This article is written by Tamma Kusumanjali of 5th Semester of ICFAI Law School, Hyderabad
Abstract:
The research paper provides a comprehensive overview of common law towards refusal of medical treatment. This article begins with the historical backdrop of refusal of medical treatment because in order to understand common law towards refusal of medical treatment, we must first understand their origins. subsequently the legal frame work towards refusal of medical treatment has been discussed. The importance of legal frame work and significance of consent has been discussed. The conclusion of this paper touches on several important elements, goals of refusal of medical treatment.
Keywords: medical treatment, health care, spiritual practices, fundamental rights, minors welfare.
Introduction:
In India, refusing medical treatment has a long history that is entrenched in personal, cultural, and religious convictions. Despite major improvements in healthcare and access to facilities, communities and people continue to decline medical care for a variety of reasons. The impact of traditional and alternative medical practises is one of the main causes of medical treatment refusal in India. Ayurveda, Siddha, Unani, and other conventional health systems have a long history in India. Many people reject current medical treatments because they fervently feel that these practises are effective and may decide to only use them. The denial of medical care in India is also significantly influenced by religious convictions. For instance, some people think that receiving medical care interferes with the natural flow of events and that illnesses are the result of bad karma from the past. Others rely on spiritual practises rather than medical assistance because they believe in the efficacy of prayer and divine intervention. The denial of medical care can also be influenced by socioeconomic circumstances. Lack of knowledge, restricted access to healthcare services, and financial restraints might cause people in rural areas and among marginalised communities to refuse medical treatment. Some people may decide not to seek medical attention in favour of other essential necessities.
History:
The legal history of medical treatment refusal is a complicated and developing subject. Different jurisdictions have different legal frameworks governing medical treatment rejection, which have been influenced by a mix of community interests, individual rights, and ethical considerations. Cruzan v. Director, Missouri Department of Health[1], a historic case decided by the U.S. Supreme Court in 1982, had a profound impact on the law surrounding medical treatment refusal. Nancy Cruzan, a young woman who was in a prolonged vegetative state, was the focus of this case. Her parents said that she had expressed a desire to not be kept alive artificially and hence wanted her feeding tube removed. The Supreme Court ruled that people have the constitutional right to refuse medical care, and that this right can be used even in cases in which a patient is unable to communicate their wishes if there is persuasive proof of their intention.
The 1993 decision in Planned Parenthood v. Casey[2] by the U.S. Supreme Court, which upheld the freedom to object to medical treatment, including the right to an abortion, is another significant case. The Supreme Court ruled that every person has a basic right to make choices about their own bodies and reproductive health, including the decision to forego receiving medical care.
The Constitution’s Article 21[3] guarantees everyone in India the fundamental right to life and personal freedom, which includes the right to refuse medical treatment. The right to refuse medical treatment and to make an educated healthcare decision has been recognised by the Supreme Court of India, subject to some restrictions, such as where a minor’s welfare or the public’s health are at stake. It is crucial to remember that the right to refuse medical care is not absolute and may have restrictions in specific circumstances. When there is a compelling governmental interest, such as safeguarding the public’s health or a minor’s welfare, or when there are questions about the person’s mental competence to make wise judgements.
The legal framework towards refusal of medical treatment:
The constitutional rights, statute regulations, and court precedents serve as the main foundation for India’s legal framework surrounding the denial of medical care. The following are some crucial facets of the legal system:
1. Rights guaranteed by the constitution: Article 21 of the Indian Constitution, which upholds the fundamental rights to life and personal freedom, provides protection for the right to refuse medical treatment. The ability to make decisions regarding one’s own body and healthcare is included in this right, according to the Supreme Court of India.
2. Informed Consent: The legal system is based on the idea of informed consent. Before giving patients medical treatment, healthcare professionals must have their informed consent. In order for patients to provide their consent voluntarily and with knowledge, it is necessary to offer them with enough information regarding the nature, risks, advantages, and alternatives of the proposed treatment.
3. Mental Capacity: The legal system takes into account a person’s mental ability to make decisions about receiving medical treatment. A person’s right to refuse treatment is typically honoured if they are judged to be mentally competent. A legal guardian or next of kin may take over decision-making in situations when a person is determined to lack mental capacity.
4. Exceptions and Limitations: Though generally speaking, the right to refuse treatment is honoured, there are some exclusions and restrictions in specific circumstances. For instance, the state may step in to safeguard the welfare of the public if a person’s reluctance to receive treatment endangers the public’s health or the lives of others. Similar to this, when dealing with children, the child’s best interests are taken into account, and their parents or legal guardians may be able to make medical decisions on their behalf.
5. Advance Directives: In India, the legal system acknowledges the significance of advance directives and living wills. These legal agreements enable people to express their preferences for medical care in advance, especially in cases where they might later be unable to talk or make decisions. Advance directives give instructions to healthcare professionals and help to guarantee that the patient’s desires are honoured.
6. Judicial precedents: Indian courts had a significant impact on the development of the law governing medical treatment rejection. Infamous rulings, like those in the Aruna Shanbaug case, have upheld the right to decline medical treatment and emphasised the value of informed consent and personal autonomy.[4]
Importance of the legal framework towards the refusal of medical treatment:
1. Protection of Individual Autonomy: Individuals’ autonomy to make choices about their bodies and healthcare is protected by acknowledging their right to refuse medical treatment. It maintains the idea that people have the freedom to decide what happens to their bodies and to make decisions in accordance with their particular preferences, values, and beliefs.
2. Making Informed Decisions: A common law framework guarantees that people have the knowledge they need to make decisions about their medical care. It supports the idea of informed consent, according to which patients have a right to complete information regarding the nature, advantages, and drawbacks of a recommended course of treatment. Patients are better protected from unwanted or needless medical interventions because to this.
3. Ethical Issues: Refusing medical treatment frequently entails ethical issues, such as respecting a person’s own values, religious or cultural views, or the desire to prevent unnecessarily suffering. It is ensured by a common law framework that these ethical issues are taken into account and that people are not coerced into receiving medical treatment they do not want to.
4. Striking a balance between individual rights and the public interest: While preserving individual autonomy is crucial, a common law system also enables this. In circumstances where foregoing treatment could threaten others’ lives or pose concerns to the public health, it offers rules and restrictions. This aids in striking a balance between personal freedoms and the interests of society at large.
5. Common Law Framework Provides Clarity and Consistency in Legal Practise: A common law framework offers legal practise clarity and consistency. It aids in the understanding of the rights and responsibilities associated with the denial of medical treatment by individuals, legal experts, and healthcare providers. As a result, there would be less ambiguity and choices will be founded on a transparent legal foundation.
6. Protection from Coercion and Abuse: Under the common law system, people are protected from potential coercion or abuse on the part of medical professionals or other parties. It creates legal protections for those who are vulnerable and might be coerced or misled into receiving unnecessary medical care.
Significance of Consent in refusal of medical treatment:
In India, refusal of medical treatment often hinges on consent. Here are some critical elements relating to the function of permission in this situation:
1. Informed Consent: In India, the idea of informed consent is essential to making decisions about medical care. Healthcare professionals must tell patients on the nature, dangers, advantages, and alternatives of the recommended treatment in order for them to give their informed consent when it comes to declining medical treatment. Patients must fully comprehend the repercussions of forgoing therapy and how it can affect their health.
2. Independence and Choice-Making: Individuals are given the freedom to exercise their autonomy and make choices regarding their own healthcare through informed consent. It acknowledges that people have the right to control what happens to their bodies and to make decisions in accordance with their unique preferences, values, and worldviews. In the case of refusing medical treatment, informed consent enables people to exercise their autonomy by declining or stopping a particular course of action.
3. Decisions Must Be Made Voluntarily and Without excessive Influence: Consent must be granted voluntarily and without excessive pressure or compulsion. Without feeling controlled or under pressure, patients should be allowed to freely choose their medical care. Healthcare providers have a duty to take precautions to prevent coercion or undue influence on patients’ decisions to refuse medical treatment.
4. Capacity to Consent: An important factor to take into account is a person’s ability to consent to medical treatment. Individuals must be mentally capable of comprehending the pertinent facts, appreciating the implications of their decision, and communicating their choice in order to give legal consent. Decision-making power may be given to a legal guardian or next of kin if a person lacks mental capacity.
5. Documentation of approval: To ensure clarity and legal validity, informed permission should be documented in writing. This documentation often contains details regarding the procedure, potential side effects, other options, and the patient’s choice to forego the procedure. By demonstrating the patient’s informed refusal of treatment, adequate documentation serves to safeguard both the patient and the healthcare professional.
6. Advance Directives: Advance directives, commonly referred to as living wills, are formal legal instruments that enable people to declare their preferences for future medical care. As they give the person’s preferences in writing when they are unable to converse or make decisions, they might be quite important in the context of refusal of medical treatment. Advance directives make sure that even if the patient is incompetent, their wishes are respected and carried out.[5]
CONCLUSION
In conclusion, human autonomy, informed consent, and the right to make healthcare decisions are all recognised under India’s common law framework for refusing medical treatment. It maintains the idea that people have the freedom to decide for themselves what they want to do with their lives and to make decisions based on their own opinions, values, and beliefs. The legal system places a strong emphasis on the value of informed consent, which calls on healthcare professionals to adequately inform patients about the nature, risks, benefits, and treatment alternatives. Patients must fully comprehend the repercussions of forgoing therapy and how it can affect their health. A person’s capacity to make decisions about receiving medical care is taken into account, and if they are found to be mentally competent, their decision to forgo treatment is typically supported. A legal guardian or next of kin may take over decision-making in situations when a person lacks mental capacity. Although the right to refuse treatment is normally recognised, there are occasions where it may put the public’s health at risk or put other people’s lives in danger. The legal framework offers principles for striking a balance between personal freedoms and the general good. In general, the common law framework on medical treatment refusal in India attempts to safeguard human liberty, encourage informed choice, and offer clear and consistent legal standards. It guarantees that people have the freedom to decide what treatments they receive for themselves while taking wider society interests and moral issues into account.
[1] Cruzan v. Director, Missouri Dep’t of Health, 497 U.S. 261 (1990).
[2] Planned Parenthood v. Casey, 505 U.S. 833 (1992).
[3] Art. 21, the Constitution of India.
[4] Consent and medical treatment, the legal paradigm in India, PMC, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779959/. Last seen on 30/07/2023.
[5] Ibid, at 5.
