26 Dec 2023 : The Hindu Editorial

Topic 1: Carry on, doctor.

Context: Doctors must not fear prosecution unless gross negligence is proven.

Introduction

• The proverbial slip between the cup and lip was in evidence when the Union Home Minister’s assurance on the floor of the Lok Sabha was at variance with the actual amendment on punishment for doctors in cases of death due to negligence.

Request by Indian Medical association (IMA).

• Amit Shah initially said: “If someone died due to medical negligence by doctors it was treated as culpable homicide not amounting to murder. I am bringing an amendment today. Doctors have been exempted from punishment [under this section].
• The Indian Medical Association [IMA] had requested us [for the exemption].” The amended Bharatiya Nyaya (Second) Sanhita Bill, 2023, passed since, however did not provide that blanket exemption to doctors.
• Instead, the amended Section 106(1) specifies that a registered medical practitioner (RMP) shall be punished with imprisonment up to two years and a fine. In effect, the punishment for doctors as specified under Section 304(A) of the Indian Penal Code that the BNSS replaces, has been retained.

IMA still thanking the government despite the status quo situation.

• With the IMA still thanking the government despite the status quo situation, a deft look behind the scenes reveals that a draft Bill submitted to the Parliamentary Standing Committee on the issue, actually suggested a seven-year imprisonment term for death due to negligence in case of an RMP.
• The IMA then submitted to the Standing Committee that there was no mens rea or criminal intent in the relationship between the patient and the doctor, and thus the increased punishment was not justified.
• The committee then reduced the imprisonment to five years, which finally rested at two years, as the law was passed.

Defined guidelines relating to medical negligence.

• It is pertinent to look at the index case that defined guidelines relating to medical negligence — Jacob Mathew vs State of Punjab & Anr. (2005). The court held that the negligence should be ‘gross’, of a significantly high degree, and consequently, criminal liability would come up only if the physician’s act can be demonstrated to be negligent or reckless, causing death.
• Even during prosecution, at various levels, the weight is on the opinion of a similarly qualified expert on whether negligence on the part of the doctor led to death.

What is the reality?

• While it may be argued that doctors thus enjoy adequate protection under the law in the execution of their duties, the reality is that the incidence of violence against medical professionals is indeed increasing.

• To offer doctors refuge from fear of assault while discharging their duty, and to ensure that any decision made is not clouded or impaired from such fear is important.

Conclusion

No one is above the law, but any attempt to demonise doctors for deaths that occur may cause them to hold back from giving patients the best available care. That, under no circumstances, is acceptable.

Topic 2 : Debt debate

Context: The IMF’s sovereign debt risk assessment for India has spurred a sharp reaction.

Introduction

• The Finance Ministry, last Friday, issued a statement titled ‘Factual position vis-à-vis IMF’s Article IV consultations with India’. For context, the International Monetary Fund (IMF), under its Articles of Agreement, holds bilateral discussions with members, usually every year.
• IMF staffers collect economic and financial information, and discuss policies with top officials, before preparing a report that is discussed by the Fund’s executive board.

Ministry’s statement

• The Ministry statement, four days after the IMF released its latest India consultation details, noted that “certain presumptions have been made taking into account possible scenarios that does not reflect factual position”.
• In particular, the Ministry was referring to an IMF view that adverse shocks could lift India’s general government debt to, or beyond 100% of GDP in the medium-term (by 2027-28). The
• Ministry asserted this was only a worst-case scenario and not a fait accompli, and emphasised that other IMF country reports show much higher extreme ‘worst-case’ scenarios, for instance, at 160%, 140% and 200% of GDP, for the U.S., the U.K. and China, respectively.

India’s debt

• The combined debt of central and State governments stood at 81% of GDP in 2022-23, from 88% in 2020-21. Under favourable circumstances, the IMF reckons this could even go down to 70% by 2027-28.
• The shocks faced by India so far in this century were global, and affected the entire world economy, be it the 2008 financial crisis or the pandemic, the Ministry pointed out.
• Reacting to initial news flashes, it further clarified its statement was not a rebuttal to the IMF but “an effort to arrest misinterpretation or misuse” of its comments to imply that General Government debt would exceed 100% of GDP in the medium term.
• Semantics experts may argue whether the communiqué was confrontational or clarificatory. India’s Director on the IMF Board had already placed on record reservations about its staff’s conclusions on debt risks [“sounds extreme”], and some other aspects of the economy.

Perceptions of India’s fiscal position

• In the broader picture, IMF staff’s perceptions of India’s fiscal position have actually improved over the past year.
• From arguing in 2022 that India’s fiscal space is at risk, they now believe sovereign stress risks are moderate. This is in no small part due to the ability of the Centre, whose debt levels were about 57% of GDP last year, to meet fiscal deficit targets in recent times.

• Conclusion

• Reducing debt and spends to stay the course on its commitment to bring the deficit to 4.5% of GDP by 2025-26 from an estimated 5.9% this year, is critical. While reacting to an adverse detail in a report sometimes ends up drawing more attention to it, actions tend to always speak louder than words.

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