The Supreme Court today(October 27) expressed its inclination to lay down some guidelines based on constitutional principles for mandatory compulsory rural service by medical students across the country.

A bench comprising Justice PS Narasimha and Justice Alok Aradhe orally expressed this in view of the lack of clarity on the Union's stand on the same. It may be recalled that the bench is hearing a writ petition challenging a notification issued by the Karnataka Government that required medical students to fulfil one year of compulsory public rural service in order to be eligible for permanent registration with the Karnataka Medical Council.

In previous hearings, the bench has questioned the exemption and asked why the private institutions don't want to serve people in rural India. In the latest hearing, the Court suggested that there should be a uniform policy regarding compulsory rural service to be rendered by medical students. The Solicitor General agreed to get instructions from the Centre regarding such a pan-Indian policy.

When the matter was taken up today, Additional Solicitor General Aishwarya Bhati submitted that there is a compulsory requirement for Postgraduate students on a rotation basis. But nothing at the undergraduate level. She further submitted that since health is a State subject, many States have issued bonds for such compulsory service. Bhati added that a Committee was set up which has recommended that such bonds may be uniformly adopted by all States.

Senior Advocate Raju Ramachandran, who is the amicus in this case, suggested laying down appropriate guidelines to fill the legislative gaps based on Article 21 and Directive Principles of the State Policy. Per contra, Bhati suggested that the Union can pursue a consultative exercise and a mandate from the Court may not be there as it would impact the institutions across the country.

Terming the matter important, Justice Narasimha said what they will decide today will impact the future of medical aid in India. He added that since the Union's stand is not clear and there seems to be a "policy deficit."

He said: "What is suggested is not a mandate. As a matter of principle, are the policy makers and constitutional requirements in sync with that principle that rural service across India for our doctors is a necessary measure or not for betterment of our health and national health? That is the short issue. After that, the second issue is, how it is to be implemented in the form of a bond or regulation, but as a principle, there is no clarity. You must reflect on this with the Secretary of Medicine or whoever is the policy maker; otherwise, on the basis of the constitutional interpretation, the right to health is a fundamental right, and the obligation of the State, it is necessary. In times to come, where access to hospitals will virtually be access to hospitals run by private institutions, moving away from catering to the needs of the rural areas."

The Court ultimately kept the matter to be heard next week and asked the Union to clarify whether they intend to formulate a policy and whom it will consult.

"We will formulate the constitutional requirement of it just as a guiding principle. The formulations will be by the State in consultation with the Commission," Justice Narasimha suggested.

The Karnataka Compulsory Service Training by Candidates Completed Medical Courses Act, 2012, and subsequently framed the Karnataka Compulsory Service Training by Candidates Completed Medical Course Rules, 2015 are in question.

The scheme mandates every MBBS graduate, every Post-Graduate (Diploma or Degree), and every Super Specialty candidate who has pursued their course of study either in a government university or on a government seat in a private/deemed university to render one year of compulsory public rural service. Only after the fulfillment of this requirement will the requisite No-objection certificate (NOC) be issued, and this will enable the petitioner to be eligible for permanent registration with the Karnataka Medical Council.

As per the notification dated 28.07.2023, this requirement was extended to candidates enrolled in private seats in private/deemed universities.

Pertinently, in the petition it has been argued that the Candidates enrolled in private or deemed universities on private seats, who are pursuing their studies at significantly higher costs, constitute an intelligible differentia under Article 14 of the Constitution of India. Consequently, they are not to be subjected to compulsory service requirements, argued the petitioner.

To support this, the Court's decision in Association of Medical Super Speciality Aspirants Residents & Ors. Vs Union of India & Ors W.P.(C) No. 376/2018 has also been cited. In this, the Court rejected the challenge against the imposition of compulsory bonds to be executed for admission to post-graduate medical courses and super specialty courses. However, at the same time, it was noticed that certain State Governments have rigid conditions in the compulsory bonds and therefore suggested that Union of India and the Medical Council of India may take steps to have a uniform policy regarding the compulsory service to be rendered by the Doctors who are trained in government institutions.

In view of this projection, the writ petitioner has primarily prayed for the following two directions: