Supreme Court's 'Anmol' Moment Opens the Door to Justice for Disabled Students in Medicine

The Supreme Court has called out the ableism in medical education. However, Anmol v. Union of India comes as a paradigm shift not only in medical education but also in our constitutional discourse.

Rejection of the obsolete ableist ‘both hands intact’ rule to pursue medical education makes our medical colleges kinder, gentler, and more accepting sites of knowledge for disabled students who wish to pursue medical education. A judgment alone cannot weed out the ingrained ableism in our institution. However, it opens the door to epistemic justice for disabled students in medicine. 

Dismantling ‘compulsory able-bodiedness’ of medical education

Critical disability scholar Robert McRuer opines that in our daily life, ‘compulsory able-bodiedness’ masquerades as the natural order of things. In this valorisation of able-bodiedness, disabled embodiment is marked, pathologised, and policed as a deviant and diminished body.

The National Medical Commission's guidelines for medical education enable this compulsory able-bodiedness and negate the aspiration of several disabled students to pursue medical education. In this case, a bright disabled student, Anmol, secured his position in the OBC-PwD category in the NEET examination 2024. Experiencing 58% disability, he faced the first ableist injustice by the Disability Assessment Board of Government Medical College, Chandigarh, which rendered him ineligible to pursue medical education without giving any reason and without examining functional disability.

The Supreme Court, while hearing the writ petition filed by Anmol, directed the director of AIIMS, New Delhi, to constitute a committee to have a fresh assessment. Sadly, the board's majority opinion did not find him fit to join the MBBS course, though they accepted that current NMC guidelines may need revision. The majority opinion failed to consider that Anmol can navigate his MBBS course if he is provided with reasonable accommodations of assistive technologies and clinical accommodations. 

The sad reality of medical education is that its curriculum and rules are not disability-friendly and disability-affirming. Even the coveted AIIMS Delhi has outdated syllabi that simply do not take into account an inclusive approach to providing reasonable accommodations for students with disabilities. Apart from casual ableism and lack of reasonable accommodation, such as assistive technologies in medical colleges, medical education brings another pedagogical impediment called the ‘undifferentiated graduate’ problem. This pedagogical approach demands that every medical graduate be capable of entering any specialty. The demand for compulsory able-bodiedness comes in its totalitarian avatar, as this pedagogical approach demands an extremely high threshold of motor, sensory, and other abilities and makes medical education inaccessible for disabled students. 

A recent article in the prestigious medical journal Lancet by Ananya Tina Banerjee called out the legacies of ableism in medicine and the need to pursue disability justice in the discipline. In his powerful work, Medicine and Colonialism, Frantz Fanon pointed out that colonial medical practices were the enabling epistemic forces of colonialism and the racial production of bodies. Ableism in the present-day medical practice supports the colonial and eugenic logic subtly.

Democratisation of our medical curricula demands a powerful epistemic counter to ableist logic and practice in medicine.

Constitutional discourse 

In recent times, the battles for human dignity and the rights of the disabled in our courtrooms are shaping our constitutional discourse and imagination. In Anmol, the Supreme Court has come down heavily against the ableism of the ‘both hands intact’ rule and found it violative of Article 41 of the constitution and rights guaranteed under the Rights of Persons with Disabilities (RPwD) Act, 2016.

In Om Rathod, another case related to the medical admission of a disabled student, the Supreme Court, while highlighting that fraternity is a pivot of a progressive grundnorm, deployed it as a bulwark against the prejudices of ableism. Dr. B.R. Ambedkar was of the view that fraternity has the potential to undermine and break down social hierarchies and social dominations. Ableism is social domination that sees and renders the majority of us invalid. It is an ever-present and evolving dominance, as ‘Talila “TL” Lewis’ working definition of ableism highlights. Talila points out that ableism is linked with anti-blackness (read anti-Dalit and minority in the Indian Context), eugenics, misogyny, colonialism, imperialism, capitalism, and other debilitating factors. We need a progressive constitutional imagination to fight ableism that produces physical, social, visible, and invisible disabilities. Ableist social dominance is antithetical to our constitutional spirit and framework and hence, it must be rejected. 

In the preface of The Idea of Justice, Amartya Sen reminds us that perfect and complete justice is impossible to achieve in an imperfect world. Still, there are remedial injustices around us that we must attempt to eliminate. The lack of reasonable accommodation is one such remedial injustice that the Supreme Court has tried to eliminate in Anmol. The court deserves our respect for doing so and being the ally of disabled students to make medical education accessible. 

Vijay K. Tiwari is an assistant professor of law at West Bengal National University of Juridical Sciences, Kolkata. Tiwari engages in critical disability studies. 

Satendra Singh is director-professor at the University College of Medical Sciences, Delhi. Singh was part of the six-member committee constituted by the director of AIIMS Delhi under the direction of the Supreme Court in the Anmol case. 

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