Sonam Wangchuk Case: Can the State Force Medical Treatment? SG Explains

[00:00:00]loss of life has an impact on the law and order situation. That is where the state's interest come in. Normally my lord if I'm not well I can say I don't want to have a treatment and that is what my lord right to die with dignity which this honorable court recognized.

[00:00:19]This was a case which my learned friend cited was a case where persons were terminally ill. The doctors were unanimous that there is no cure for this particular disease and the patients were demanding that we would like to die with dignity not on ventilator or not on any other artificial way. Therefore the five judge bench me lord analyzed all the foreign case law me as it was customary in that era reverentially followed all the case law and me laid down the law that euthanasia is also a right we are not dealing with a case of euthanasia we are dealing with a case of a person who has definitely a right to protest which is a fundamental right I don't need to distinguish that judgment beyond a point But a person who is exercising his right to protest examined this a little very carefully suppose tomorrow someone were to say that I'm sorry am I with your lordships?

[00:01:25]>> Yes yes yes >> yes tomorrow someone were to say that unless and until my demand is met met I'll commit suicide. My learned friend that suicide is not now a criminal offense. is right. Suicide is not a criminal offense. But when you commit a suicide under some circumstances where it becomes difficult for you to leave under some mental condition, under some depression etc. But suppose someone says as a part of the protest that I'll commit suicide unless my demands are met then the interest of the state which is the public interest comes in. Then you say that though my parameters are likely to deteriorate my health which may uh lead to any potential serious illness or maybe my lord it may be terminal then my lord it would be not only in the interest of the state but the duty of the state to ensure that his health is not further lord deteriorated. Please lord note we are not dealing with a case of an ordinary person staying in his house and for his own personal reasons he says I don't want any medication we are dealing with a person who is on a protest site we are dealing with a person whose deterioration of health or any subsequent god forbid not any uh unforeseen event to his health not will have possibly potentially some repercussions. Look that is where the state comes into the play. So my lord right of autonomy like any other right can never be absolute if it is >> Mr. Solicitor.

[00:03:12]>> Yes m >> you'll address to all these issues. We want to know his health condition as on today.

[00:03:19]>> Lord I I grateful. I'm grateful. Now kindly I would request my colleague there please bring it on record.

[00:03:30]>> Yes >> bring on record and we'll take a call.

[00:03:33]>> Please I have one more suggestion also.

[00:03:36]>> And you say that one sample was sent to the Sabza Jang hospital laboratory the other to the as laboratory and third to the private laboratory.

[00:03:45]>> Yes. This was in respect of the uh pigga arrived at by these laboratories for sodium sorry potassium to be 2.8.

[00:03:56]>> Yes.

[00:03:57]>> What are the what are what are what are what are the other reports? It's not only the potassium sodium sodium potassium is only electrolyte. The difficulty in such situation is causing stress stress to kidney. And in one report which was uh shown by you there is a higher level of uh creatinine perhaps >> correct >> creatinine or >> yes what I am >> what does thatically mean I emphasize on potassium because my learned friend was on potassium >> are for those reports. Yes ms my lords will find mers the first report of the 17 is malertz at page 77 to 80 are certain reports out of that I had shown my lords the potassium at 78 wherea after >> if your lordship comes to page 76 >> page 88 >> keton is found keton I'm told has something to do with uh in dehydration that happens >> I'm not a doctor. I may not be able to say with that level of confidence but doctors say that this has some very very significant relevance. private.

[00:05:23]>> Okay.

[00:05:38]You are not being given sample of the blood.

[00:05:40]>> I'm sorry. Yes, I am being given. Yes.

[00:05:43]And I showed my lords when I had that tested it said normal. Both samples on >> the border line. It's not normal.

[00:05:49]>> It's within the range.

[00:05:52]>> I I didn't want to >> was within 3.5 to it is fluctuating.

[00:05:56]It's just as the minimum level. It's it's not healthy.

[00:06:00]The question is only one minute can be forced.

[00:06:04]>> Just no just let me tell you two three things about these uh clinical uh sorry these pathological reports.

[00:06:14]Now the same sample is taken to test by two different laboratories. The values of these parameters may vary >> may vary. Correct.

[00:06:25]There is a error called laboratory error which is permissible to some percentage. We I'm not aware as to to what percentage one two the pathological reports are to be always corroorated with the clinical condition of the patient. Exactly blindly rely on this. There may be situation where your uh blood picture as depicted by the laboratory reports may suggest that yes you have certain infection you're not having fever.

[00:06:58]Infection invariably is accompanied by fever in the body but there are situations where the counts are raised but you don't feel fever.

[00:07:08]>> Yes.

[00:07:08]>> So whether or not your body is infected or not that does not solely depend on the laboratory reports. Those laboratory reports are to be corporated by the clinical examination of the patient to come at a definite conclusion medical >> but that is whatever they share with us which says he's stable fine >> just the report given uh by the subsurjan hospital showed uh the potassium level to be 2.8 8 your report shows 3.5 correct >> please see the timing please see the timing this is what doctors told me I want to go into that the sample was drawn on 17th July at 1503 >> page 75 >> page 75 that was prior to him being uh Malut's >> taken to the hospital for >> he was picked up it was 4.3 Next morning it went down to >> Yeah. Yes. Please explain that because doctors did try to explain me.

[00:08:16]>> Yes. It's like this that whatever apprehension my friend has cannot be a substitute mullet for expert medical advice and >> I'm not on I'm not asking you on marriage. What is the current position?

[00:08:30]>> Yes m in in so far there are two parts to it. The doctor is also here but my my uh learned friends clients made a representation. We have a reply that has been given which was not talked off. May I hand over that to your loss?

[00:08:45]>> I'm sorry with Chetan just a minute.

[00:08:48]There was a representation that I want to participate in the protest.

[00:08:55]It was supposed to be decided and bound to be decided by the medical experts whether his body will be able to withstand the stress which is associated with the protest and therefore now give the health bulletin in this context.

[00:09:09]>> May I have a copy?

[00:09:13]>> Can I get a copy please? We don't have it's given to the petition. It doesn't matter. You will have it doesn't it must be given to you.

[00:09:26]You can add a give one copy to you to Mr. Cibil. You can use soft copy.

[00:09:38]>> Oh, thank you.

[00:09:41]>> Now, this is what happens in a private hospital that this is by the government of India, Ministry of Health. S so and so is admitted that so and so remains conscious and hemodynamically stable.

[00:09:56]His pulse, blood pressure and oxygen saturation are currently within normal limits because he's taking potassium and he's also taking oral dehydration salts without sugar. However, he is exhibiting clinical signs of dehydration and in view of his prolonged fasting. His condition warrants immediate medical intervention to prevent further deterioration and potentially serious complications.

[00:10:22]An independent expert from as New Delhi examined the patient. Since he had some discomfort with the local doctors, a doctor from as permanently stationed there. Ames New Delhi examined the patient and concurred with the treating team's assessment that immediate oral or intravenous fluid and electrolyte therapy is medically indicated. An Ames doctor has also joined the treating team and will remain continuously available for monitoring and clinical management.

[00:10:52]Despite repeated counseling by the treating team and the independent expert regarding the urgent need for treatment, the patient had has declined intravenous fluids, oral rehydration solution and all medications. The patient's family has also not yet provided consent for the recommended medical intervention.

[00:11:12]The patient continues to be under close medical observation. The treating team is making every effort to counel the patient and his family to provide consent and accept the recommended treatment at the earliest in the interest of safeguarding his health and preventing avoidable complications.

[00:11:32]Thereafter his request for participating solicitor please wait please wait >> I'm told your my lord's head to leave my lord if justice kar had to leave I can continue my lord at 10:30 tomorrow.

[00:12:08]He is under medical supervision and as doctor is permanently stationed >> you were reading right now from where that >> I'm so sorry my lord I'm so sorry >> have a copy of that but what's given to us is something else >> I I'll just share it with my learned friend I I'll just share it my apology I Thought my learned friend would be having it. My apologies.

[00:12:35]>> No, Mr. SG.

[00:12:36]>> Yes.

[00:12:38]>> You compile all these reports.

[00:12:40]>> You are getting it done twice twice a day or only once?

[00:12:44]>> Uh the doctor is present before your lordships. He will be >> if he allows two times.

[00:12:49]>> Huh?

[00:12:50]>> If he allows two times, if he cooperates then two times.

[00:12:53]>> Why will he not cooperate? He is cooperating. That's the problem.

[00:12:59]taking the samples twice.

[00:13:02]>> If he cooperates, supposing he doesn't, which he has not, >> has he been cooperating till now or not?

[00:13:06]>> Samples are taken.

[00:13:08]>> Has he resisted to give the blood samples also?

[00:13:11]>> The doctor is here.

[00:13:12]>> Please.

[00:13:12]>> No. Say yes or not.

[00:13:13]>> He refused to blood sample also.

[00:13:16]>> If like court has asked us to videography whenever the samples has been done when we tried he denied key why you are videoraph.

[00:13:24]>> That videography why do you videoraph?

[00:13:26]No, >> just just a minute please.

[00:13:31]The uh petitioner has been granted access by the learned single judge's order.

[00:13:36]>> His brother has been granted access by learned single judges order. So you take sample in their presence.

[00:13:41]>> Yes. No difficulty.

[00:13:43]>> Mr. saying something.

[00:13:47]>> So when we sent this first sample when it came to >> what about first time?

[00:13:51]>> They didn't believe you had sent somebody else's sample. all may >> I mean that apprehension they were they may they may wait a bit they may or may not have any basis for that >> but if that occurred to their mind I mean this this is all this is this is all very natural with any patient being brought to you in such circumstances >> we are not on that >> court's concern is to save his life first >> we are not concerned with any other thing >> no I I fully any other thing.

[00:14:27]>> Therefore, whatever samples you have analyzed by Sabrang Laboratory, by uh uh >> AS and also by the third private laboratory.

[00:14:38]>> Yes sir.

[00:14:38]>> Please compile a report file it on.

[00:14:41]>> Sure.

[00:14:41]>> And you also please >> compile these reports which have been obtained by you by sending the samples to the private laboratory.

[00:14:48]>> Whatever we have is filed already filed.

[00:14:51]>> No no this is till yesterday. what we have. Yes. If anything further also at one place just him at one place.

[00:14:58]>> Yes.

[00:14:58]>> Correct. This is one two Mr. Sharma >> uh who is heading the team of doctors uh who is monitoring uh >> the medical superintendent of Sabar Jang >> medical superirector must be only supervising director >> asking about the team of doctors.

[00:15:16]>> Director Sarjang Hospital.

[00:15:18]>> Director Sabhar Jang Hospital may not be part of the team of the doctors. May I suggest may I suggest May I sgest Mr. Mr. Sharma only let petitioners apprehensions concerns also may be taken care of. I have no difficulty at all.

[00:15:37]May I suggest the in charge director of as will supervise the team because there is no director in in place right now. In charge director of as who is a doctor a practicing doctor we'll supervise this team.

[00:15:55]One second.

[00:16:02]May I say something? Mr. Solicitor.

[00:16:05]>> Yes. Mal, >> we were asking this only to ensure that the doctor in charge of the team who has been taking care of uh the husband of the petitioner may be here tomorrow to assist us.

[00:16:18]>> He will be here. He will be here.

[00:16:21]>> And the doctor to whom they are consulting, he will also be there.

[00:16:28]We had suggest of course I made my point on the autonomy. I made my legal submission that my lords will consider but man at the very least what can be my lord's the legitimate objection to being shifted to maidanta I said they can be associated they we can share all the reports with them >> nobody can say malords he will be illreated there it is Mr. Mr. ible that that goes against the very basic medical protocol being followed not only by the government hospital but by the private hospitals also. No hospital permits any kind of intervention from an outsider.

[00:17:06]>> No, but my my lords can pass an order.

[00:17:09]We have no objection. They can be malad all the reports can be shared.

[00:17:12]>> I was I was only pointing it out can be shared.

[00:17:14]>> I was only pointing it out to you as to what is the difficulty in making such an arrangement. That's >> so we'll take a call on your prayer tomorrow. Let us examine the reports and uh let us interact with the doctors.

[00:17:27]We'll have this matter.

[00:17:28]>> Nobody has said that he's not in a position to be mal transferred. It's not like he's in a situation where Mal is life-threatening to transfer him. Why shouldn't he have at least that much mal doctors of his choice?

[00:17:38]>> So we'll we'll we'll take a we will we'll consider this prayer tomorrow once they file the all the reports and we are able to interact with the doctors. Yes, a doctor some if necessary I'll make >> just a minute a doctor who is the in charge of the team of doctors presently attending him and a doctor to whom you are consent because we are not experts >> and I take it my nothing forcible hasn't been done so far but it should not be done till tomorrow until my lords have a chance to cons that order by learned single judges is always already there >> no but my par 29 is is our apprehension No suppose something happens to him and takes the responsibility that's why I want to be in hospital of my choice but it can't be I am not allowed to go there and they will mal forcibly do something I am not >> no if they have not done so far what if we have I I worry I don't know malo they've done a lot of things which were not there in the order that's my worry here it's there in the order par 29 >> no nothing is done beyond the >> leave of the court to do something otherwise for even normal medical protocol is a person is entitled to discharge followed on against doctor's advice that's also a protocol typically followed by hospitals >> no we'll provide that in case uh The medical team treating him is of the opinion that any kind of intervention is needed then unless and until that medical team also consults the director of as nothing will be done because if you have application about sarj we can understand but doubting as perhaps >> I I am only saying that malots allow me to go to the hospital of my >> we'll consider this prayer tomorrow but let us understand the whole do anything >> medical situation with the assistance of the doctors Sorry >> please. My law said our doctor will have access which has not been provided so far. Our doctors have not treating nobody has had access.

[00:19:52]>> No no doctor will be here.

[00:19:54]>> No that's a fact. We've said so in our petition it's not denied.

[00:19:57]>> Doctor doctor as per the medical protocol of any hospital. That's what I told you. But my lord just said malos that our doctor would for assistance for assistance assistance of the court in the courtroom to be here for our assistance then our mother >> I don't want to say more point this is this this will create a very difficult situation for any private hospital as well tomorrow suppose your uh uh I mean somebody known to you is admitted to a private hospital and he wants intervention of a uh government hospital doctor will it be permitted?

[00:20:36]There are there are >> there are times when I I know myself personally where hospitals have allowed outside doctors with the consent of the of the second opinion is permitted permitted any case my lord private hospital >> hospital can't have an issue if my lord so direct we'll decide it the her senior advocate representing the appalent and Shri Dishar Ma solicitor general Chetan Sharma additional solicitor general of India for respond number one who is for respond number two Sri Basht standing council representing GNCTD is also present paragraph having heard the council for the parties We direct that subjing hospital comes under the central government.

[00:21:43]>> Yes ma'am.

[00:21:44]>> Yes.

[00:21:44]>> That that you are representing four also.

[00:21:55]1 three and four.

[00:21:56]>> Yes.

[00:21:58]1 three and four.

[00:22:04]Having regard to the overall circumstances and facts of the case as also the submissions made on behalf of the respective parties, we direct that all the pathological reports of the husband of the appalent based on the samples analyzed at the laboratory of Saberjang Hospital, KMA, All India Institute of Medical Sciences and the Private Laboratory shall be filed on FAD to be sworn in by none other than the director of the respondable four hospital.

[00:22:56]The appellent shall also file the laboratory the pathological reports based on the analysis of the uh blood or urine sample of the appellent's husband which are said to have been conducted at some private laboratory.

[00:23:25]the you this these reports will include today's sample analysis also.

[00:23:31]>> Yes.

[00:23:45]We direct that the team leader of leader of the doctor doctors is he Mr. SG. Yes my >> you say that his medical condition is being constantly monitored by the uh team led by the uh director as >> no I I'm suggesting >> presently who is leading the team >> the the medical superintendent of uh Sabar Jang >> medical superintendent >> there are it's a it's a team which consists of medical experts of Sabar Jang including the medical superintendent and emergency specialist of as emergency specialist of Sarda.

[00:24:37]>> We just want to know who is heading the team who can be who can remain present.

[00:24:41]>> Mr. Arin Chri is heading the team.

[00:24:43]>> I think the person the real person who will really assist your lordship would be >> Mr. Sharma >> sorry >> the doctor who is an expert in emergency medication in AIDS let he come so that there is no confusion.

[00:25:02]He's he's a part of the team. He's a part of the team.

[00:25:16]>> He's a part of the team alone.

[00:25:19]He is a part of the team.

[00:25:21]>> Teams.

[00:25:23]>> Uh Mr. Solic since when he is part of the teams from day one.

[00:25:27]>> From day one. From day one.

[00:25:30]Let them choose. They can give one name.

[00:25:34]They can give one from as >> we'll request the director as along with Dr. Aka to be present.

[00:25:48]>> In director in >> there is no direct. Yes.

[00:25:54]uh we direct that uh SLK we request the director the in charge director all India Institute of Medical Sciences and Dr. Ra in charge of >> emergency medicine >> emergency med medicine as >> emergency medicine >> shall be present tomorrow >> for our assistance post the uh doctor whom the appellent has been consulting may also be present during the course of hearing tomorrow.

[00:26:32]Uh it is further directed that respond number four while filing the affidabit under this order shall also bring on record all the medical public health bulletans.

[00:26:48]issued from time to time by the hospital uh issued from time to time in respect of the health condition of the husband of the appalent >> 2:30 could it be in the first half there's a difficulty >> yes >> is the learn >> I have no difficulty but 2:30 unless it's really difficult for my learn I have special benchm 1230 public put up tomorrow at 12:30.

[00:27:24]>> Can it be at 1:00? Can it be at 1:00? We should have half an hour time that will not uh please to have sufficient time please.