Medical deviance: medical ethics, negligence, the Lentin Commission and drug abuse
White Collar Crimes · Unit IV · Topic 13 of 17 · 6 min read
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Cases checked to exist. Read the judgment before quoting a holding.
Every case cited here has been checked to exist — the citation resolves and names the right parties. The propositions attributed to each case have not been verified line by line against the judgment. Case names link through to the full judgment: read it before quoting a holding in an examination answer, and never carry a proposition from notes into court on trust.
1. Forms of medical deviance
- Negligence in diagnosis, treatment and surgery.
- Unnecessary procedures (caesarean sections, hysterectomies, stents) for profit; over-prescription and unnecessary tests.
- Kickbacks and commissions from pharmaceutical companies, laboratories and diagnostic centres; acceptance of gifts and sponsored travel.
- Sex determination and sex-selective abortion; illegal termination of pregnancy.
- Organ trade in violation of the Transplantation of Human Organs and Tissues Act, 1994.
- False medical certificates, for leave, insurance claims, bail or injury reports.
- Spurious and adulterated drugs, and corruption in drug licensing and testing.
- Clinical trials without informed consent.
- Quackery: practice by unqualified persons, and practice beyond one's system of medicine.
2. Medical ethics and its enforcement
The ethical code descends from the Hippocratic Oath and the Declaration of Geneva. In India it was stated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, made under the Indian Medical Council Act, 1956. Their main duties: to treat patients with care and keep their confidences; to obtain informed consent before any operation; not to advertise or solicit patients; to prescribe drugs by generic names as far as possible; not to accept gifts, travel or hospitality from the pharmaceutical industry; not to issue false certificates; and not to refuse a patient in an emergency.
The National Medical Commission Act, 2019 replaced the Medical Council of India with the National Medical Commission. Professional conduct is now under its Ethics and Medical Registration Board, which maintains the National Register and hears appeals from the State Medical Councils, which act on complaints of misconduct in the first instance. The penalty for misconduct is reprimand, suspension or removal of the name from the register.
3. Medical negligence
- Civil liability: the Bolam test, that a doctor is not negligent if he acted in accordance with a practice accepted by a responsible body of medical opinion. Medical services for consideration are “services” under consumer protection law: Indian Medical Association v. V.P. Shantha, 1995 INSC 720, (1995) 6 SCC 651.
- Criminal liability: in Jacob Mathew v. State of Punjab, 2005 INSC 334, (2005) 6 SCC 1, the Supreme Court held that for criminal liability the negligence must be gross or reckless, not a mere error of judgment; a private complaint should be accompanied by the credible opinion of another competent doctor; and a doctor should not be arrested as a matter of routine.
- Bharatiya Nyaya Sanhita, 2023: causing death by a rash or negligent act is punishable up to five years (section 106(1), old IPC section 304A), but where the act is done by a registered medical practitioner while performing a medical procedure, the maximum is two years. Parliament has thus written a lesser punishment for doctors into the code.
4. The Lentin Commission
The facts. In early 1986, a number of patients at the J.J. Hospital, Bombay, a large government hospital, died of kidney failure. Investigation showed that the glycerol administered to them had been contaminated with diethylene glycol, an industrial solvent, and was not of pharmacopoeial standard. The Government of Maharashtra appointed a commission of inquiry under Justice B. Lentin, a judge of the Bombay High Court.
Observations. The Commission, which reported in 1988, found:
- that the deaths were caused by the adulterated glycerol;
- that the drug had been supplied by a manufacturer whose licence and products had not been properly checked, and that the hospital's purchase and testing procedures had failed;
- that officials of the Food and Drug Administration had been lax and, in some cases, corrupt in licensing and in testing samples;
- that there was a nexus between drug manufacturers, regulatory officials and persons in political office, so that defaulting firms were protected;
- that the State's drug control machinery was understaffed and without adequate laboratories.
Recommendations included strengthening the drug control administration and its testing laboratories, purchase of drugs only from reliable sources with testing of each batch, fixing responsibility on hospital and FDA officials, prosecution of those responsible, and freeing drug regulation from political interference.
Significance for this paper. It shows professional deviance (doctors and pharmacists who failed to check), official deviance (corrupt drug inspectors), corporate deviance (the manufacturer) and political deviance in a single episode. The control law is the Drugs and Cosmetics Act, 1940, which punishes manufacture and sale of adulterated and spurious drugs, with heavier punishment where the drug is likely to cause death or grievous hurt, and the drug-adulteration offence in section 276 of the BNS (old IPC section 274).
5. Drug abuse: the NDPS Act, 1985
Problem (June 2025). A celebrity is found to be addicted to drugs. Can he be prosecuted?
Issue. Whether consumption, as distinct from trafficking, is an offence, and what protection the law gives an addict.
Law. Section 8(c) of the Narcotic Drugs and Psychotropic Substances Act, 1985 prohibits possession and consumption except for medical or scientific purposes. Section 27 punishes consumption: where the drug is cocaine, morphine, diacetyl-morphine (heroin) or a notified drug, rigorous imprisonment up to one year or fine up to twenty thousand rupees or both; for other drugs, up to six months or fine up to ten thousand rupees or both. Section 64A gives immunity to an addict charged under section 27, or with an offence involving a small quantity, who voluntarily seeks de-addiction treatment at a hospital or institution maintained or recognised by the Government and undergoes it; the immunity may be withdrawn if he does not complete the treatment. Section 39 allows the court to release a convicted addict for treatment instead of sentencing him. Possession of more than a small quantity is a separate and more serious offence.
Application. Addiction alone is not an offence, but consumption is. The celebrity can be prosecuted under section 27 if consumption is proved (usually by medical test). If he voluntarily undergoes treatment, section 64A bars prosecution. If he was found with more than a small quantity, he will be charged with possession and cannot claim section 64A for that. His celebrity status is irrelevant in law; in practice, the media attention makes this a typical case of upper class deviance.
Conclusion. Yes, under section 27, unless he volunteers for de-addiction treatment and completes it, in which case section 64A protects him.
How this is examined
June 2025 and February 2025: a 6-mark note on the observations of the Lentin Commission. February 2025: a note on medical ethics. June 2025: the celebrity drug problem. For the Lentin note, give the facts (J.J. Hospital, 1986, contaminated glycerol), the findings on the nexus, the recommendations and the significance. For medical ethics, the 2002 Regulations and the NMC Act machinery, with Jacob Mathew.
Now try the real questions: White Collar Crimes past question papers.