Author: Abhinav Pandey, I year of B.A.,LL.B.(Hons.) from University of Lucknow
Introduction
Medical Jurisprudence is the application of medical knowledge in the legal field for providing justice in both criminal as well as civil cases.The Latin term ‘Juris’ stands for ‘law’ and ‘Prudentia’ stands for ‘Knowledge’. Thereby, it is the domain which makes the use of the medically relevant facts and then integrates them with the legal system, providing assistance to the criminal justice system. In order to convict a probable offender, it is utmost important to know the relevancy of the evidences. Thus, the need of using scientific principles was felt. As this field grew, it gave immense power to the medical practitioner as they were now playing a very important role by having an expert opinion in the cases. But with this power came huge responsibilities. The doctor patient relation, medical negligence, ethical conducts, professional misconducts are a few to name. The field of medical jurisprudence is a very ancient field but with the advent of technology and the reforms being added in the legal system, this branch is always under development. In order to completely understand true meaning and its importance one should understand how actually did this field came into action.
History of Medical Jurisprudence
The History of medical jurisprudence dates back to 4000-3000 BC and the data recorded can be studied from the Materia Medica Imhotep around 2300 BC, the chief justice and the personal physician to the ruler of Egypt was considered as the first medico-legal expert.While in India, the Charaka Samhita around the 7th century BC contained rules related to the ethics, privilege, obligationsetc. mandatory to be followed by a Physician. Various other texts like Manusmriti, YajnavalkyaSmriti, Sushruta Samhitaetc. also played a majorrole in maintaining and regulating the medical practice.An autopsy is considered as the most important tool in medicolegal practice. In the 18th century Dr. Edward Bulkley was the first to do a medico-legal autopsy in India.With the introduction of this branch in India, it didn’t take much of a time for it to grow in all directions. In 1822, the state of Calcutta got the countries first Medical School. This development further proceeded to the states of Bombay and Madras .Over the last few decades, the scientific techniques have advanced by multiple folds. The tests performed and the results obtained are so precise that they can act as evidence, sufficient in itself to prove or disprove a convict. This growth has also led to the enlargement and thus diversification of medical jurisprudence into numerous small branches.To fit more accurately in the present time, the term medical jurisprudence has mostly been replaced by the new terminology ‘forensic science’.
Some of the major branches in Forensic Medicine are
1.Forensic Odontology
Forensic odontology is a branch of forensic medicine and, in the interests of justice, deals with the proper examination, handling, and presentation of dental evidence in a court of law.The work of a forensic odontologist covers the following:
1.Analysis of weapon marks using the principles of bite-mark Analysis
2.Presentation of bite and weapon mark evidence in court as an expert witness
3.Assistance in building up a picture of lifestyle and diet at an Archeological Sites.
2.ForensicPathology
Forensic pathology is a field of forensic science which involves application of pathological methods in investigation of a crime and of sudden, suspicious or unexplained deaths. A forensic pathologist examines bodies in order to determine the cause of death and circumstances surrounding the cause of death as well as looks for evidence that can be used in trials.
3.Forensic Anthropology
Forensic Anthropology is a special sub field of Physical Anthropology the study of human remains that involves applying skeleton analysis and techniques in archaeology to solving criminal cases. When human remains or a suspected burial are found forensic Anthropologists are called upon to gather information from the bones and their recovery context to determine who died, how long ago they died and how they died. Forensic Anthropologists specialize in Analyzing hard tissues such as bones.
4.Forensic Toxicology
Forensic toxicology is the application of toxicology to the field of law. The discipline continues to flourish as a result of human fascination with poisons, their effects on living organisms, detection in human remains, and role of toxicology in judicial proceedings, forensic drug testing, and human performance toxicology are the three major subdivisions of the discipline at the present time. Forensic toxicology investigations begin with the fundamental and critical requirement of acquisition of an appropriate specimen.
The Major Professions involved in Legal Cases are
Medicine Department- consisting of Doctors, Pharmacists Nurses,
Legal Department-consisting of Judges, lawyers, Police
For enhancing the knowledge of a personnel of medical background different courses in forensic medicine have been introduced in their curriculum. Along with providing legalguidance this course focuses on training the doctors in the major advancements in the forensic medicine field, their responsibilities, ethics, rights, etc.By providing scientific evidence and assisting the judiciary and legal system, the medical field helps in strengthening the ultimate of providing justice and thereby, benefitting all.The legal practitioners i.e., the lawyers who may have to time and again encounter the medical issues in their practice are hardly aware about the medical language, knowledge, profession and the associated complexities of this profession.The Medical Practitioners are also humans and it is impossible for them to be unerring. When a simple mistake of a doctor leads to the loss of a life, he is answerable to the system.In a hypothetical case, if a patient dies due to a hypersensitive allergic reaction from a certain drug, which is widely accepted by the majority of the population then is the death to be considered as the fault of the doctor. The patient’s family may file a report against the doctor for medical negligence. The lawyers working on the case on behalf of the doctor and the patient, should have ample knowledge for understanding the reasons which led to the sudden death. This is how medical jurisprudence will help in determining whether the doctor is supposed to be held guilty or not. Many times, in a bizarre circumstance, the doctors keep aside their legal restrictions and prioritize the patient’s wellbeing and this often leads them as guilty in the court. To avoid and keep such actions under a check, hospitals have their own legal firms who timely monitor the work of the doctors.While considering medical jurisprudence one cannot brush aside certain controversial areas like role of doctor for evidence collection from crime scene, mercy killing, organ transplantation, medical negligence, civil negligence, therapeutic misadventure, etc.
From the world of fiction to reality, the cases of Anaesthetic and Operative Deaths are always under the limelight.
The causes of death due to anaesthetic agents can be found out via post-mortem examination. These causes may include; hypersensitivity, cardiac arrest, respiratory inadequacy, etc. The cardiac arrest and respiratory failure are the most common modes of death.These cases often invite an investigation on the medical personals involved in the procedure. Legal department overlaps here with the medical department and helps in figuring out whether it was a medical negligence or a medical Maloccurence. Some of the most common cases under medical jurisprudence include:
1.Injury and Wounds
Wounds, a break in the continuity of any bodily tissue due to violence, where violence is understood to encompass any action of external agency, including, for example, surgery.
2.Paternity Testing
DNA paternity testing is an important tool used to prove or disprove a biological parent-child relationship. The test uses a DNA (deoxyribonucleic acid) profile for each individual and compares the data to determine if there is a genetic match. If the child and potential non-gestational parent genetically match, then they are the biological parent. If the data does not match, then they are excluded as the biological parent.
3.Cause and Manner of Death
The cause of death can be either natural or unnatural. For example, if a head injury is the cause of death broadly, then how the head injury occurred can be accidental, suicidal, or homicidal
4.Death due to Poisons
Any substance that can cause severe organ damage or death if ingested, breathed in, injected into the body or absorbed through the skin. Many substances that normally cause no problems, including water and most vitamins, can be poisonous if taken in excessive quantity. Poison treatment depends on the 'substance.
LAWS RELATED TO MEDICAL JURISPRUDENCE IN INDIA
(INDIAN PENAL CODE, 1860)
Section 44 of IPC
The Provision provides the definition of Injury as any harm whatever illegally caused to any person in body, mind, reputation, or property.
Section 319 IPC
The provision lays down the definition of hurt as bodily pain, disease, or infirmity caused to any person.
Section 320 IPC
This provision defines grievous injury and lays down a list of injuries that comes under the broad head of grievous injury. Any of the following injuries is grievous:
1.Emasculation
2.Permanent privation of sight of either Eye
3.Permanent privation of the hearing of either ear
4.Destruction or permanent impairing of powers of any member or joint
5.Fracture or dislocation of tooth or bone
Any hurt which Endangers life, or which causes the Victim to be in severe bodily pain, or unable to follow his ordinary pursuits for a period of Twenty day.
Section 321 IPC
The section defines “Voluntarily Causing Hurt”.
Section 322 IPC
The section defines “Voluntarily Causing Grievous Hurt”.
Section 351 IPC
Defines Assault Attempt to apply force. Whoever makes any gesture or preparation intending or knowing it to be likely that such gesture or preparation will cause any person present to apprehend that he who makes the gesture or preparation is about to use criminal force to that person, is said to commit an assault.
Section 323 IPC
The section defines Punishment for Voluntarily Causing Hurt. Shall be imprisonment which may extend for One year with or without fine which may be One Thousand Rupees.
Section 324 IPC
The Section defines Punishment for Voluntarily Causing Hurt by dangerous weapon shall be imprisonment for up to Three years with or without fine.
Section 325 IPC
The section defines Punishment for Voluntarily Causing Grievous Hurt. Shall be imprisonment which may extend for Seven years with or without fine.
Section 326 IPC
The section describes Punishment for Voluntarily Causing Grievous Hurt by dangerous weapon or means. Shall be imprisonment for life or for Ten years with or without fine.
Section 328 IPC
The section describes Punishment of causing hurt using poison, etc., shall be imprisonment up to Ten years with or without fine.
(INDIAN EVIDENCE ACT, 1872)
Section 45
The provision deals with the Opinions of experts. When the Court has to form an opinion upon a point of foreign law or of science or art, or as to identity of handwriting, the opinions upon that point of persons especially skilled in such foreign art, law or science , are relevant facts. Such persons are called experts.
Section 114A
In a prosecution for rape, where the question is whether sexual intercourse was without the consent of the woman, and she states in her evidence that she did not consent, the court shall presume that she did not consent.
(CODE FOR CRIMINAL PROCEDURE, 1973)
Section 53 (i) CrPC
An accused may be examined by a Medical Practitioner/Doctor at the request of a Police officer using reasonably necessary force.
Section 53 (ii) CrPC
Whenever the person of a female accused is to be examined, the examination shall be made only by or under the supervision of a female registered medical practitioner.
Section 54 CrPC
An arrested person may be examined at his request by a medical practitioner to detect evidence in his favour.
Section 174 CrPC
Police to enquire and report on suicide, etc.
Section 176 CrPC
Inquiry by Magistrate into cause of death.
(INDIAN MEDICAL COUNCIL ACT,1956)
Section 20A- Professional conduct
The Council may prescribe standards of professional conduct and etiquette and a code of ethics for Doctors.
Regulations made by the Council under sub-sectionmay specify which violations thereof shall constitute infamous conduct in any professional respect, that is to say, professional misconduct, and such provision shall have effect notwithstanding anything contained in any law for the time being in force.According to the Current Indian Scenario, there are certain drawbacks with respect to these laws.Irrespective of having several indispensable benefits, the evidences procured via medical jurisprudence are still considered under the expert opinion rather than a Primary evidence.Under theIndian Evidence Act, 1872only in certain cases the report of an autopsy procedure is considered as a documentary evidence.Doctors are bounded by the Doctor-Patient confidentiality and this often places them in a dilemma of whether to share the information or not with the legal system.If it is in the doctor’s knowledge that any of hispatient has committed a crime other than suicide, then he is bound to inform the Legal Authorities. In failing to do so, he may be punished.Thus, clear briefing to the doctors on these Pre-Existing Laws and Amendment in certain conflicting laws is the need of the hour.
A few suggestions would be legal drafting of legislation which will consider the evidences of medical jurisprudence as a primary evidence.
Other scientific test results, when performed under standard testing protocol, must also be considered as documentary evidences.
If a patient tries to commit suicide the doctor must report to the concerned authorities as this may help in resolving the factors which may have led to such a huge step by the victim and also ensure the patients safety in the near future.
Medical jurisprudence plays a very crucial role in bridging this gap between the doctors and the lawyers. This field has contributed to the society by opening the new doors to those old pending cases, which were once considered to be stuck at a dead end.
Jurisprudence of emergency medical care in India
In India in the 1980, 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.
By standers 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 save live Foundation in 2012, the Honourable 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. Parmand and KataraVs. Union of Indiaand 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 Vs. 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 Twenty 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 PIL 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 or Judicial 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 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 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 Consumer Protection ion Act1986.
The case of Indian Medical Association Vs. 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.
Conclusion
Both the Legal fields and Medical 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 paternity as well as the Identification of Human remains that have been disfigured beyond recognition in Incidents such as factory explosions, and so on. It may be used to solve instances involving rape, murder 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 private and public healthcare systems would necessitate a number of policy measures, including a complete statute to institutionalise ethical principles for maintaining the right to healthcare.
REFERENCES
1.PaschimBangaKhetMazdoorSamitiVs State of West Bengal (1996)
2.Poonam Sharma v. Union of India
3.Indian Medical Association VS. V.P. Shantha (1995)
4.Articles
5.Wikipedia
8.Oxford English Dictionary