Mr. ‘X’ Vs. Hospital Z (1998) 8 SCC 296
Author: Yukti Gupta
Coram- S. Saghir Ahmad and B.N. Kirpal, JJ.
Decided on- September 21, 1998
Judgment Delivered by Justice S. Saghir Ahmad
- INTRODUCTION
HIVAIDS is not just a medical problem, it affects social and economic development too. It has an impact on the legal order of society. It poses a problem of discrimination against HIV/AIDS patients, violation of their civil liberties and basic human rights, and their victimization. It is a dreadful disease without any cure and it can only be prevented, therefore, a person who is found to be HIV positive nowadays is isolated by the society and sometimes even by his own family members and blood relatives, under the misconception that AIDS is easily communicable and that is why the name of the parties has not been disclosed in the Judgment to protect them from being looked down upon by the society and a subject to societal misconceptions. It is in this background that the Supreme Court of India has given a landmark Judgment, resolving certain complex legal issues.
Mr. X v. Hospital Z case emerged with a series of events that began in 1995. Doctors in the eastern state of Nagaland recommended to a patient (who was the uncle of a state-level minister) to travel to the southern city of Madras for a surgical operation. A local doctor, referred to in the case as Mr. X, accompanied the patient on his journey to Madras. Just prior to the operation, the doctors in Madras asked Mr. X to donate blood in case they needed it during the operation. Mr. X complied, but his blood was not used; the patient was discharged and he and Mr. X returned to their home state. A couple of months later Mr. X proposed to a Ms. Y and a wedding date was scheduled for December of 1995. However, sometime before the wedding, the Nagaland state minister received a call from the hospital informing him that Mr. X was HIV positive. Soon Mr. X’s family, friends, and neighbors became aware of his condition; the wedding was canceled and he was ostracized from his community. Mr. X left Nagaland and took a medical position, coincidentally, in the city of Madras. Mr. X subsequently filed a complaint in the National Consumer Disputes Redressal Commission, arguing that the hospital breached its duty of confidentiality when it released the information of his blood donation to a third party. The Commission dismissed the petition and instructed Mr. X to litigate this matter in civil court if he wished to seek a remedy. Mr. X then appealed this dismissal to the Indian Supreme Court.
In an unusual move, the Court used this case to address a range of issues that Mr. X did not raise on appeal such as-
- The issue of Confidentiality
The court acknowledged the sanctity that confidentiality in the medical profession has been provided in (i) Hippocratic Oath administrated to doctors, (ii) covenant to maintain secrecy and confidentiality in the International Code of Medical Ethics and; (iii) the Indian Medical Council Act 1956. These provisions provide duty on the medical practitioners to not disclose the secrets of a patient and one of the provisions lays down as follows-
‘Do not disclose the secrets of a patient that have been learned in the exercise of your profession. Those may be disclosed only in a court of law under orders of the presiding Judge.’
But, the court after going through the guidelines on HIV infection and AIDS issued by the general medical council of great Britain noted that the doctor-patient privilege allowed for exceptions when the “public interest would override the duty of confidentiality, particularly where there is an immediate or future health risk to others.” Ultimately, using this rationale the Hon’ble Supreme Court reasoned that public interest would override the duty of confidentiality, particularly where there is an immediate or future health risk to an identifiable person who had to be protected from being infected with the communicable disease from which the appellant suffered. On this count, the court upheld the action of the respondent hospital, in disclosing the HIV positive status of the appellant to the hitherto prospective bride and others.
- Right to privacy of HIV AIDS patient vs. Disclosure in larger interest
The court extensively discussed the nature of the ‘right to privacy’ in general and that of AIDS patients in particular by citing several Indian as well as American cases and also Article 8 of the European Convention on Human Rights. The division bench stated while recognizing the right to privacy as a fundamental right emanating from the right to life and personal liberty under Article 21 of the constitution of India, that as one of the basic Human Rights the right of privacy is not treated as absolute and limits may be placed on these rights so long there is a compelling state interest and such action as may be lawfully taken when the health or morals or protection of rights and freedom of others are at stake. Thus, on this basis, the court concluded that having regard to the fact that the appellant was found to be HIV positive, its disclosure would not be violative of either the rule of confidentiality or the appellant’s right of privacy as Ms. ‘Y’ had a greater interest in knowing about her potential husband’s medical condition than any individual claim of privacy. Therefore, the found no fault on the part of the Hospital for divulging Mr. X’s status.
- HIV AIDS as the basis for Divorce in India
During the course of the judgment, the court curiously decided to discuss the issue of the right to marriage of HIV AIDS patients. The apex court outlined the grounds of divorce available to a married person in religious laws such as Hindus, Muslims, Parsees, and Christians which allows for divorce when one party has a venereal disease. The court also cited Indian penal law which sets forth criminal sanctions against those who knowingly spread infection or endangers the life of another person. On the basis of this, the court held that those persons who were suffering from a venereal disease, even prior to the marriage cannot be said to have any right to marry so long as he is not fully cured. It also remarked that a person may have a right to marry but this right is not without a duty which is created upon people like Mr. X “not to marry”. Thus, by giving primary mental and physical health prime importance in marriage the court concluded that a person suffering from a venereal disease which is communicable in nature, may not claim a right to marry as an absolute right.
The decision pronounced by the Hon’ble Supreme Court shook the HIV community and soon after the decision a coalition of activists filed a petition before the Hon’ble Supreme Court to set forth the exact parameters of the Supreme Court’s decision in the Hospital Z case. Thereafter, a three-judge panel in X vs. Hospital Z (Civil Appeal) [1] decided on December 12th, 2002 stated that earlier the Court correctly held that the privacy rights of X with HIV, in that case, were not violated as a far as revealing his HIV positive status to the relatives of his fiancé is concerned. The court while discarded the rest of the decision, including the section on marriage rights for people with HIV as “unnecessary” and “uncalled for” held that earlier the judges had erred in their judgment by deciding on the matters irrelevant to the matter before them. A prominent activist interpreted the decision of 2002 ruling as restoring the right to marry of an HIV positive person though the 1998 Judgment was not overturned by this ruling explicitly.
It is safe to say that the disadvantaged communities in India have their rights best protected by using Public Interest Litigation as a tool. The constitution is the Magna Carta which provides means for groups to have their voices heard and courts accordingly safeguard their rights. Though it has been revealed by the HIV community that a smattering of judgments has recognized the importance of tackling the HIV AIDS crisis in a direct, forthright manner such as MX case [2]wherein disqualification on the basis of HIV status of an individual from employment was rejected, the Common Cause case wherein the Supreme Court ordered a total reform in the operation of Blood Bank and various other cases. The decisions made by the courts depicts the openness of the court while considering the claims of people with HIV AIDS and normalize such medical problem in the society to prevent total isolation faced by HIV Community. But, when seen as a whole, this story shows one side of the coin. The rulings such as made in Mr. X v. Hospital Z (1998) and Mr. X v. Hospital Z (2002) shows the predicament faced by the HIV Community when the court decides to use a situation before it to make a public policy decision on issues such as the right to divorce or the right to marry of HIV positive person, that goes beyond its reach. The use of words such as “undisciplined sexual impulse” by the highest court in the world’s largest democracy to characterize HIV AIDS shows its lack of information, insensitivity, and a major disservice to society. It totally negated the complexity of the illness and failed to grasp that the level of illness associated with HIV varies and individuals who have the virus may remain asymptomatic for years. Apart from sexual intercourse, the court failed to consider other ways that may act as a catalyst in the transmission of the disease such as tainted blood transfusions as well as intravenous drug use. On the question of who has the right to marry which the court took upon itself to answer without it being an issue in the matter in the first place and trampled over the nuances inherent in the question. It failed to note that The Universal Declaration of Human Rights and the International Covenant on Civil and Political Rights both recognize the right to marry as a natural right guaranteed to every individual of full age and yet with one swell swoop ruled that people contracted with HIV AIDS do not have the right to marry. It seemed that the Court was more worried about the acquisition of the disease by the healthy spouse from her infected husband who has failed to disclose his illness rather than the humiliation faced by the HIV positive person from his relatives and society at the behest of disclosure made by his doctor to a third party thereby breaking the doctor-patient confidentiality privilege. The court kept public policy interest above in protecting the innocent party and totally ignored the fact that there were already criminal statutes existing punishing such behavior. Moreover, there were many related issues that the Court failed to consider such as What if Ms. Y had consented to marry Mr. X even after knowing about his condition? Is it not possible for a loving couple who would still want to proceed with marriage even when one of the parties is ill? Is it reasonable to say to a couple that they could not marry if the man had diagnosed with cancer? Is not Article 21 of the Indian Constitution including individual autonomy in its broad ambit of the fundamental right to life and personal liberty? Why should an informed couple lose the right to choose their destinies because one of them has HIV? Why the court did not grant damages in favor of the appellant against the Hospital who instead of contacting the appellant (patient) himself, revealed such sensitive information to a relative resulting in utmost disgrace to Appellant’s reputation? Similarly, the Apex Court barred people with HIV from marrying in its 1998 judgment on the premise that such a union interferes with a couple’s ability to live a “healthy” and “moral” life together. Even a generous reading of the Supreme Court’s 2002 decision cannot entirely substantiate the claim that the Hospital Z judgment is formally overruled but in turn, it talked about Section 2 of the Consumer Protection Act, 1986 which raises curiosity as can we say that disclosure of the information would amount to a deficiency in service of the hospital or the doctor’s and hospital’s manner of performance Section 2 provides-
Deficiency” means any fault, imperfection, shortcoming or inadequacy in the quality, nature, and manner of performance which is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise in relation to any service
Recently, the Hon’ble Supreme Court in Justice K.S. Puttaswamy (Retd.) &Anr. Vs. Union of India &Ors[3] unanimously declared Article 21 as a Fundamental Right which is protected under Article 21 of the Constitution. It meticulously laid down that Privacy includes at its core the preservation of personal intimacies, the sanctity of family life, marriage, procreation, the home and sexual orientation. Privacy safeguards individual autonomy and recognizes the ability of the individual to control vital aspects of his or her life. It is an essential facet of the dignity of the human being. On the lines of this Judgment, it can be construed that the Supreme Court’s decision in Mr X vs. Hospital Z on right to marry stands overruled. Also, in the garb of progressive development in India, The Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (Prevention and Control) Act, 2017 (hereinafter referred as Act) was enacted on September 10, 2018 by the Parliament to fulfil its commitment under the Declaration of Commitment to the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (2001). The act is made with a motive to prevent, control and protect human rights of persons affected by the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) with an aim to further the principles/objectives set out by the judicial precedents by encapsulating both the prevention of discrimination against HIV-infected persons and their treatment. Section 8(2)(d) of the Act provides that a person cannot be compelled to disclose his HIV status, such disclosure shall be made with his informed consent, however Section 9 carves out an exception stating that an informed consent of a person to disclose his HIV status is not needed by the doctors or the healthcare providers to inform the partner of the person about his HIV status when he reasonably believes that the partner is at risk of transmission of HIV, the HIV person has been already counseled to inform his partner, the doctor is satisfied that the HIV person is not going to inform his partner or when the doctor has informed the HIV that he is going to tell the person’s partner. But section 9 do not provide a legal duty or restraint on the partner of the HIV patient who is informed of his HIV status to not spread such sensitive information which is personal to the HIV patient which if disclosed in public might harm the reputation and lead to the victim’s banishment from the society as what happened with Mr. X in this case. In the author’s opinion, the law with respect to the Rights of HIV community has evolved progressively since the Judgement in Mr X v Hospital Z. The steps taken by the legislature and judiciary to protect the Human Dignity of the HIV Community has been commendable but, in my opinion, it is the society which needs to take a leap of faith to normalize the stigma attached with HIV AIDS patients.
[1] MANU/SC/1121/2002
[2] AIR 1997 BOM 406
[3] 2017 (10) SCC 1
Mr. X Vs. Hospital Z
Mr. ‘X’ Vs. Hospital Z (1998) 8 SCC 296
Author: Yukti Gupta
Coram- S. Saghir Ahmad and B.N. Kirpal, JJ.
Decided on- September 21, 1998
Judgment Delivered by Justice S. Saghir Ahmad
HIVAIDS is not just a medical problem, it affects social and economic development too. It has an impact on the legal order of society. It poses a problem of discrimination against HIV/AIDS patients, violation of their civil liberties and basic human rights, and their victimization. It is a dreadful disease without any cure and it can only be prevented, therefore, a person who is found to be HIV positive nowadays is isolated by the society and sometimes even by his own family members and blood relatives, under the misconception that AIDS is easily communicable and that is why the name of the parties has not been disclosed in the Judgment to protect them from being looked down upon by the society and a subject to societal misconceptions. It is in this background that the Supreme Court of India has given a landmark Judgment, resolving certain complex legal issues.
Mr. X v. Hospital Z case emerged with a series of events that began in 1995. Doctors in the eastern state of Nagaland recommended to a patient (who was the uncle of a state-level minister) to travel to the southern city of Madras for a surgical operation. A local doctor, referred to in the case as Mr. X, accompanied the patient on his journey to Madras. Just prior to the operation, the doctors in Madras asked Mr. X to donate blood in case they needed it during the operation. Mr. X complied, but his blood was not used; the patient was discharged and he and Mr. X returned to their home state. A couple of months later Mr. X proposed to a Ms. Y and a wedding date was scheduled for December of 1995. However, sometime before the wedding, the Nagaland state minister received a call from the hospital informing him that Mr. X was HIV positive. Soon Mr. X’s family, friends, and neighbors became aware of his condition; the wedding was canceled and he was ostracized from his community. Mr. X left Nagaland and took a medical position, coincidentally, in the city of Madras. Mr. X subsequently filed a complaint in the National Consumer Disputes Redressal Commission, arguing that the hospital breached its duty of confidentiality when it released the information of his blood donation to a third party. The Commission dismissed the petition and instructed Mr. X to litigate this matter in civil court if he wished to seek a remedy. Mr. X then appealed this dismissal to the Indian Supreme Court.
In an unusual move, the Court used this case to address a range of issues that Mr. X did not raise on appeal such as-
The court acknowledged the sanctity that confidentiality in the medical profession has been provided in (i) Hippocratic Oath administrated to doctors, (ii) covenant to maintain secrecy and confidentiality in the International Code of Medical Ethics and; (iii) the Indian Medical Council Act 1956. These provisions provide duty on the medical practitioners to not disclose the secrets of a patient and one of the provisions lays down as follows-
‘Do not disclose the secrets of a patient that have been learned in the exercise of your profession. Those may be disclosed only in a court of law under orders of the presiding Judge.’
But, the court after going through the guidelines on HIV infection and AIDS issued by the general medical council of great Britain noted that the doctor-patient privilege allowed for exceptions when the “public interest would override the duty of confidentiality, particularly where there is an immediate or future health risk to others.” Ultimately, using this rationale the Hon’ble Supreme Court reasoned that public interest would override the duty of confidentiality, particularly where there is an immediate or future health risk to an identifiable person who had to be protected from being infected with the communicable disease from which the appellant suffered. On this count, the court upheld the action of the respondent hospital, in disclosing the HIV positive status of the appellant to the hitherto prospective bride and others.
The court extensively discussed the nature of the ‘right to privacy’ in general and that of AIDS patients in particular by citing several Indian as well as American cases and also Article 8 of the European Convention on Human Rights. The division bench stated while recognizing the right to privacy as a fundamental right emanating from the right to life and personal liberty under Article 21 of the constitution of India, that as one of the basic Human Rights the right of privacy is not treated as absolute and limits may be placed on these rights so long there is a compelling state interest and such action as may be lawfully taken when the health or morals or protection of rights and freedom of others are at stake. Thus, on this basis, the court concluded that having regard to the fact that the appellant was found to be HIV positive, its disclosure would not be violative of either the rule of confidentiality or the appellant’s right of privacy as Ms. ‘Y’ had a greater interest in knowing about her potential husband’s medical condition than any individual claim of privacy. Therefore, the found no fault on the part of the Hospital for divulging Mr. X’s status.
During the course of the judgment, the court curiously decided to discuss the issue of the right to marriage of HIV AIDS patients. The apex court outlined the grounds of divorce available to a married person in religious laws such as Hindus, Muslims, Parsees, and Christians which allows for divorce when one party has a venereal disease. The court also cited Indian penal law which sets forth criminal sanctions against those who knowingly spread infection or endangers the life of another person. On the basis of this, the court held that those persons who were suffering from a venereal disease, even prior to the marriage cannot be said to have any right to marry so long as he is not fully cured. It also remarked that a person may have a right to marry but this right is not without a duty which is created upon people like Mr. X “not to marry”. Thus, by giving primary mental and physical health prime importance in marriage the court concluded that a person suffering from a venereal disease which is communicable in nature, may not claim a right to marry as an absolute right.
The decision pronounced by the Hon’ble Supreme Court shook the HIV community and soon after the decision a coalition of activists filed a petition before the Hon’ble Supreme Court to set forth the exact parameters of the Supreme Court’s decision in the Hospital Z case. Thereafter, a three-judge panel in X vs. Hospital Z (Civil Appeal) [1] decided on December 12th, 2002 stated that earlier the Court correctly held that the privacy rights of X with HIV, in that case, were not violated as a far as revealing his HIV positive status to the relatives of his fiancé is concerned. The court while discarded the rest of the decision, including the section on marriage rights for people with HIV as “unnecessary” and “uncalled for” held that earlier the judges had erred in their judgment by deciding on the matters irrelevant to the matter before them. A prominent activist interpreted the decision of 2002 ruling as restoring the right to marry of an HIV positive person though the 1998 Judgment was not overturned by this ruling explicitly.
It is safe to say that the disadvantaged communities in India have their rights best protected by using Public Interest Litigation as a tool. The constitution is the Magna Carta which provides means for groups to have their voices heard and courts accordingly safeguard their rights. Though it has been revealed by the HIV community that a smattering of judgments has recognized the importance of tackling the HIV AIDS crisis in a direct, forthright manner such as MX case [2]wherein disqualification on the basis of HIV status of an individual from employment was rejected, the Common Cause case wherein the Supreme Court ordered a total reform in the operation of Blood Bank and various other cases. The decisions made by the courts depicts the openness of the court while considering the claims of people with HIV AIDS and normalize such medical problem in the society to prevent total isolation faced by HIV Community. But, when seen as a whole, this story shows one side of the coin. The rulings such as made in Mr. X v. Hospital Z (1998) and Mr. X v. Hospital Z (2002) shows the predicament faced by the HIV Community when the court decides to use a situation before it to make a public policy decision on issues such as the right to divorce or the right to marry of HIV positive person, that goes beyond its reach. The use of words such as “undisciplined sexual impulse” by the highest court in the world’s largest democracy to characterize HIV AIDS shows its lack of information, insensitivity, and a major disservice to society. It totally negated the complexity of the illness and failed to grasp that the level of illness associated with HIV varies and individuals who have the virus may remain asymptomatic for years. Apart from sexual intercourse, the court failed to consider other ways that may act as a catalyst in the transmission of the disease such as tainted blood transfusions as well as intravenous drug use. On the question of who has the right to marry which the court took upon itself to answer without it being an issue in the matter in the first place and trampled over the nuances inherent in the question. It failed to note that The Universal Declaration of Human Rights and the International Covenant on Civil and Political Rights both recognize the right to marry as a natural right guaranteed to every individual of full age and yet with one swell swoop ruled that people contracted with HIV AIDS do not have the right to marry. It seemed that the Court was more worried about the acquisition of the disease by the healthy spouse from her infected husband who has failed to disclose his illness rather than the humiliation faced by the HIV positive person from his relatives and society at the behest of disclosure made by his doctor to a third party thereby breaking the doctor-patient confidentiality privilege. The court kept public policy interest above in protecting the innocent party and totally ignored the fact that there were already criminal statutes existing punishing such behavior. Moreover, there were many related issues that the Court failed to consider such as What if Ms. Y had consented to marry Mr. X even after knowing about his condition? Is it not possible for a loving couple who would still want to proceed with marriage even when one of the parties is ill? Is it reasonable to say to a couple that they could not marry if the man had diagnosed with cancer? Is not Article 21 of the Indian Constitution including individual autonomy in its broad ambit of the fundamental right to life and personal liberty? Why should an informed couple lose the right to choose their destinies because one of them has HIV? Why the court did not grant damages in favor of the appellant against the Hospital who instead of contacting the appellant (patient) himself, revealed such sensitive information to a relative resulting in utmost disgrace to Appellant’s reputation? Similarly, the Apex Court barred people with HIV from marrying in its 1998 judgment on the premise that such a union interferes with a couple’s ability to live a “healthy” and “moral” life together. Even a generous reading of the Supreme Court’s 2002 decision cannot entirely substantiate the claim that the Hospital Z judgment is formally overruled but in turn, it talked about Section 2 of the Consumer Protection Act, 1986 which raises curiosity as can we say that disclosure of the information would amount to a deficiency in service of the hospital or the doctor’s and hospital’s manner of performance Section 2 provides-
Deficiency” means any fault, imperfection, shortcoming or inadequacy in the quality, nature, and manner of performance which is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise in relation to any service
Recently, the Hon’ble Supreme Court in Justice K.S. Puttaswamy (Retd.) &Anr. Vs. Union of India &Ors[3] unanimously declared Article 21 as a Fundamental Right which is protected under Article 21 of the Constitution. It meticulously laid down that Privacy includes at its core the preservation of personal intimacies, the sanctity of family life, marriage, procreation, the home and sexual orientation. Privacy safeguards individual autonomy and recognizes the ability of the individual to control vital aspects of his or her life. It is an essential facet of the dignity of the human being. On the lines of this Judgment, it can be construed that the Supreme Court’s decision in Mr X vs. Hospital Z on right to marry stands overruled. Also, in the garb of progressive development in India, The Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (Prevention and Control) Act, 2017 (hereinafter referred as Act) was enacted on September 10, 2018 by the Parliament to fulfil its commitment under the Declaration of Commitment to the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (2001). The act is made with a motive to prevent, control and protect human rights of persons affected by the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) with an aim to further the principles/objectives set out by the judicial precedents by encapsulating both the prevention of discrimination against HIV-infected persons and their treatment. Section 8(2)(d) of the Act provides that a person cannot be compelled to disclose his HIV status, such disclosure shall be made with his informed consent, however Section 9 carves out an exception stating that an informed consent of a person to disclose his HIV status is not needed by the doctors or the healthcare providers to inform the partner of the person about his HIV status when he reasonably believes that the partner is at risk of transmission of HIV, the HIV person has been already counseled to inform his partner, the doctor is satisfied that the HIV person is not going to inform his partner or when the doctor has informed the HIV that he is going to tell the person’s partner. But section 9 do not provide a legal duty or restraint on the partner of the HIV patient who is informed of his HIV status to not spread such sensitive information which is personal to the HIV patient which if disclosed in public might harm the reputation and lead to the victim’s banishment from the society as what happened with Mr. X in this case. In the author’s opinion, the law with respect to the Rights of HIV community has evolved progressively since the Judgement in Mr X v Hospital Z. The steps taken by the legislature and judiciary to protect the Human Dignity of the HIV Community has been commendable but, in my opinion, it is the society which needs to take a leap of faith to normalize the stigma attached with HIV AIDS patients.
[1] MANU/SC/1121/2002
[2] AIR 1997 BOM 406
[3] 2017 (10) SCC 1
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