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1996 Supreme(P&H) 580
PUNJAB & HARYANA HIGH COURT
G.S.Singhvi and Sarojnei Saksena JJ.
Waryam Singh
Versus
State Of Punjab
Civil Writ Petition No. 16570 of 1995,
Decided On : APRIL 12, 1996
The right to life under Article 21 of the Indian Constitution includes the right to adequate medical assistance, and the Directive Principles of State Policy, particularly Articles 41 and 47, are integral to this right and can be used to interpret fundamental rights.
Headnote:
MEDICAL REIMBURSEMENT - RIGHT TO LIFE - DIRECTIVE PRINCIPLES OF STATE POLICY - INTERPRETATION OF STATUTES - JUDICIAL REVIEW - ADMINISTRATIVE INSTRUCTIONS - GOVERNMENT POLICY - HEART SURGERY - MEDICAL ATTENDANCE RULES - PENSIONERS - PUBLIC HEALTH - RECOGNIZED INSTITUTIONS - STATE LIABILITY.
Fact of the Case:
Numerous petitions were filed before the Punjab and Haryana High Court by government employees and pensioners seeking reimbursement of medical expenses incurred for treatment of various ailments, including heart surgery, at private hospitals and institutions. The petitioners contended that the government was obligated to provide adequate medical assistance under Articles 21, 41, and 47 of the Indian Constitution, which guarantee the right to life, the right to work and public assistance, and the duty of the state to raise the level of nutrition and standard of living and improve public health. The government, on the other hand, argued that reimbursement was subject to certain conditions and limitations, including prior approval from a Medical Board and restrictions on the amount of reimbursement based on rates set by the All India Institute of Medical Sciences (AIIMS).
Finding of the Court:
The High Court, after examining the relevant provisions of the Constitution, administrative instructions, and government policies, held that the right to life enshrined in Article 21 includes the right to live with human dignity and encompasses access to adequate medical assistance. The Court further held that Articles 41 and 47, which are part of the Directive Principles of State Policy, are integral to the right to life and impose an obligation on the state to provide medical assistance to its citizens. The Court also interpreted the relevant statutes and administrative instructions in a manner that favored the petitioners, holding that the government could not deny reimbursement solely on the ground of lack of prior approval from the Medical Board or limit reimbursement to the rates set by AIIMS.
Issues: 1. Whether the right to life under Article 21 of the Indian Constitution includes the right to adequate medical assistance? 2. Whether the Directive Principles of State Policy, particularly Articles 41 and 47, are enforceable in a court of law and can be used to interpret fundamental rights? 3. Whether the government can impose conditions and limitations on the reimbursement of medical expenses incurred by its employees and pensioners? 4. Whether the government can deny reimbursement solely on the ground of lack of prior approval from a Medical Board? 5. Whether the government can limit reimbursement to the rates set by a particular institution, such as AIIMS?
Ratio Decidendi: 1. The right to life under Article 21 of the Indian Constitution includes the right to live with human dignity and encompasses access to adequate medical assistance. This right is not limited to protection from bodily harm or deprivation of life but also includes the right to receive necessary medical treatment to preserve life and maintain a dignified existence. 2. The Directive Principles of State Policy, though not enforceable in a court of law, are integral to the right to life and can be used to interpret fundamental rights. They provide guidance to the state in formulating policies and enacting laws that promote the welfare of its citizens. 3. The government can impose reasonable conditions and limitations on the reimbursement of medical expenses incurred by its employees and pensioners, but these conditions and limitations must be applied fairly and consistently and should not result in the denial of necessary medical treatment. 4. The government cannot deny reimbursement solely on the ground of lack of prior approval from a Medical Board, especially in cases where the need for urgent medical treatment precludes the possibility of obtaining such approval. 5. The government cannot limit reimbursement to the rates set by a particular institution, such as AIIMS, if the actual expenses incurred by the employee or pensioner are higher. The government is obligated to reimburse the actual expenses incurred, subject to reasonable limits.
Final Decision: The High Court allowed the writ petitions filed by the petitioners and directed the government to reimburse the medical expenses incurred by them for treatment at private hospitals and institutions. The Court also directed the government to settle all pending claims for reimbursement of medical expenses within a specified time frame and to ensure that future claims are processed and reimbursed promptly.
G.S.Singhvi, J.
1. To some people State is essentially a class-structure, an organization of one class dominating over the other classes; others regard it as an organization that transcends all classes and stands for the whole community. They regard it as a power-system. Some view it entirely as a legal structure, either in the old Austrinian sence which made it a relationship of governors and governed, or, in the language of modern jurisprudence, as a community, organized for action under legal rules. Some regard it as no more than a mutual insurance society, others as the very texture of all our life. Some class the state as a great corporation and others consider it as indistinguishable from society itself. (Mac Iver, "The Modern State")
2. During recent times, the concept of State has undergone drastic changes. Today, State cannot be conceived of simply as a coercive machinery wielding the power of authority for simply collecting tax or for enforcing law and order. It now carries out multifarious activities affecting the lives of the individuals. State also renders varied kind of services to the people. According to Mac Iver- "if we clearly grasp the character of the State as a social agent, understanding it rationally as a form of service and not mystically as an ultimate power, we shall differ only in respect of the limits of its ability to render service."
3. Part III of the Constitution of India gives a picture of various fundamental rights available to citizens of India whereas Part IV indicates the areas in which the State has to render service to the people in general and the weaker sections in particular.
4. The interplay of part III and part IV has been considered by the Courts in various decisions. In one of the earliest decisions-in The State of Madras v. Champakam Dorairajan, A.I.R. 1951 SC 226 - fundamental rights were held pre- eminent vis-a-vis Directive Principles but since then there has been a perceptible shift in the Courts approach to the inter-play of Fundamental Rights and Directive Principles. In the Kerala Education Bill, A.I.R. 1958 SC 956 a Special Bench of the Supreme Court speaking through S.R. Das, C.J., while affirming the primacy of Fundamental Rights, qualified in with the following words :-
"Nevertheless, in determining the scope and ambit of the fundamental rights relied upon by or on behalf of any person or body, the Court may not entirely ignore these directive principles of State Policy laid down in Part-IV of the Constitution but should adopt the principle of harmonious construction and should attempt to give effect to both as much as possible."
5. In Keshavananda Bharti v. State of Kerala A.I.R. 1973 SC 1461, various Judges constituting the larger Bench expressed themselves on the inter relationship of the fundamental rights and the directive principles. Hedge and Mukherjee, JJ., observed :-
"The Fundamental Rights and Directive Principles constitute the conscience of the Constitution.......... To ignore part IV is to ignore the sustenance provided for in the Constitution, the hopes held out to the nation and the very ideals on which our Constitution is built... There is no anti-thesis between the Fundamental Rules and the Directive Principles.....one supplements the other."
Shelat and Grover, JJ, in their judgment observed :-
"Both Parts II and IV....have to be balanced and harmonised.... then alone the dignity of the individual can be achieved.....They (Fundamental Rights and Directive Principles) were meant to supplement each other."
Mathew, J. while adopting the same approach remarked :-
"The object of the people in establishing the Constitution was to promote justice, social and economic liberty and equality. The modus operandi to achieve these objectives is set out in parts III and IV of the Constitution, Both Parts III and IV enumerate certain "moral rights. Each of these Parts represents in the main the statements in one sense of certain aspirations whose fulfillment
