Opinion National Medical Commission’s ableism, is ignorant – and harmful

Dr Sujith Jose recently completed his fellowship in Urology at Columbia University, New York, and practices urological operations in Kerala while using a standing wheelchair. His example emphasises that access to high-quality assistive products can transform the lives of people with disabilities, as well as the patients treated by physicians and surgeons with disabilities who utilise callipers, crutches, and wheelchairs.

The doctor from Safdarjung Hospital who wrote the NMC guidelines, Ajay Gupta, personally utilises an assistive device for vision and holds a degree in physiatry (PMR). He may not be aware of it, but his speciality of rehabilitation medicine was pioneered in India by another wheelchair user, Mary Verghese. Furthermore, the individual who petitioned the court to establish mandatory PMR departments in Delhi government hospitals is also a doctor with a physical disability and relies on an assistive device.

The NMC guidelines do not mention reasonable accommodations. Jain told The Indian Express: “Why provide accommodations before the race even begins? This is a disadvantage to others”. Let’s explore what the law has to say on the matter.

In the case of Vikash Kumar v UPSC & Ors, the Supreme Court elaborated on the concept of inclusive equality and emphasised that the denial of reasonable accommodations constitutes discrimination. Justice D Y Chandrachud added that the accommodation needs of individuals should be assessed on a case-by-case basis.

It is worth noting that the NMC has not provided any specific guidance on disability accommodations till now. Conversely, its counterpart in the UK, the General Medical Council, has a comprehensive guideline, ‘Welcomed and Valued’, which outlines how disabled learners can thrive in medical education and training. It also addresses the ableism of NMC experts, highlighting that it is not considered direct discrimination against a non-disabled person to treat a disabled person more favourably, in accordance with both the Equality Act 2010 and the Rights of Persons with Disabilities Act 2016.

The genesis of these new NMC guidelines lies in the Delhi High Court’s directives to the NMC to revise the guidelines for each speciality in line with our disability Act and suggested amendments that consider advancements in modern science. The NMC experts’ perspective on assistive technologies reveals their lack of familiarity with the concept and relevant laws.

The NMC’s ableism becomes even more apparent when we consider that the Chief Commissioner of the Persons with Disabilities Court specifically instructed it to include doctors with disabilities in the committee responsible for framing the new guidelines. However, none of the 16 experts involved in the process was a physician with disability, which goes against the recommendations of the statutory body as well as the concluding observations of the United Nations Committee on the Rights of Persons with Disabilities. The latter advised India to involve organisations representing disabled individuals in policy-making processes.

The professional medical associations and bodies of orthopaedics and physiatrists need to challenge the injustice meted out by their own colleagues. Courts frequently say medical doctors are the real experts and refrain from interfering. However, the NMC experts have failed to provide any evidence to support their opinions. Their viewpoints lack merit and have been contradicted by international professional bodies and medical councils. It is worth noting that no G20 country has implemented such discriminatory guidelines. As India holds the G20 presidency, it should set an example and lead the way, instead of becoming an embarrassment on the matter.

Clinicians with disabilities make valuable contributions to improving care for patients with disabilities. The deep and personal empathy they possess is evident in their provision of care to patients, regardless of whether they have disabilities or not. This issue is relevant to regulatory bodies, the medical profession, the patient population, and the global community. The Chief Justice of India succinctly encapsulated this sentiment in the Supreme Court in the Vikash Kumar judgment: “When competent persons with disabilities are unable to realise their full potential due to the barriers posed in their path, our society suffers, as much, if not more, as do the disabled people involved. For it is denying to the nation the opportunity to be served by highly competent people who claim nothing but access to equal opportunity and a barrier-free environment.”

The writer is Co-chair of International Council for Disability Inclusion in Medical Education. Views are personal