Medical care is unique in that the vulnerable patient depends on the skill, knowledge, and intention of the doctor in a relationship of trust.
Credit: DH Photo/S K Dinesh
In May 2024, the Supreme Court ruled in Bar of Indian Lawyers vs D K Gandhi PS National Institute of Communicable Diseases and Ors that complaints against lawyers could not be decided by consumer courts in the country.
The Court held that services rendered by lawyers do not fall under the purview of the Consumer Protection Act (CPA) of 1986/2019. This landmark decision called into question the reasonableness of holding other professionals, such as medical practitioners, liable under the CPA. Many arguments in the ruling could be applied to the medical profession as well.
In fact, the Court suggested that the 1996 decision by a three-judge bench in IMA vs V P Shanta and Ors, which brought services rendered by medical practitioners within the CPA’s definition of ‘services,’ should be revisited by a larger bench.
This ruling is a huge relief to medical practitioners, who have long argued that healthcare services should not be treated on par with services provided by businesses or traders. The medical profession cannot be branded as a ‘business’ or ‘trade,’ just as the patient cannot be reduced to a ‘client’ or ‘consumer.’
Medical care is unique in that the vulnerable patient depends on the skill, knowledge, and intention of the doctor in a relationship of trust. As argued by the Indian Medical Association (IMA), successful treatment may not be achieved in every case, and failure may be due to factors beyond the control of the professional.
The 1996 judgement unfortunately resulted in a rise in consumer court cases against doctors, as they were less expensive to file and reviewed quicker than cases filed in civil courts.
Doctors had to leave their clinics, hire lawyers, and attend court for every case filed by dissatisfied patients, causing disruption in health services and professional demoralisation. Abundant caution and defensive practice by doctors meant extensive investigations, consultant referrals and over-treatment. This in turn raised the cost of care to the detriment of patients, who became resentful of these unnecessary tests and treatments, eroding trust in the doctor-patient relationship.
The crucial issue is the unique nature of medical care, which does not lend itself to the definition of ‘service’ as described under the CPA. Medicine continues to be an inexact science despite care protocols, evidence-based medicine, and advancements.
There are still gaps in our understanding and treatment of many ailments and diseases. Further, every patient is unique, based on their genetic and physical makeup, symptom presentation, and social and environmental factors.
Doctors can provide care that may assist the body in recovery but cannot guarantee a cure. It is the knowledge, expertise, and experience of the doctor that is at the service of patients, providing the conditions for recovery. ‘Care’ can include prevention, comfort, education, advice, and emotional support.
Recovery from an illness can have different meanings and endpoints for different patients. This nuanced perspective of the role of the medical professional within the medical enterprise suggests a quality of service that is not easily quantifiable, and cannot be readily transacted.
This does not mean that doctors should not be held accountable in cases of negligence or misconduct. The medical profession is well regulated by the Indian Medical Council (IMC) Act and its code of conduct, and the IMC Regulation 2002.
In cases of negligence, patients can appeal in civil or criminal courts, and complaints can be filed in the State Medical Councils. Even here, the judiciary, in the case of Jacob Mathew vs State of Punjab (2005), has emphasised the need for care and caution in prosecuting doctors in the interest of society, as a caution against frivolous and unjust prosecutions.
The Consumer Protection Act 1986 was drafted as a response to the 1985 Resolution of the United Nations General Assembly on Consumer Protection: “The very purpose and object of the Consumer Protection Act 1986 (2019) was to protect consumers from unfair trade practices and unethical business practices.
The Legislature never intended to include either the professions or the services rendered by professionals under the purview of the said Act of 1986/2019”. Internationally, too, the service of medical professionals is kept out of consumer protection laws.
As suggested in the May 2024 judgement, it is in the interest of society and the medical profession to revisit the 1996 decision that brought doctors and their services under the CPA. The advocates have certainly argued their case well and shown the way to appeal that unfortunate decision.
(The writer is a doctor and author of Biomedical Ethics)