Issue Fresh Guidelines for Admitting PwD Candidates to MBBS Course: SC Directs NMC
New Delhi: In a significant ruling, the Supreme Court recently stressed the importance of creating an inclusive atmosphere for persons with disabilities seeking to pursue medical education, noting it to be a "vital component of quality healthcare".
Highlighting that Disability Assessment Boards must comply with the rule of law principles by injecting transparency, fairness and consistency in their approach, the Apex Court bench comprising Chief Justice of India D.Y Chandrachud and Justices J B Pardiwala and Manoj Misra directed the National Medical Commission (NMC) to issue fresh guidelines for admitting persons with disabilities into medical courses.
"The committee formulating the guidelines must include experts with disability or persons who have worked on disability justice. The guidelines shall comply with the judgments of this Court and contemporary advancements in disability justice," observed the Apex Court bench.
Apart from this, the top court bench has issued these following directions:
√ The Disability Assessment Boards shall eschew from a benchmark model to test the functional competence of medical aspirants with disability. The second respondent shall issue appropriate guidelines in this regard
√ The Disability Assessment Boards shall include a doctor or health professional with disability as per the directions of the first respondent dated 24 March 2022
√ The conduct of the Disability Assessment Boards shall be fair, transparent and in compliance with principles of the rule of law. Attention must be paid to ensure that candidates appearing before the Board do not feel uncomfortable on account of physical or attitudinal barriers
√ Reasonable accommodation is a gateway right to avail all other fundamental, human and legal rights for persons with disabilities. Non-availability of reasonable accommodation amounts to discrimination and violates substantive equality of persons with disabilities
√ The inclusion of persons with disability in the medical profession would enhance the quality of healthcare and meet the preambular virtue of fraternity and the guarantees in Articles 21, 19, 14 and 15 of the Constitution
√ Applicants to the NEET examination must be informed about the compliance of accessibility norms and provisions of reasonable accommodation available at colleges. The respondents shall issue appropriate directions to create a database with relevant information on accessibility and reasonable accommodation; and
√ Enabling Units at medical colleges shall act as points of contact for persons with disability desirous of accessing clinical accommodations.
The Supreme Court bench issued these directions in a detailed judgment concerning the case of a candidate suffering from muscular dystrophy to participate in the ongoing counselling for NEET-UG 2024.
Medical Dialogues had earlier reported that while considering the plea of the candidate, the Supreme Court bench, after perusing an Expert Report by Dr. Satendra Singh, had allowed the candidate to participate in the NEET-UG 2024 counselling.
Issuing a detailed judgment in this regard, the bench opined that when a person with disability is denied reasonable accommodation, it amounts to discrimination and violates the fundamental rights of the aggrieved person and the preambular virtue of fraternity along with justice, liberty, and equality.
"Persons with disability are not objects of pity or charity but an integral part of our society and nation. The advancement of rights for persons with disabilities is a national project along with eradication of all forms of discrimination. A component of this project is the inclusion of persons with disabilities in all pursuits of life," the Apex Court bench observed.
"When we create avenues for inclusion, we work towards improving systems and institutions. In the context of healthcare, the inclusion of persons with disabilities is a vital component of quality healthcare. The guidelines and recommendations which express concern about "lowering the standard of medical practice" on account of persons with disabilities miss the fact that these standards may not be adequate to begin with. The quality of a system is informed by its ability to empathise with and relate to the recipients. A system without adequate number of practitioners who have lived experiences will not be able to fully imagine the obstacles and grievances faced by a diverse population. Diversity of workforce is crucial for a diverse society, so that everyone may have a stake in the system and the system can effectively discharge its duties toward everyone," it further noted.
The top court bench referred to the Section 25 of the RPWD Act that outlines the positive obligation of Government and local authorities to provide healthcare to persons with disabilities. It noted that an affirmative obligation is placed to ensure that persons with disabilities receive a barrier free access to all public and private healthcare institutions.
"Removal of barriers can only be achieved if persons with disabilities feel comfortable while accessing healthcare. The barriers faced by a person may be physical, psychological and attitudinal. The inclusion of persons with disabilities within medical practice is vital to ensure that the approach of the medical community and of hospitals and other healthcare institutes is humane, sensitive and informed by lived experiences. It strengthens our fraternity. Therefore, the process through which medical aspirants with disability enter the profession must be compatible with constitutional and statutory entitlements and guarantees," it noted.
The bench also highlighted how the United Nations Committee on the Rights of Persons with Disabilities in its concluding observations on the initial report of India has identified the medical model of disability as a prominent concern. This committee had recommended that the concern should be remedied with reforming guidelines assessing persons with disabilities by adopting a human rights model. The recommendation also opined against the multiplicity of assessments.
Referring to the recommendations of the Committee, the Supreme Court further mentioned that the Disability Assessment Boards must comply with rule of law principles by injecting transparency, fairness and consistency in their approach. The Boards must further elaborate on the reasons for the outcome of their assessment, in particular when they opine that the candidate is ineligible. They must focus on the functional competence of persons with disabilities and not merely quantify the disability.
"The quantification of disability is a task in need of a purpose within the human rights based model of disability. The functional competency approach to assessment for a medical course is globally recognised. To enable members of the Assessment Boards in effectively applying the functional competency test, they must be adequately trained by professionals and persons with disabilities or persons who have worked on disability justice. These trainings must be with a view to enhance the understanding of the Board members in assessing persons with disabilities and must not pathologize or problematize them," observed the bench.
Noting that the disability of a person is quantified at the time of availing a Unique Disability ID Card, the Apex Court bench observed that quantification is moot at the point of admission to educational courses since the eligibility for a person to benefit from reservation may evaluated using the quantification in the UDID Card
"If a person with disability wants to have themself re-assessed so as to verify whether their disability falls within the prescribed parameters for reservation - they may choose to do so by updating their UDID Cards. The role of the Disability Assessment Boards must be tailored (with a functional competency approach) only for the course which the candidate seeks to pursue," the bench noted.
Further, the bench note that a person's journey with disability to apply for the NEET Examination and thereafter pursue medicine at the college must also comply with accessibility norms.
"The application portal for NEET Examination must outline the accessibility compliances of different colleges to enable prospective students with disabilities in making an informed decision. Once admitted, the Enabling Units established under the directions of the University Grants Commission must act as a point of contact for persons with disabilities to access clinical accommodations. Students must be informed about the Enabling Units and Equal Opportunity Cells through the information booklet circulated for new MBBS students, the college website and the Equal Opportunity Policy under Section 21 of RPWD Act. The second respondent [NMC] must make appropriate directions in this regard," the bench noted.
At this outset, the Court also referred to the UK General Medical Council's advisory guidance outlining how institutions can comply with their duties to afford reasonable accommodation to disabled medical students. Referring to this, the bench noted, "The provision of an audit trail to assess whether a given accommodation required by a student with disability places an undue burden on the institution is a vital safeguard for transparency and fairness."
The bench noted that Dr. Satendra Singh in his report dated 20 October 2024 made suggestions to (i) rename the Disability Assessment Boards as Ability Assessment Boards to align them better with their intended purpose; (ii) include a doctor with disability or who is well conversant with disability rights in such Boards; (iii) use a human rights model of disability for assessment; (iv) issue guidance on clinical accommodations; (v) train the Boards in carrying out the disability competency assessment; and (vi) use the Enabling Units to serve as a contact point for clinical accommodations.
Regarding the inclusion of doctors with disabilities in the Disability Assessment Boards, the bench noted that NMC issued a circular on 24 March 2022 mandating such inclusion further adding all the Boards to comply with this direction.
It further noted that NMC submitted that in light of the Court's order in Omkar Gond, it would constitute a new committee of domain experts to comply with the directions in that judgment.
"We note the assurance of the second respondent and direct that this committee shall include persons with disability or one or more experts who are well conversant with disability rights. The committee shall recommend fresh guidelines to replace the existing guidelines. The above suggestions shall be duly considered by the government on its own merits. The recommendations so formulated shall comply with this judgment," ordered the bench.
Accordingly, the Nagpur bench of the Bombay High Court set aside the report of the Disability Assessment Board of AIIMS, Nagpur dated 13 August 2024 for failing to apply the statutory and regulatory standards applicable to the assessment of a person with disability. It also directed AIIMS, Nagpur to create a supernumerary seat and allocate it to the applicant, provided that he has not already secured a seat at a college of his choosing.
"The college shall be given the report dated 20 October 2024 which makes suggestions as to the accommodations which may be extended to the appellant to successfully pursue the MBBS course," it further observed, further adding that "The appellant shall be protected from victimisation."
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/supreme-court-pwd-candidate-259563.pdf
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