In this paper, I examine the rhetoric employed by court judgements, with a particular emphasis on the narrative construct of the ‘passive patient’. This construction advances and reinforces paternalistic values, which have scant regard for the patients’ preferences, values, or choices within the legal context. Further, I critique the rhetoric employed and argue that the use of this rhetoric is the basis for a precedent that limits the understanding and respect of patients. Through this paper, I present the contemporary use of the ‘passive patient’ construct in the context of the Indian legal system and describe how such constructions have become a source of normative justification for legal reasoning that jeopardizes the patient’s agency. I argue for the primacy of ‘respect for persons’ within Indian law and the need to treat each patient as a person who has agency, preferences, and values during clinical interactions. I conclude by suggesting that laws that adopt narratives that acknowledging the significance of patient engagement and the relevance of effective communication during clinical encounters would help cultivate a culture of patient-centred care, by moving beyond the rhetoric of ‘passive patient’ and the ‘health/choice’ dichotomy.
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One of the objectives of my doctoral study was to analyze Indian medical negligence cases, particularly consent cases, to understand the underlying ethical and legal values and principles of ‘consent’. I had employed critical legal hermeneutic method along with textual content analysis (Danelski 1965; Dworkin 1986; Elo and Kyngäs 2008; Hsieh and Shannon 2005; Moloney 2001). More details of the analysis are provided in Subramani (2019).
All the excerpts are from Samira Kohli vs. Dr. Prabha Manchanda (2008), case, MANU/SC/0430/2008.
Analysis based on 22 medical negligence cases which had referred to the Samira Kohli case. Further details in Subramani (2019).
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I thank Dr Calvin Ho for providing me an opportunity to present this paper at the Asian Bioethics Review Seminar on People-Centred Universal Health Coverage held at Singapore, 28–29 January 2019. I had quite engaging discussions with fellow scholars on my work, particularly during coffee breaks and commuting! In this paper, I build my argument based on the data analysis of my doctoral study. I am grateful for the grant awarded by the University Grants Commission under a Junior/Senior Research Fellowship for the doctoral work. I also thank Prof. Arvind Sivaramakrishnan for reviewing my first draft of this paper, and providing critical comments on the main argument. I thank the reviewer(s) for their comments.
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Subramani, S. The Rhetoric of the ‘Passive Patient’ in Indian Medical Negligence Cases. ABR 11, 349–366 (2019). https://doi.org/10.1007/s41649-019-00106-1