Theme: Health & Environment

Appointing Someone on your Behalf

A nominated representative is a person who is appointed by a person with mental illness to discharge the following duties((Section 17,  the Mental Healthcare Act, 2017 )):

  • Consider the wishes, life history, values, cultural background and the best interests of the person with mental illness, and give importance to their views regarding such decisions.
  • Provide support to the person with mental illness in making treatment decisions.
  • Seek information on diagnosis and treatment to provide adequate support to the person with mental illness.
  • Have access to the family/home-based rehabilitation services with respect to the person with mental illness.
  • Be involved in discharge planning. This includes, discharge back into the community or transfer of their care to a new psychiatrist/mental health establishment.
  • Apply to the mental health establishment for admission of the person with mental illness.
  • Apply to the concerned Mental Health Review Board on behalf of the person with mental illness for discharge or to complain regarding any violation of rights.
  • In case of the admission of a minor in the mental health establishment, appoint a suitable attendant who will stay with the minor.
  • Have the right to give/withhold consent for research that can be conducted on the person with mental illness.

Criteria for Appointment of a Nominated Representative

To appoint a nominated representative, a person should be((Section 14(3),  the Mental Healthcare Act, 2017. )):

  • Major (above 18 years of age)
  • Competent to discharge their duties
  • Able to give written consent to being the nominated representative. However, the respective mental health professional should get this in writing.

Order of Appointment of a Nominated Representative

If you are a person with mental illness, you can yourself appoint a nominated representative. However, if you do not appoint  a nominated representative, then the following people shall be considered as your nominated representative (in  this order from first to last)((Section 14(4),  the Mental Healthcare Act, 2017 )):

  • The individual appointed as a nominated representative in the advance directive
  • A relative
  • A caregiver
  • A person appointed by the Mental Health Review Board
  • The Director of the Department of Social Welfare, or their designated representative

Additionally, to appoint a nominated representative, you should approach an NGO which works in this field or a lawyer, who will be able to help you out.

Glossary terms

  • Effluents: Waste in liquid form; usually outflows from industries, sewage plants or wastewater treatment plants into a natural body of water.
  • Polluter pays principle: An accepted legal principle where the person responsible for the pollution is the one who pays for the damage to the environment.
  • Precautionary principle: the legal principle based on the idea of taking preventive action in the face of uncertainty or likelihood of an event in order to fix liability on the person responsible for that event.

Does a woman suffering from mental illness have the right to get an abortion?

If a woman suffering from mental illness wants to undergo an abortion, the law requires that the consent of her guardian (could be a parent or a spouse) should be taken(( Section 3(4)(a), The Medical Termination Of Pregnancy Act, 1971)). This is not the same for a mentally retarded woman(( Section 2(b), The Medical Termination Of Pregnancy Act, 1971.)). In cases of mental retardation a pregnant woman’s consent must be taken and no other person, including a guardian, can take the decision of abortion on the woman’s behalf.

 

Right to Choose Source for Medicines/Tests

Patients have the right to decide where they want to buy medicines from or where they want to get tests done from.1.This ensures that no limit to a patient’s options while choosing pharmaceutical brands or medicines. For example, if a doctor forces you to buy overpriced medicines for the purpose of earning a commission, you have the right to refuse such medicines. Further, patients can get tests done from any diagnostic centre/laboratory accredited by the National Accreditation Board for Laboratories (NABL). You can check for a list of accredited laboratories here.

The doctor or hospital administration must inform patients regarding the information given above. No one can force a patient to buy medicines or do tests from a particular facility. Further, this should not result in unfair treatment if the patient decides to choose their own facility or medicine store.(( Charter Patient Rights, Ministry of Health and Family Welfare))

  1. Charter Patient Rights, Ministry of Health and Family Welfare [↩]

Packaging and Warning Labels on Tobacco Products

Packaging of Tobacco Products

Under the law, every package of cigarettes, or any other tobacco product, must contain the following details(( Section a(iv), the Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules, 2014.)):

  • Name of the product
  • Name and address of the manufacturer, importer or packer
  • Origin of the product (in case of import)
  • Quantity of the product
  • Date of manufacture

More details may be added to this list by the government from time to time.

Warning Labels on Tobacco Products

It is mandatory for every package of cigarettes, or any other tobacco product, has a health warning(( Section 3(a), the Cigarettes and Other Tobacco Products (Packaging and Labelling) Rules, 2008.)). Such a warning must follow certain specifications, such as:

  • For both smoking and smokeless forms of tobacco products, the warning “TOBACCO CAUSES PAINFUL DEATH” and the words “QUIT TODAY CALL 1800-11-2356” should be printed on the package(( Section b(i), the Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules, 2020.)). This is enforceable from September, 2020.
  • The warning should cover at least 85 percent of the largest side of the package, 60 percent being the picture and 25 percent being the text.(( Section 2(i), the Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules, 2014.))
  • The ill-effects of tobacco on health are pictorially represented below the warning. For example, a picture of mouth cancer.(( Schedule 1(2), the Cigarettes and Other Tobacco Products (Packaging and Labelling) Rules, 2008))
  • The warning should appear in English, Hindi and any other regional languages.(( Section b(iii), the Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules, 2020.))

Selling Tobacco without Warning Label

If you produce or sell tobacco products without the required warnings, you may be punished in the following manner:

 

Cannabis

Trigger Warning: The following content contains information on drugs and narcotics which some readers may find disturbing. 

As per Indian law, possession and use of cannabis are illegal. However, from the cannabis plant only activities relating to the flowering part, aka Ganja/Weed, and the resin, aka Hashish, hash or charas, are illegal. 

Ganja/Weed

Ganja, also known as Weed, refers to merely the flowering part of the cannabis plant that becomes the fruit of the cannabis plant. The production, manufacture, possession, sale, purchase, transport, inter-state import/export, and the use of Ganja is banned in India. The punishment for carrying out any of these activities is proportional to the quantity of Ganja involved and not the type of activity.

  • Small amount (up to 1 kg):  Jail time up to 1 year, and/or fine up to Rs. 10,000.
  • Between 1 kg and 20 kgs: Jail time up to 10 years, and fine up to Rs. 1 lakh.
  • Commercial amount (20 kg): jail time  between 10 years and 20 years, and fine between Rs 1 lakh and Rs 2 lakh. The Court may also impose fine exceeding Rs. 2 lakh by recording reasons in the judgment.(( Section 20, Narcotic Drugs and Psychotropic Substances Act, 1985))

Charas/Hash

Charas is the separated resin (crude or purified) obtained from the cannabis plant and also includes concentrated preparation and resin known as hashish oil or liquid hashish. The production, manufacture, possession, sale, purchase, transport, inter-state import/export, and the use of Charas is banned in India. The punishment for carrying out any of these activities is proportional to the quantity of Charas involved and not the type of activity. 

  • Small amount (up to 100 grams): jail time  up to one year, and/or fine up to Rs. 10,000.
  • 100 grams – 1 kg: jail time  up to ten years, and fine up to Rs. 1 lakh. 

Commercial amount (1 kg): jail time  between ten years and twenty years, and fine between Rs 1 lakh and Rs 2 lakh. The Court may also impose fine exceeding Rs. 2 lakhs by recording reasons in the judgment.(( Section 20, Narcotic Drugs and Psychotropic Substances Act, 1985))

How do you get Covid-19 vaccination in India?

In India, the Government’s regulator for drugs CDSCO (Central Drugs Standard Control Organization) has allowed two vaccines which are:

  • Covishield (Oxford-AstraZeneca vaccine developed in the UK) and 
  • Covaxin (by Bharat Biotech). 

These vaccines have only received the permit to be used in a restricted manner for emergency situations. This means that they can be used despite the companies not having completed the entire procedure of clinical trials(( Press Statement by the Drugs Controller General of India (DCGI) on Restricted Emergency Approval of COVID-19 Virus Vaccine,  accessed at https://pib.gov.in/Pressreleaseshare.aspx?PRID=1685761#:~:text=The%20Subject%20Expert%20Committee%20of,III%20clinical%20trial%20of%20M. Covishield and Covaxin Is in Phase II/III and in Phase III of clinical trails respectively (as on Jan 2021.)). 

Cost and manner of vaccination

Currently, the vaccine provided in the first phase of vaccination will be given free of cost. Two doses of the same vaccine, given 28 days apart, will be required to be taken by an individual to complete the vaccination(( FAQ on COVID-19 Vaccines,  Ministry of Health and Family Welfare, accessed at https://www.mohfw.gov.in/pdf/FAQsonCOVID19VaccineDecember2020.pdf))

Priority groups getting vaccinations

The first phase of the Covid-19 vaccine will be administered to priority groups including:

  • Health Care Workers (HCWs): Health care providers and workers in health care settings (Public and Private), including ICDS (Integrated Child Development Services) workers. 
  • Frontline Workers (FLWs): Personnel from State and Central police department, armed forces, home guard, prison staff, disaster management volunteers and civil defense organization(( Directorate General, Fire Services, Civil Defence & Home Guards, Ministry of Home Affairs, available at https://dgfscdhg.gov.in/civil-defence.)), municipal workers and revenue officials engaged in Covid-19 prevention, containment, surveillance and associated activities. 
  • Persons More than 50 years of age and less than 50 years with co-morbidities like diabetes, hypertension, cancer, lung diseases etc(( COVID-19 Vaccines Operational Guidelines, Ministry of Health and Family Welfare, accessed at https://main.mohfw.gov.in/newshighlights-3)).

Process to get vaccinated in India 

Covid-19 vaccine will be provided only to beneficiaries pre-registered in the COVID Vaccine Intelligence Network (Co-WIN) system at www.cowin.gov.in(( COVID-19 Vaccines Operational Guidelines, Ministry of Health and Family Welfare, accessed at https://www.mohfw.gov.in/pdf/FAQsonCOVID19VaccineDecember2020.pdf)).

Step 1: Registration

Any person can register  by providing  basic demographic details like name, date of birth, permanent and current address, and details of co-morbidities, if any.  They will be required to provide their photo identity from one of the following: 

  • Aadhaar Card
  • Driving License
  • Health Insurance Smart Card issued under the scheme of Ministry of Labour
  • MGNREGA Job Card 
  • Official identity cards issued to MPs/MLAs/MLCs
  • PAN Card
  • Passbook issued by Bank/Post Office
  • Passport
  • Pension Document
  • Service Identity Card issued to employees by Central/State Govt./PSUs/ Public Limited Companies
  • Smart Card issued by RGI under NPR 
  • Voter ID Card

Step 2: Date and Place of Vaccination

Following online registration, the beneficiary will receive an SMS on their registered mobile number regarding the Health Facility where the vaccination will be provided, along with the scheduled date and time for the same. 

Step 3: Verification of Identification Proof

The Photo ID produced at the time of registration must be produced to the health officials and they will verify it  at the time of vaccination(( FAQ on COVID-19 Vaccines,  Ministry of Health and Family Welfare, accessed at https://main.mohfw.gov.in/newshighlights-31)). 

Step 4: Acknowledgment after receiving the vaccination

On getting a due dose of Covid-19 vaccine, the beneficiary will receive SMS on their registered mobile number. 

Step 5: Results

After all doses of vaccine are administered, a QR code based certificate will  be sent to the registered mobile number of the beneficiary. Their information will be uploaded on the Co-WIN platform(( FAQ on COVID-19 Vaccines,  Ministry of Health and Family Welfare, accessed at  https://main.mohfw.gov.in/newshighlights-31)). 

Even after getting vaccinated, people are required to continue taking the key precautions like wearing a mask, maintaining hand sanitization and physical distance ( 6 feet or Do Gaj)(( FAQ on COVID-19 Vaccines, Ministry of Health and Family Welfare, accessed at  https://main.mohfw.gov.in/newshighlights-31)).

Confidentiality of Health Related Information

The right to confidentiality of a person with mental illness about their mental health, mental healthcare and physical healthcare((Section 23(1),  the Mental Healthcare Act, 2017 )) means that the mental health professional who is providing care/treatment must keep all such health related information private, and not reveal it without the person’s consent .

This also includes the release of information to the media, such as the release of photographs or any other information without consent((Section 24(1),  the Mental Healthcare Act, 2017 )).

For instance, information is released by the relevant medical professional in the following cases((Section 23(2),  the Mental Healthcare Act, 2017 )):

  • To the nominated representative to enable them to fulfil their duties
  • To other health professionals to enable them to provide care and treatment
  • If it is necessary to protect any person from harm or violence or threat to life
  • On an order by an authority, such as the Mental Health Review Board, High Court, Supreme Court, etc.
  • In the interests of public safety and security.

The right to confidentiality of the person with mental illness applies to all information stored in electronic or digital format.((Section 24(2),  the Mental Healthcare Act, 2017 )).

What is the law on abortion for rape survivors?

The law provides that a pregnant woman may get an abortion if her pregnancy is a result of rape. The doctor has a legal duty to assume in such cases that the pregnancy gravely affects the woman’s mental health. However, it has to be noted that even if the pregnancy is a result of rape, an abortion can be performed legally only if the fetus is under 20 weeks and if the doctor believes it will not affect the woman’s or child’s health. While it is possible to go to Court to request for an abortion after 20 weeks, these abortions depend upon the discretion of the Court.

Safe and Quality Healthcare

It is the duty of medical establishments to provide a safe and clean environment for treatment. Infection control measures, safe drinking water and sanitation facilities should be provided in accordance with BIS(Bureau of Indian Standards)/FSSAI(Food Safety and Standards Authority of India) guidelines. The standard of care to be followed with regard to medical equipment and infrastructure has been mentioned in the Clinical Establishment (Central Government) Rules, 2012. The National Accreditation Board for Hospitals and Healthcare Providers (NABH) has released standards to be followed by hospitals for quality assurance.

If a doctor causes death of a patient due to a rash or negligent act, they can be punished for such death.(( Section 304 A, Indian Penal Code, 1860)) If hurt(( Section 319, Indian Penal Code, 1860)) or grievous hurt(( Section 320,  Indian Penal Code, 1860)) is caused to a patient as a result of the rash or negligent act of a medical professional, the medical professional can be punished with jail term up to 1 year((  Section 323, Indian Penal Code, 1860)) (in case of hurt)/7 years or fine or both(( Section 325, Indian Penal Code, 1860))