Delhi High Court: In a petition by a 31-year-old married woman, residing with her husband and 9-year-old son, who had approached the Court for medical termination of ongoing pregnancy under Section 3(2B) and 3(3) of the Medical Termination of Pregnancy Act, 1971 (‘MTP Act’), a Single Judge Bench of Sanjeev Narula, J. accepted the recommendation of the AIIMS Medical Board and allowed the petitioner to undergo medical termination of pregnancy beyond 24 weeks, at a medical facility of her choice.
Background
The petitioner delivered her first child on 10-10-2015 at Deen Dayal Hospital. The child had been suffering from mental disability since birth and was completely dependent upon the petitioner to take care of him for his basic needs and day-to-day activities.
The petitioner conceived again after 9 years and got an ultrasound done on 12-02-2024, which confirmed a pregnancy of 12 weeks. The next ultrasound was done on 01-04-2024. On 29-04-2024, the doctors who had examined the petitioner counselled her about the possibility of chromosomal abnormalities in the ongoing pregnancy that could be a part of Dandy-Walker Continuum and advised her to go through a fetal MRI.
The fetal MRI conducted on 21-05-2024 also suggested an abnormality of the Dandy-Walker Continuum likely mega cisterna magna. On 29-05-2024, another doctor at the Lok Nayak Hospital considered the fetal MRI report and confirmed the abnormality. On 29-05-2024, the petitioner wrote an application for medical termination of pregnancy (‘MTP’) to the Medical Director of Lok Nayak Hospital, and on 01-06-2024, underwent an ultrasound scan at Mahindru Hospital, which further corroborated the finding of an abnormality.
On 13-06-2024, the Medical Board at Lok Nayak Hospital denied the MTP application of the petitioner, which resulted in the filing of the present petition. On 24-06-2024, after the Court noted the facts of the matter, the constitution of a Medical Board was directed for the medical examination of the petitioner. The Board was to comprise two doctors from the Lok Nayak Hospital, and they were directed to submit their opinion on the MTP.
On 28-06-2024, it was submitted before the Court that MTP was not possible in the present case since the Medical Board had not recommended the same. The documents declining the MTP were presented before the Court on 01-07-2024 and upon reviewing them, the Court found that both the reports were inconclusive.
The opinion in the report dated 27-06-2024 was based on old medical records of the petitioner, without conducting any further tests. The doctors expressed their inability to conclusively confirm the diagnosis of fetal abnormalities which led to their negative opinion of the MTP.
Due to the seriousness of the matter, the Court directed the petitioner to be re-examined by a Medical Board constituted at AIIMS. The Court specifically requested the Medical Board to opine on the fetal abnormalities and assess the safety of the petitioner in undergoing the procedure.
Accordingly, a Medical Board was constituted at AIIMS consisting of six members, and a thorough examination was conducted. Subsequently, a report was submitted recommending the termination of the pregnancy.
The Medical Board at AIIMS concluded that Joubert Syndrome, a multisystem disorder with a poor neurodevelopmental outcome was present. They also determined that the gestational period was 30 weeks and 4 days in contradiction to the report of Lok Nayak Hospital which stated that the pregnancy was over 32 weeks.
Analysis and Decision
The Court stated that Joubert Syndrome is recognized as a severe condition due to its multisystem impact that affects not only neurological development but also leads to respiratory, renal, and ocular complications.
The Court said that the report of the AIIMS Medical Board was unequivocal in its findings and clearly stated that the fetus exhibited features suggestive of Joubert Syndrome and the diagnosis indicated that the child, if born, would likely face severe neurological impairments and extensive health challenges.
The AIIMS Medical Board also assessed the petitioner’s physical fitness for the termination procedure and found her to be medically fit to undergo the procedure. Given the conclusive nature of the findings, the Court was inclined to accept the report that supported the termination of the pregnancy due to identified substantial fetal abnormalities and significant health risks posed to the unborn child.
The Court stated that under the MTP Act, the termination of pregnancy is permitted up to 20 weeks if a registered medical practitioner opines that the continuation of the pregnancy would involve a risk to the life of the pregnant woman or cause grave injury to her physical or mental health and that the child, if born, would suffer from a serious physical or mental abnormality.
The Court stated that Section 3(2)(b)(i) of the MTP Act allows for termination on these grounds up to 24 weeks, provided two registered medical practitioners concur that the pregnancy should be terminated.
Further, the Court stated that Section 3(2B) of the MTP Act ensures that the gestational age does not hinder necessary medical interventions in cases of substantial fetal abnormalities. The Court stated that the legislative framework must be read in conjunction with Section 3(3) of the MTP Act, which considers the actual or reasonably foreseeable environment in determining whether the continuance of the pregnancy would injure the woman’s physical or mental health.
The Court referred to Suchita Srivastava v. Chandigarh Administration, (2009) 9 SCC 1, and stated that the Supreme Court highlighted that the right to make reproductive choices is integral to the right to personal liberty under Article 21 of the Constitution.
The Court stated that the provisions of the MTP Act read in harmony with principles of personal liberty, affirm the right of a pregnant woman to seek a termination of pregnancy under medically justified circumstances.
The Court noted that another crucial aspect of the present case was the invocation of Section 3(3) of the MTP Act which mandated taking the actual foreseeable environment of the petitioner into account.
The Court noted that the petitioner had a 9-year-old son who suffered from neurological handicaps and was completely dependent on her. It was noted that as a homemaker, the petitioner devoted most of her time to her child and that if the pregnancy were not allowed to be terminated, the foreseeable environment for the petitioner would be extraordinarily challenging.
Further, the Court noted that the burden of raising two children with severe disabilities in a household with limited financial resources was a daunting prospect that would likely lead to grave injury to the petitioner’s mental health.
The Court, while accepting AIIMS’ recommendation, stated that the opinion rendered by the AIIMS Medical Board aligned with the ‘Guidance Note for Medical Boards for Termination of Pregnancy Beyond 20 weeks of Gestation’ by the Ministry of Health and Welfare, and the Court also found their recommendation to be well-founded in evidence.
The Court found it appropriate to permit the termination of pregnancy and allowed the petition. The Court also mentioned that the petitioner was free to undergo medical termination at a facility of her choice and that she had to make a final decision to undergo the procedure, which would be at her own risk and consequences.
Further, while disposing of the petition, the Court stated that the opinion of the Medical Board in such cases of termination of pregnancy is of considerable importance for assisting the courts in arriving at a just order and that the Board at the Lok Nayak Hospital did not meet the Court’s expectation.
The Court stated that the Board at Lok Nayak Hospital failed to conduct necessary tests and did not approach the issue with the required level of seriousness and the delay, as well as inadequate counselling, had resulted in an advanced stage of pregnancy of the petitioner.
[R v. Principal Secretary Health and Family Welfare Department, 2024 SCC OnLine Del 4610, Decided on 05-07-2024]
Advocates who appeared in this case :
For Petitioner — Advocate Amit Mishra
For Respondents — Advocate Rachita Garg, Advocate Agam Rajput, Advocate Preeti Chauhan, CGSC Arunima Dwivedi, Advocate Pinky Pawar, Advocate Aakash Pathak, Advocate Satya Ranjan Swain, Advocate Kautilya Birat, Advocate Ankush Kapoor
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