CBME Controversy Continues: Madras HC seeks report from NMC on Inclusion of 'Gender Identity Disorder' term in New MBBS Curriculum

Chennai: The controversy regarding the Competency-Based Medical Education (CBME) 2024 guidelines continues as the Madras High Court has now expressed concerns about using the term "Gender Identity Disorder" in the new MBBS curriculum.

Taking note of this topic, which falls under the psychiatric competency, the HC bench comprising Justice N. Anand Venkatesh once again clarified that there is no psychological disorder involved in a person belonging to the LGBTQIA+ community and held that "such a mistaken understanding must be corrected by making appropriate changes in the curriculum. Unfortunately, once again the work “disorder” has found its place even in the new curriculum and it has to be immediately removed."

The Court also highlighted several other concerns raised in this regard by Dr. L. Ramakrishnan in an article titled 'Curriculum Content Disorder' and directed the Apex Medical Commission to submit a report before the next date of hearing and make the necessary changes/inclusions in the curriculum before that. The matter has been listed for further hearing on 06.01.2025.

Medical Dialogues had earlier reported that the Madras High Court in 2021 had highlighted the need to revamp the existing medical courses' curriculum and make them up to date. The bench had observed that medical courses in India reaffirm queerphobia and discrimination against the LGBTQIA + communities. 

Back then, the Court had sought NMC to file a report as to how it would handle the issue in the future by carrying out necessary changes in the curriculum. Thereafter, in a similar order, the Kerala High Court directed the NMC to review the queerphobia text in MBBS course textbooks.

Also Read: NMC directs major changes in Medical Education Curriculum, Textbooks to make them LGBTQIA friendly, details

Later, NMC issued an advisory asking to make the textbooks LGBTQIA+ friendly and the Commission also removed the word "unnatural" from the classification of sexual activities including sodomy, buccal coitus, and lesbianism from the subject of Forensic Medicine & Toxicology of MBBS course. Following this, an expert committee of NMC made suggestions to modify the CBME MBBS curriculum to make it LGBTQIA+ ( Lesbian, gay, bisexual, and transgender) Community-friendly.

However, the controversy regarding the MBBS curriculum started again when the CBME 2024 guidelines, released in August, were criticised by activists alleging that they violated the Rights of Persons with Disabilities Act (RPDA) 2016 and the Transgender Persons (Protection of Rights) Act (TPA) 2019.

Two activists, who represent the disabled and transgender people, recently wrote to the Union Health Minister and NMC Chairperson pointing out how the newly released MBBS curriculum listed sodomy and lesbianism as "unnatural sexual offences" and also removed the Disability Competencies, which should have been longitudinally throughout the curriculum in AETCOM, from the guidelines. An RTI had also been filed in respect to the latter.

Under the Curriculum for Forensic Medicine, the CBME 2024 had listed "lesbianism" and "sodomy" as "unnatural sexual offences", which according to the activists is a violation of the TPA 2019. Further, it identified "transvestism" (cross-dressing) as a "sexual perversion".

Also Read: Lesbianism 'unnatural sexual offence', transvestism a 'sexual perversion': New MBBS curriculum guidelines draws flak

New CBME 2024 Guidelines:

Following the complaint, NMC withdrew and cancelled the CBME guidelines and released a modified version, where the Commission removed "lesbianism", "sodomy" words from the list of "sexual offences" and removed the word "unnatural" from the syllabus of Forensic Medicine & Toxicology of MBBS course.

The new syllabus also asked students to describe and discuss informed consent in sexual intercourse. As per the syllabus, students are required to describe and discuss histories of gender and sexuality-based (sexual orientation) identities and rights in India. They are also required to describe the history of decriminalization of 'adultery' and consensual adult homosexual sexual behaviour.

Madras HC Expresses Concern regarding usage of 'Gender Identity Disorders' in CBME 2024: 

Now, the Madras High Court, which has been monitoring the issue since 2021, recently expressed its concern regarding a topic in Psychiatry called, "Psychosexual and Gender Identity Disorders".

The HC bench noted that NMC on 29.08.2024 published the medical curriculum with outdated and inaccurate content pertaining to gender and sexuality and how these guidelines were withdrawn and cancelled after objections were raised by persons belonging to the LGBTQIA+ community and also the various NGOs who are working for their welfare. Thereafter, a fresh publication was made on 12.09.2024.

However, the Court noted that even in the fresh guidelines, only certain issues were addressed and there were lots of areas where concerns were raised. In this regard, the HC bench referred to an article written by Dr. L. Ramakrishnan titled 'Curriculum Content Disorder' and opined that NMC can consider this article as a base document to submit a report specifically addressing the issues raised in the article. 

"In order to understand the actual grievance that has been expressed in this regard, this Court wants to take note of a detailed article written by Dr.L.Ramakrishnan titled as 'Curriculum Content Disorder', dated 16.09.2024. This article provides the background, the changes that has been made and the changes which are yet to be made in the curriculum. This article can be taken as the base document to enable the NMC to submit a report. The report shall specifically deal with the issues that has been raised in this article. Either, the necessary change must be made in the curriculum or if it is not carried out, the report must specifically state as to why such change cannot be made," observed the HC bench.

Regarding the usage of the term "Gender Identity Disorder", the Court expressed its concern and noted,

"Apart from the other issues that have been flagged in the above article, this Court is more concerned with the usage of the term “Gender Identity Disorder” in topic 9. This falls under the psychiatric competency. This Court has been urging right from the beginning that there is no psychological disorder involved in a person belonging to the LGBTQIA+ community and such a mistaken understanding must be corrected by making appropriate changes in the curriculum. Unfortunately, once again the work “disorder” has found its place even in the new curriculum and it has to be immediately removed. This is apart from the other concerns raised in the above article."

Asking the Commission to submit a report before the next date of hearing, the Court ordered, "The NMC shall submit a report in this regard before the next date of hearing and the necessary changes/inclusions shall be made before the next date of hearing."

On Conversion Therapy: 

Regarding the issue of incorporating "Conversion Therapy" as a professional misconduct in the relevant regulation, the HC bench pointed out that it had issued some directions in its order dated 10.06.2024 and the counsel for NMC had submitted that a report would be submitted in this regard during the next date of hearing.

"A decision has already been taken for incorporation of conversion therapy as a professional misconduct. In order to add authenticity to the decision taken, it has to necessarily form part of the regulations. Therefore, the 2023 regulations that is going to be brought into force must deal with this issue. The stage at which the 2023 regulations are pending will become more clearer only after receiving a report from NMC," ordered the Court.

To view the HC order, click on the link below: 

https://medicaldialogues.in/pdf_upload/madras-hc-cbme-2024-253352.pdf

Also Read: NMC reintroduces MBBS CBME curriculum, talks about informed consent