Mistrust On Medical Services Becoming Narratives: Chief Justice Of India DY Chandrachud

Chief Justice of India DY Chandrachud on Sunday said that due to an overburdened healthcare system, coupled with increasing commercialisation of healthcare, mistrust and suspicion on medical services are becoming narratives surrounding healthcare.

The Chief Justice said, "We as a society need to counteract structural and policy constraint which prevent access to good healthcare in order to achieve healthcare justice", while lamenting that growing socio-economic inequalities in India have a disproportionate effect on health outcomes of marginalized groups.

Speaking at the 19th Sir Ganga Ram Oration on Prescription for Justice- 'Quest for Fairness and Equity in Healthcare', the CJI said equality and fairness are prime factors that permeate the healthcare system to facilitate justice.

"Due to an overburdened healthcare system, coupled with increasing commercialization of healthcare, mistrust and suspicion on medical services are becoming narratives surrounding healthcare. I began by telling you that this is not unique to your profession, there is an element of mistrust in legal profession as well. People are asking us judges questions as well", he said to a large gathering of doctors and healthcare professionals.

He said the fiduciary natures of patient-doctor relationships struggle when either side fails to recognize the other side is also a person.

"A doctor is a person as much as the patient and the patient is a person as much as the doctor. The simmering anger of public against injustice in healthcare is aggravated if either a patient treats the doctor as an infallible service provider, who mechanically provides services, or when a doctor looks at a patient as a medical issue which needs to be solved", he said.

Recalling the speech of President Droupadi Murmu, given last year on the occasion of the National Law Day on November 26, when she had referred to her village in Mayurbhanj district in Odisha, where villagers used to treat teachers, doctors and lawyers as gods, the CJI said that in a way she is correct as there is an element of divinity involved in these profession.

"I began by postulating divinity in medicine but we must also understand as a layperson, that there lies so much beyond our control of human agencies. This dehumanization of health care has often resulted in violent confrontation between citizens and hospitals, with medical profession being caught in crossfire.

"This puts the lives of medical professionals at the risk and creates a hostile environment for them to work in. This violence ends hampering the delivery of health services, which can have serious consequences for patients", he said.

CJI Chandrachud said violent confrontation can have worst impact on doctors, who would adopt a practice of defensive medicine, which you would never want your doctors to adopt.

"Because it is in the ability to take risk, it is in the ability to experiment, ability to explore that true evolution in all fields of human social life takes place. What then amount to justice in healthcare? Equality and fairness are prime factors that you permeate the healthcare system to facilitate justice", he said.

CJI Chandrachud said that one way of understanding justice in healthcare is that there should be health equity and this means that every person should get equal opportunity to be healthier.

"Another component of healthcare justice includes the ethical principles that govern the interaction between medical professionals and patients with a view to give primacy to patient care and the patient's bodily integrity and autonomy. Ultimately the goal is to achieve fairness, promote dignity and ensure that people have similar capability to lead healthy lives and contribute to society", he said.

Justice Chandrachud said that viewing health from the perspective of social justice, law is being increasingly employed to address inequality in access to health care.

"However, growing socio-economic inequalities in India disproportionality affects health outcomes of marginalized groups. People belonging to marginalized communities are perpetually faced with barriers in accessing health care. Social determinants of health-factors outside the healthcare system such as class, caste, gender, regional location often determine health status of an individual. Injustice in healthcare becomes evident when one looks at the people not merely by the means of stethoscope but by understanding their social determinants to health", he said.

He lauded the efforts of doctors and healthcare staffs of Sir Ganga Ram Hospital in Delhi during the COVID-19 pandemic, when they had to work non-stop to provide healthcare facilities to the surging numbers of patients.

"Each and every member of the hospital ecosystem has a critical role to play in providing healthcare justice. This becomes writ large during the time of the pandemic-whether it was the management's decision to keep the hospital functioning during Covid, the services of doctors and nurses who provided untiring medical and emotional care when the patients were alone in isolation, or the work done by the paramedical and support staff…the vision of the pioneers of Sir Ganga Ram Hospital to provide healthcare with humane touch has indeed come true", he said.

Justice Chandrachud remembered his long association with the hospital, when he had to sleep on a couch for nine days to attend to a patient in his family and when he himself had been a patient at the hospital.

He also recalled that last week, a Supreme Court judge had to be rushed to the Sir Gangaram hospital and he was afforded quality treatment after which he has now recuperated.

Justice Chandrachud also focused his speech on the intricacies of law and medicines and referred to several landmark judgements such as on LGBTQ and decriminalising homosexuality, and medical termination of pregnancy.

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