundwork for the emergence of healthcare litigations. In following litigations involving the medical profession and private and public healthcare providers, it provided a bridge for the courts to apply the right to a dignified life and the State’s constitutional responsibility to save a life. It also made it easier to write healthcare jurisprudence and declare healthcare to be a fundamental right.
The topic of emergency medical treatment, which frequently involves dealing with life and death circumstances, brings various overlapping concerns about health services, patient rights, and the state’s and medical profession’s responsibilities into sharp light. The indignity caused by the refusal to treat critically ill patients, resulting in death, undue suffering, morbidity, and financial loss, has been challenged in courts on the basis of moral-ethical principles that are at the heart of the medical profession and the reason behind the healthcare system in a welfare state.
Bystanders do not come forward to aid the victims of such emergency situations because of the medico-legal nature of the cases and the fear of being harassed by the police and courts. Following a PIL filed by the SaveLIFE Foundation in 2012, the Supreme Court of India made efforts in 2016 to enact new legislation relating to accidents and emergency treatment by requesting that the Central government draft guidelines for the protection of ‘Good Samaritans’ from police or other authorities. Santosh Ahlawat, an MP, raised the issue in Parliament. In another key ruling (Pt. Parmandand Katara v. Union of India and Ors (1989)), the subject of safeguarding doctors from legal headaches in medico-legal matters so that they can offer prompt treatment to patients in need of emergency life-saving care has been addressed.
In the well-known case of Paschim Banga Khet Mazdoor Samiti v. State of West Bengal (1996), the victim, Hakim Sheikh, was an agricultural labourer who was a member of the Paschim Banga Khet Mazdoor Samiti, a labour organisation. He was denied admission to five public hospitals after falling off a moving train on his way to work. The patient was refused admission on the ground that there were no beds available. The victim was finally admitted to a private hospital and forced to pay expensive fees for his care. Surprisingly, some 20 years after the Paschim Banga Khet Mazdoor Samiti case, the focus in “the Good Samaritan” discourse has changed from the healthcare system to the healthcare of individuals from a different social class. This discourse has been pushed into the public imagination without any mention of emergency care accessibility and availability for the disadvantaged. It appears sufficient that such care is available, through medical insurance, to the upper-middle class, who continue to overlook its inaccessibility to the underprivileged.
Role of Public Interest Litigation in developing medical jurisprudence
A number of subsequent PILs aided in the development of personhood jurisprudence, affirming the priority of the right to life and dignity. As a result, Article 21 of the Indian Constitution became the bedrock of social and civil-political rights, including health and healthcare. The right to medical treatment for employees and civil rights litigation for the rights of people in jails and police custody are two of the many components of a large number of healthcare litigations. Even though the number of lawsuits involving emergency medical treatment is less, they have shown systemic flaws in the field of life-saving care. These include medical practitioners’ insensitivity and personal/professional apathy, especially towards patients from socially disadvantaged groups, as well as delays or denials of care.
Medical care in police custody
People in state custody, such as those in police or judicial custody, as well as those in state-run asylums and prisons, are subjected to torture, ill-treatment, and abuse, as well as are denied access to necessary medical care. In Poonam Sharma v. Union of India, the Delhi High Court reaffirmed police officers’ and physicians’ constitutional obligations to care for wounded people in medico-legal matters. Article 32 of the Constitution, which establishes access to justice as a fundamental right, confirms the indisputable nature of the State’s commitment.
Viewing patients availing healthcare services as ‘consumers’
The ramifications of violating the principles of saving lives and the duty of care are clearly stated in the medical jurisprudence. Failure to give prompt medical treatment to a person in need of emergency care is claimed to be a breach of Article 21 of the Indian Constitution, which guarantees the right to life. As a result of this rationale, the medical profession was brought within the Consumer Protection Act (CPA) of 1986. The medical profession, as represented by medical groups, has fought for more than a decade to put healthcare workers in general, and physicians in particular, under the CPA 1986.
The case of Indian Medical Association v. V.P. Shantha (1995) exemplifies the medical profession’s long-standing opposition to any regulation of doctors under the guise of professional self-regulation. In this case, the definition of ‘service’ as it relates to healthcare under various circumstances was argued in order to ascertain the consumer status of the healthcare-seeking patient. The lawsuits pointed out the rejection of admission to public hospitals, which almost always results in death or treatment in private hospitals. Medical malpractice and ethical problems at private hospitals were also mentioned which include the termination of medical care due to a lack of immediate payment, medical malpractice, and the charging of unreasonable fees for treatment.
Both the medical and legal fields have profited greatly from the development of medical jurisprudence. A greater understanding and cooperation have evolved, allowing both disciplines to operate more smoothly. With the advancement of medical jurisprudence, formerly insoluble problems are now easily settled. It may be used to identify a child’s paternity as well as the identification of human remains that have been disfigured beyond recognition in incidents such as bomb blasts, factory explosions, and so on. It may be used to solve instances involving murder, rape, and other crimes in the subject of evidence laws. After a person has died, medical jurisprudence procedures like an autopsy can be used to uncover key information that is crucial to the case. The heart of ethics, codified in the Code of Medical Ethics and strengthened by ethical jurisprudence, may revitalise ethics-compliant healthcare in India. Streamlining ethics in the public and private healthcare systems would necessitate a number of policy measures, including a complete statute to institutionalise ethical principles for maintaining the right to healthcare. Most significantly, medical practitioners would have to be steadfast in their efforts to resuscitate and restore the profession to its lofty ethical ideals of patient care and suffering reduction.
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