Why Patient Autonomy, Not Procedural Formality, Must Anchor Consent In Indian Medical Law
K.Kannan, Senior Advocate
14 May 2025 8:43 PM IST
From Trust to TransparencyFor generations, the doctor-patient relationship in India was built on implicit trust, steeped in a tradition of deference to medical authority. But as medical technologies advanced and patients became more aware, the law could no longer afford to remain on the sidelines. What began as deference to professional discretion has steadily evolved into a legal doctrine...
From Trust to Transparency
For generations, the doctor-patient relationship in India was built on implicit trust, steeped in a tradition of deference to medical authority. But as medical technologies advanced and patients became more aware, the law could no longer afford to remain on the sidelines. What began as deference to professional discretion has steadily evolved into a legal doctrine that puts the patient's autonomy at the centre of clinical practice.
When the Law Bowed to Medicine
In 1957, the landmark English case Bolam v. Friern Hospital Management Committee established what became known as the Bolam test. It held that a doctor could not be considered negligent if their actions conformed to a practice accepted by a responsible body of medical opinion. This standard created a legal shield for medical professionals, embedding a culture of minimal disclosure and marginalizing the patient's right to know.
Montgomery Changes the Lens
For decades, Bolam was the law. However, as medical technologies advanced and patients became more informed, the imbalance became harder to justify. The law gradually began to absorb the language of autonomy. It found its most decisive voice in the UK Supreme Court's judgment in Montgomery v. Lanarkshire Health Board (2015). Nadine Montgomery, a woman with diabetes, was not informed of the risk of shoulder dystocia during vaginal delivery. The risk materialised, leading to son's cerebral palsy. The Court held, breaking from Bolam declared that it is not for the medical community alone to decide what risks are worth disclosing. Instead, doctors must ensure that patients are made aware of any material risks involved in a proposed treatment and of reasonable alternatives. The focus shifted from the doctor's perspective to the patient's right to make an informed choice. The paternalistic veil was finally lifted.
Indian Courts Embrace the Patient's Voice
India's legal journey has mirrored this evolution, albeit with caution. In Samira Kohli v. Dr. Prabha Manchanda (2008), the Supreme Court held that consent must be specific and informed, emphasizing bodily autonomy as an essential element of dignity under Article 21 of the Constitution. Yet, the Court did not outright abandon the Bolam principle, preserving a limited role for professional judgment in emergency situations.
The recent Agrasen Hospital decision, however, signalled a notable shift. While the case itself did not turn on risk disclosure, the Court acknowledged the Montgomery principle, indicating a growing judicial inclination to centre patient autonomy even in Indian medical jurisprudence.
The Consent Form is Not a Shield
Perhaps the most pointed reminder of this transformation came from the National Consumer Disputes Redressal Commission (NCDRC) Vinod Khanna v RG Stone Urology and Laparoscopy Hospital & Others (2020). The Commission categorically held that pre-printed, standardised consent forms with vague disclaimers do not amount to informed consent but will constitute unfair trade practice. A hurried signature on a generic document is not enough. The onus, it said, lies squarely on the medical practitioner to prove that the patient was meaningfully informed of the risks involved and the alternatives available. This ruling pierces through the institutional tendency to reduce consent to a paper exercise. It reaffirms that the process—not just the signature—is what the law values.
Elective Choices and Ethical Crossroads
The demand for disclosure becomes even more pressing in procedures that are elective or ethically sensitive—such as cosmetic surgeries, fertility treatments, and end-of-life decisions. In such cases, the absence of medical necessity only intensifies the responsibility to ensure that patients are making truly informed choices. The recognition of living wills and passive euthanasia by the Indian judiciary further underscores this legal and ethical pivot.
The Judiciary as Conscience Keeper
From Bolam to Montgomery, and now in Indian cases like Samira Kohli, Agrasen, and Vinod Khanna, courts are making it clear: healing begins with honesty. The physician's scalpel must now be guided not just by skill, but by the law's insistence on respect—for choice, dignity, and disclosure. This shift is not anti-doctor. It is pro-accountability. The law does not ask doctors to predict outcomes—it asks them to empower decisions. In a society where patients often navigate an opaque and intimidating healthcare system, this recalibration is not only necessary; it is overdue.
A Culture Change, Not Just a Legal One
The transition from professional supremacy to patient autonomy is not just a judicial deveopment—it is a cultural reset. Medical institutions, training programs, and practitioners must internalize that informed consent is not a bureaucratic formality. It is the ethical heartbeat of modern medicine. The courts have done their part. Now it is time for the clinics, hospitals, and practitioners to catch up—not with legal compliance, but with moral clarity.
Views Are Personal.
Author is a Former Judge of High Court of Punjab And Haryana.
The above is an excerpt taken from the book 'Medicine And Law' written by him and published by Thomson Reuters.
The book is Available in https://amzn.in/d/02RUSmj;