Medical termination of pregnancy: Doctors must offer expert opinion in sensitive cases without fearing legal setbacks, says Delhi HC

The HC’s observations came in a 31-year-old married woman’s plea seeking MTP of 30-week pregnancy as the MRI of the foetus suggested that it was suffering from Joubert Syndrome, “a multisystem disorder with poor neuro-developmental outcome”.

Commenting that the case raised a concerning issue, the HC emphasised that a medical board’s opinion in MTP cases is important in assisting Courts in arriving at a “just order”.

The HC said, “Medical professionals must offer their expert opinions without fear of legal repercussions, and focus on providing the best possible medical guidance in such sensitive matters….In the present case, the Medical Board at Lok Nayak Hospital did not meet the Court’s expectations. Despite the serious nature of the matter, the Board failed to conduct necessary tests and did not approach the issue with the required level of seriousness. When the Court directed them to form a Board, the subsequent report remained inadequate and lacked thorough testing and evaluation”.

It said Lok Nayak Hospital “failed to provide a definitive diagnosis or fully assess” the woman’s current condition as it had given a negative recommendation against MTP essentially due to inconclusive diagnosis while relying on her old medical reports and scans “without conducting further detailed tests”. The HC said that delay and inadequate counselling of the woman had resulted in an “advanced stage of pregnancy” underscoring the need for the board to act with “greater diligence and urgency in future cases”.

After that, the HC advised the Medical Board of Lok Nayak Hospital on the “importance of their role and the critical impact their opinions have on the lives” of such petitioners and their families.

The woman, who has had a 9-year-old son with mental disability since birth, was counselled by the doctors examining her on April 29 about the possibility of chromosomal abnormalities in the ongoing pregnancy that can be part of Dandy-Walker Continuum and advised her to get a fetal MRI.

On May 29, a doctor at Lok Nayak Hospital, after considering the fetal MRI report, confirmed the abnormality of Dandy-Walker Continuum–a neurological malformation of the cranium (skull), suggesting that there might be abnormal neurological developmental outcomes in 11 to 20% of cases such as the ongoing pregnancy of the woman.

On the same day, she wrote to Lok Nayak hospital seeking MTP, which was denied on June 13. Pursuant to this rejection, the woman approached the HC, which on June 24 directed the constitution of a medical board at Lok Nayak hospital to give their opinion on the MTP after examining the woman. On June 28, the hospital said that the procedure was not possible.

After examining the board’s opinion and the woman’s medical reports, which were found to be “inconclusive”, the HC subsequently directed the constitution of a medical board at AIIMS.

After a “thorough examination” of the woman and the “antenatal MRI scan”, the AIIMS medical board recommended MTP, stating that its findings suggest Joubert Syndrome.

Noting the different opinions given by the two boards the HC also said that although Lok Nayak Hospital reported the woman’s pregnancy being over 32 weeks, the AIIMS Medical Board–”through a more recent ultrasound scan”– determined the pregnancy to be 30 weeks and four days.

The HC said that the AIIMS medical board’s report was “unequivocal in its findings”, clearly stating that the “fetus exhibits features suggestive of Joubert Syndrome, a multisystem disorder associated with poor neurodevelopmental outcomes”, and the child, if born, would likely face severe neurological impairments and extensive health challenges.

The HC then said, “Given these considerations and the conclusive nature of the AIIMS Medical Board’s findings, the Court finds the AIIMS report to be more reliable and definitive. Therefore, the Court is inclined to accept the report of the AIIMS Medical Board, which supports the termination of the pregnancy due to identified substantial fetal abnormalities and the significant health risks they pose to the unborn child.”

The court also said that the AIIMS board’s opinion was in line with the Union Ministry of Health and Family Welfare’s 2017 ‘Guidance Note for Medical Boards for Termination of Pregnancy Beyond 20 weeks of Gestation’ and provides a solid basis for recommending termination of pregnancy.

Examining the provisions of the MTP Act, the HC said that the provisions read in “harmony with the principles of personal liberty enshrined in the Constitution” affirm a pregnant woman’s right to seek a termination of pregnancy under medically justified circumstances. This, the HC said, ensures that women are “not compelled to carry pregnancies to term” in situations where it would compromise their health or result in the birth of a child with severe abnormalities.

The HC further observed that while the court does not intend to demoralise medical professionals who play a crucial role in society, it is imperative to highlight the significance of their responsibility in such sensitive matters.

Before parting, the HC appreciated the AIIMS medical board’s assistance, stating that their opinion was provided with “commendable promptitude and clarity,” helping the court make an informed decision.

The HC, however, clarified that “doctors who have contributed their opinions as part of the Medical Board shall have immunity” in the event of any litigation arising out of the present matter.