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Aids Patients and their Fundamental Right to Medical Sevices
by S. James Vincent*

Cite as : (1997) 6 SCC (Jour) 21

Introduction

Acquired Immuno Deficiency Syndrome (AIDS) is a disease characterized by a gradual depletion of the body's natural immune system, which is caused by the Human Immunodeficiency Virus (HIV). Nearly half of the diagnosed AIDS patients have died. Others may live for one to three years. No treatment has successfully restored the immune system of an AIDS patient to normal functioning1. However, of late (March 1996), a new batch of drugs have reached the U.S. medical stores which provide "a few new reasons for hope"2. To avoid spreading AIDS, the patients should: (i) not donate blood or plasma, sperm, organs or tissues; (ii) limit sexual contacts and engage only in safe sexual practices; (iii) not engage in sexual acts resulting in exchange of body fluids like saliva and semen; (iv) refrain from sharing articles like toothbrushes, needles, syringes and razors that could become contaminated with blood; and (v) avoid or postpone pregnancy to avoid transmission of the virus from mother to the unborn child, if the sexual partner is HIV positive.

HIV is mainly transmitted through sexual contact and by exposure to infected blood or blood components (80-90%). The second major route is syringe or needle-sharing by intravenous drug users (5-10%). If the preceding user is a confirmed HIV +ve, the chance of transmission is 100%. Infected mothers also can pass it to their offsprings (0.1%). Persons at increased risk of developing AIDS are homosexuals and sexually licentious persons, intravenous drug users, individuals transfused with contaminated blood or blood products, and children born to infected mothers3. Because we cannot eradicate HIV from human body once infected, prevention is considered most effective. Sex education and awareness programmes, free distribution of condoms to adolescents and syringes to intravenous drug users, etc. have been experimented in countries like England, Netherlands and Australia4.

Constitutional and Legal Aspects

The contagious nature of AIDS has made medical personnel afraid and wary of providing prompt treatment to AIDS patients. This has raised the questions of the fundamental right of AIDS patients to medical attention and treatment, and whether hospitals and medical personnel can legitimately deny them such services in view of the hazardous nature of the treatment.

The right to life and liberty has its origin in natural law and is rooted in antiquity. It has found its constitutional expression first, in England, in Magna Carta (AD 1215). Now, Article 25(2) of the Universal Declaration of Human Rights, 1948 assures everyone the right to a standard of living adequate for the health and well-being of himself and of his family, including medical care, sickness and disability coverage. In our Constitution, this right is guaranteed in Article 21 which reads as follows:

"21. Protection of life and personal liberty.-No person shall be deprived of his life or personal liberty except according to procedure established by law."

Probably this article has received maximum attention from both the Constituent Assembly and the Supreme Court. Because of the vibrant interpretation given by the Apex Court to Article 21, it has become the thrust and throb of the Constitution itself. It has been judicially interpreted that the word "life" does not mean mere animal existence - it has to mean a life befitting human dignity. The right to livelihood is also a part of this article. Since a man cannot earn his livelihood without being healthy, the health of a person would also become an integral facet of his right to life. Article 41 mandates the State to provide, consistent with its economic capacity, for its citizens the right to public assistance in sickness and disablement. In a case concerned with the legal obligation of the State to prohibit the sale and use of banned drugs, the Supreme Court almost accepted the right to health as a fundamental right, in the following words: (para 16)5

"A healthy body is the very foundation for all human activities. That is why the adage 'Sariramadyam Khalu Dharma Sadhanam'. In a welfare State, therefore, it is the obligation of the State to ensure the creation and the sustaining of conditions congenial to good health."

In another case6, the Supreme Court had to directly decide whether the members of the medical profession have a professional or legal duty to provide medical aid to a person who was injured in an incident involving a criminal case, and held: (p. 293, paras 7 and 8)

"7. There can be no second opinion that preservation of human life is of paramount importance. ... The patient whether he be an innocent person or be a criminal liable to punishment under the laws of the society, it is the obligation of those who are in charge of the health of the community to preserve life so that the innocent may be protected and the guilty punished....

8. Article 21 of the Constitution casts the obligation on the State to preserve life. ... A doctor at the Government hospital positioned to meet this State obligation is, therefore, duty-bound to extend medical assistance for preserving life. Every doctor whether at a Government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life. ... The obligation being total, absolute and paramount, laws of procedure whether in statutes or otherwise which would interfere with the discharge of this obligation cannot be sustained and must, therefore, give way."

Again, the question of the State's duty to protect life arose before the Supreme Court in Gian Kaur case7 in which the right to commit suicide was in issue. A Constitution Bench held as follows: (paras 20 and 21)

"20. To give meaning and content to the word 'life' in Article 21, it has been construed as life with human dignity. Any aspect of life which makes it dignified may be read into it but not that which extinguishes it and is, therefore, inconsistent with the continued existence of life resulting in effacing the right itself....

21. ... The 'right to life' including the right to live with human dignity would mean the existence of such a right up to the end of natural life... ."

A Division Bench of the Punjab and Haryana High Court8 also ruled that Article 21 is wide enough to read a duty of the State to provide medical facilities. It held:

"8. Article 21 ... is wide and of far reaching consequences. As and when life in any form or to any extent is taken away or endangered by any functionary of the State, a duty is cast upon the State ... to compensate the victim by granting adequate compensation. ... The maintenance of law and order and providing adequate facilities in the Government hospitals is the responsibility of the Government...."

Practical Aspects

Constitutionally, as we have seen, an AIDS patient is entitled to get medical treatment, without any discrimination. It is also possible for him to secure damages if he is denied medical treatment and as a result suffers any injury. However, the question of enforcement of their right to medical treatment gains importance in the context of the warning of the World Health Organisation that, by AD 2000, 50% of the patients in the hospitals of India will be AIDS patients. This alarming situation make us focus our attention on preventive measures.

Although the medical community primarily directs its efforts to the (now) comparatively infinitesimal percentage of those currently infected with HIV who are symptomatic, we ought to be more concerned about the asymptomatic HIV-carriers. Not for several decades has the fundamental, dynamic tension between the constitutional rights of the individual and those of the community been so critically scrutinized. This paper focuses on the legal issues surrounding HIV testing and identifies several potential areas for misuse of, and the inherent risk associated with, information available to the professional, and the possibilities for discrimination and legal action.

Reliability of HIV Infection Tests

Even individuals who are tested negative for the presence of antibodies to HIV may be discriminated against, on the basis that they would not have allowed themselves to be tested unless they had indulged themselves in risk-taking behaviours. Because HIV lies dormant in various tissues of the body, it is presumed that all exposed individuals are infected and capable of transmitting the virus for years. As a fully reliable test for HIV detection is not commercially available, serologic tests for antibodies directed against HIV are in vogue. The sensitivity of the currently licensed Enzyme-Linked Immuno-Sorbent Assay (ELISA) antibody screening test is over 99%; while a negative ELISA antibody test does not absolutely rule out exposure to HIV, as it generally takes a minimum of six weeks from the time of exposure/infection to develop a measurable antibody response. However, prolonged periods of infectivity up to 18 months have been noticed. Moreover, a few cases of antibody-negative and culture-positive individuals have been documented, as well as of antibody-positive individuals who have later become seronegative.

Individual Rights and the Determination of HIV Infection

Most countries have no specific law protecting individual rights. In U.S.A., too, most States have no specific laws governing the sharing of any HIV-related medical information; medical personnel are bound by the established hospital policies and State laws with regard to disclosure of medical information. The civil laws on slander and libel are clearly applicable where there is an improper disclosure of information. Medical personnel face the dilemma of not knowing when, and whether, they should notify other medical personnel or even a patient's spouse or sexual partner. A physician may be liable for damages if he fails to notify those potentially exposed to an infectious disease9. The medical practitioner involved with direct patient care has an affirmative "duty to warn" other individuals known to be at risk of infectious diseases10. In "duty to warn" cases, a physician has no liability where the victim has been notified of the danger from the patient11. An HIV-carrier has also a duty to warn those in danger of becoming infected. Failure to notify the sexual partner of the risk of infection may subject that individual to liability for any resultant physical or emotional injuries12. Earlier, a husband and been found liable for infecting his wife with a venereal disease13.

Litigation focusing on defendants accused of having knowingly exposed others to HIV infection is reported. In the U.S.A., Florida and Idaho have made it a crime to wilfully or knowingly expose another person to HIV. Similar statutes are in contemplation in other States. Legislation providing for forcible isolation of infected people who are believed to threaten public safety is also in contemplation. HIV tests are routinely used to screen blood and organ donors, and is compulsorily required of all Defence and Foreign Service personnel, Peace Corps Volunteers and military recruits. Seropositive personnel generally are not discharged if they are able to perform their military duties. Other potential users of the HIV test, such as screening applicants for jobs, insurance policies and marriage licenses, are currently the focus of a national debate. Proponents of testing claim that identifying HIV-positive cases will protect those who are not infected. The objection is that routine testing might involve huge expense of mass testing, while it would drive those most at risk underground. Proposals to require routine testing of hospitalized patients provoked strong objections by medical experts who argue that such a policy would not curtail the spread of infection, but rather raise serious legal questions regarding informed consent and patients' rights. In the U.S., Louisiana has passed a law requiring premarital testing.

HIV Testing and Confidentiality

In the U.S., despite assurances of confidentiality, HIV test results must be noted in the patient's medical record, and, as such, may be summoned in legal proceedings. Further, test results must be reported to public health authorities for surveillance and identifying case contacts. A new law in Colorado imposes a fine on doctors who do not report the names of seropositive individuals to the Health Department, and officials who breach the confidentiality of this information are fined.

Discrimination

(a) Workplace.-The U.S. Occupational Safety and Health Administration has announced a voluntary plan for establishing guidelines for protecting the nation's five million health care workers from infectious blood-borne diseases, including HIV. Its guidelines can be enforced under the Occupational Safety and Health Act which requires employers to maintain workplace free from "recognized hazards". In 1982, the Centre for Disease Control (CDC) issued voluntary guidelines for protecting health care workers from HIV14, which called for infectious material to be placed in an impervious bag, and gave specific cleaning instructions in respect of equipment, linen, reusable dishes and utensils; of cleaning "blood spills"; and handling and disposal of needles and other sharp items. Gloves, gowns, masks, and eye coverings should be used when the possibility of an employee being exposed to blood or other body fluids, exists. To avoid the need for mouth-to-mouth resuscitation, employees should use mouth-pieces, resuscitation bags, or other ventilation devices. Guidelines for the protection of dental care personnel and persons performing necropsies or providing mortician's services were published by the CDC in 198315.

Despite the CDC Guidelines and reassuring scientific data in the U.S., fear of AIDS transmission by casual contact in the workplace has led to numerous dismissals. Most cases of discrimination and wrongful termination are being litigated under existing civil rights statutes. However, many States have specific legislation forbidding discrimination due to AIDS. In June 1986, the Justice Department rules that employers receiving federal funds can discriminate against people with AIDS. However, in March 1987, the U.S. Supreme Court overruled that, stating that employers who receive federal funds cannot discriminate against people who are physically or mentally impaired by contagious disease16. The privileges of medical personnel affected with AIDS have also been curtailed on the ground that the public's fear of contracting AIDS would deter patients from seeking medical care from such persons. A patient could claim that he had been the victim of the tort of battery by unknowingly receiving treatment from an HIV-infected clinician, and that he would not have sought treatment if he had known that the clinician was infected. Some professionals believe that a physician practising as per guidelines does not place patients at significant risk of infection, and that, whether or not a physician is HIV positive, is immaterial to the delivery of good medical care.

(b) Availability of Medical care and Quarantine.-Fear of contracting AIDS has resulted in numerous instances of patients in high-risk groups being refused treatment. Many feel that such actions, although not specifically illegal, are not in keeping with the physician's ethical responsibilities. In a recent case in Florida, litigated under the existing civil rights statutes, a 14 year old HIV +ve boy was quarantined in a hospital psychiatric ward because his continued sexual activity was a danger to public health17. In the face of growing public fear of contracting AIDS, many States are likely to adopt quarantine measures.

(c) Problem Faced by Refugees with AIDS.-National policies of exclusion of HIV/AIDS victims from entry imperil procedures of admission, resettlement, local integration and repatriation of a refugee, which constitute the essential basis of refugee protection and assistance. The consequent anomaly has necessitated the UN High Commission for Refugees to formulate a course of action specific to refugees infected with HIV/AIDS. It gives primacy of two grounds for waiver of exclusion from grant of refugee status - humanitarian reasons and the need for family unity. Public interest, too, is a factor. The ground of humanitarianism is violated when a refugee is denied entry because of HIV/AIDS, even though he fits the other criteria for resettlement18. In India, Section 2(2) of the Epidemic Diseases Act, 1897 invests the State Governments with the power to make measures and regulations for the inspection of persons travelling by railway or otherwise, and the segregation, in hospital, temporary accommodation or otherwise, of persons suspected by the inspecting officer of being infected with any such disease.

(d) Availability of Insurance.-The enormous expenditure for health care of AIDS patients has resulted in insurers requiring HIV testing for applicants for life or health insurance, and denying policies to the infected. They claim that the ability to assess risk is the foundation of insurance underwriting, and that denial of this ability will destroy the industry. Opponents hold that insurance is integral to achieving quality health care, and refusal to insure on the basis of antibody status, is illegal discrimination. In the U.S., most States have had to consider legislations governing the use of HIV tests by insurers. California and Wisconsin have banned mandatory testing. The City Council of Washington D.C., also followed suit, resulting in more than 90% of insurers refusing to underwrite policies within the city. In many States, AIDS patients are eligible for social assistance. AIDS is now classed as an epidemic in countries like U.S.A., and there is evidence that HIV positive individuals are being discriminated against19.

Legal Aspects of Doctor-Patient Relationship in HIV/AIDS Cases20

(a) Confidentiality.-Confidentiality arises when intimate information is imparted during a relationship creating an obligation of confidence. All doctors are guided by the moral codes in the Hippocratic Oath. The declaration of Geneva, 1968 (as amended at Sydney) requires a doctor to respect the secrets confided in him. The doctor is also under a Common Law obligation to respect the confidences of the patient. Yet all known nations, with the exception of France and Belgium, recognise exceptions to breach of confidentiality, where the public interest outweighs the patient's interest in maintaining confidentiality. Doctor/patient confidentiality, has gained greater importance since the rise of AIDS. The association of HIV/AIDS with homosexuality and drug abuse has led to immense social stigmatisation and ostracisation. Hence, the confidentiality of one's HIV/AIDS status carries enormous consequences.

In England, there is no specific law for maintaining confidentiality of HIV status. There is no federal legislation in Australia either. Protection for confidentiality in respect of an AIDS patient is provided by each separate State; e.g. in New South Wales, a 1991 Act requires medical practitioners to keep an Individual's HIV status confidential, except in certain special circumstances. In the U.S., confidentiality is a right guaranteed by the First Amendment to the Constitution. Various States have enacted legislation which prevents the disclosure of professional information by a medical practitioner. In India, there is no central statute which specifically provides for medical confidentiality. However, in Goa there is the Public Health Act, 1985. Specifically regarding HIV/AIDS, the Bombay High Court, based on the provisions of the Act, held in Lucy case21 that an individual's HIV status can be disclosed if the public interest outweighs the patient interest. Because of the intimate nature of doctor-patient relationship, medical confidentiality is protected by the common law. Breach of confidentiality is actionable by filing a suit for damages and obtaining an injunction restraining the person from disclosing the confidential information.

(b) Notification.-As discussed above, almost all common law countries recognise the duty of the doctor to maintain confidentiality. However, most countries have enacted statutes which oblige doctors to disclose the health status of the individual in specific instances, such as in the event of epidemics. The law in England requires medical practitioners to notify the Health Authority of any person with AIDS/HIV; but his identity need not be disclosed. In Australia, all States, excepting Victoria, have legislation which requires the medical practitioner to notify the Health Department if he has reason to believe that a patient is suffering from AIDS/HIV. In the U.S., the power of notification is with the States. The discovery of HIV has led certain States to add HIV for notification.

In India, the Epidemic Diseases Act, 1897 requires medical practitioners to notify the Health Officer of any person with infectious disease and disclose the identity of the individual. The Goa Public Health (Amendment) Act, too, by implication, allows for disclosure/notification to public officials of an individual's HIV status by giving them the power to test and isolate such persons they suspect of having the virus. The weighing of the social and personal consequences, is not always as easy task. In most cases, the doctor has to assess the risk of infection to a third party caused by his patient's reluctance to disclose his HIV status. He has to balance his duty to warn the third party and that of confidentiality of his patient.

In England, the courts have balanced the doctor's duty to maintain patient confidentiality and the countervailing duty to warn potential victims. The court, in Egdell case22, held in favour of disclosure, feeling that the public interest far outweighed the duty of confidentiality, while in another case23 against disclosure, holding that the public interest was not sufficient to disclose the doctor's name with AIDS. In the U.S., the California Supreme Court24 held a psychiatrist responsible for informing a stranger of the danger posed by his patient. The Indian courts have yet to decide on the doctor's duty to warn a third party vis-a-vis his duty to maintain patient's confidentiality.

(c) Consent and Testing.-The common law protects an individual's body from any interference by others, or the individual himself, without consent - implied or express. In routine tests or treatments, the patient's consent is often implied. In less routine procedures, e.g., a Caesarian section, or where the doctor needs to perform an internal surgery, he should obtain a written consent from the patient. Consent is often necessary for HIV/AIDS testing because it involves removing an individual's body fluids. There is much debate as to whether, once the body fluid is removed, the patient still has authority over how it is used, e.g., for research or other purposes.

There are predominantly two types of testing carried on by doctors - non-invasive and invasive. Usually, diagnostic tests, e.g., sputum, faeces and urine tests do not interfere with the individual. But, in a blood test, as in AIDS testing, blood has to be removed from the patient by puncture, causing interference with his body, which requires his previous explicit consent. Ethical concerns arise when, once the blood is removed from the patient with consent, it is used for purposes other than those the patient consented to. Because of the major social and personal implications of being HIV positive, testing is a very sensitive procedure. It is argued that mandatory testing is necessary to prevent the further spread of AIDS. This is part of a larger isolationist approach which calls for no-confidentiality, isolation of infected people, and discrimination. The alternative is the integrationist approach which calls for consensual testing, confidentiality, integration of HIV positive people into society, and no discrimination against infected persons. The latter system, being more humane, is gaining acceptance.

In England, there has been no significant court decision with regard to consent in HIV testing. But the General Medical Council has stated that testing should occur only with the specific consent of the patient, except in the most exceptional circumstances. In Australia three States have enacted statutes imposing a duty on doctors to provide information to patients in regard to HIV/AIDS. The New South Wales Public Health Act, 1991 provides that, if a doctor suspects a patient of having HIV/AIDS, he must provide the patient with information concerning the means of minimising the risk of infection, public health implications, and treatment options. Legislation providing that the patient must give full and free consent prior to being tested and that he be fully informed of the medical and social consequences of HIV/AIDS, is on the anvil in Tasmania. In the U.S., courts have held (e.g. in Doe case)25 that the doctrine of informed consent applies to taking blood for HIV testing. In India, the Union or the States (excepting Goa) have not enacted statutes to provide for mandatory testing, and it cannot be performed without the individual's consent. In Goa, the Public Health Act, 1985 empowers the State Government to collect blood for HIV/AIDS investigation if the health officer has reasonable grounds to suspect that any person has HIV/AIDS.

(d) Treatment.-Doctors should obtain the patient's consent before treatment - invasive or otherwise. In cases of blood transfusions, the doctor needs to interfere with the patient's body to perform the surgery, and is required to obtain the consent of the patient. Issues dealing with consent to HIV treatment do not often arise. Instead, HIV infected persons are often denied treatment owing to their HIV status. Doctors are obliged (under the Geneva Declaration) to treat patients regardless of "religion, nationality, race, party politics, or social standing". Its application to AIDS patients, is still on debate. In many countries, AIDS is regarded as an "impairment" or "handicap" and thus protected by antidiscrimination laws. But many doctors argue that the risk of their contracting AIDS by treating HIV positive patients is a sufficient reason not to treat, though courts have not been sympathetic to that argument.

Generally speaking, Indian courts have had no chance to deal with such cases. However, in a recent PIL case of discriminatory and inhuman treatment meted out to a suspected HIV-infected mother and her baby by the medical authorities, the Guwahati High Court has directed the State AIDS Programme Officers to appear before the Court in relation to the pathetic condition of one Jahnabi Sharma, a 21 year old mother and her daughter. Allegedly, Mrs Sharma's trauma started since her husband died of AIDS. Her in-laws drove her out of the house apprehending that she might be HIV +ve. On arrival at her parental home, her condition worsened: the whole family was ostracised. On being brought to the Guwahati Medical College Hospital, they were sent to the Infectious Diseases Hospital, and then to the Isolation Ward. Later on, when discharged, they had no place to go26. People are so much afraid of AIDS that even those of the most literate State (Kerala) resent even voluntary organisations/philanthropists giving shelter and treatment to AIDS patients27. Along with the doctor's duty to treat persons infected with HIV, there is also the issue of access to innovative treatments. Ethical concerns arise when terminally ill patients are denied access to new treatments because of their poverty.

In England and Australia, doctors are not obliged to treat persons with whom they have had no previous professional contact. But they have an obligation to treat a person to save his life. In the U.S., doctors have a legal and ethical obligation to provide treatment when it is necessary to prolong the life of a person. The California Supreme Court has held in Doe case28 that persons with HIV cannot be discriminated against in the receipt of health care services. In India, presently, there is no statute which specifically requires that doctors should treat AIDS patients. However, all medical practitioners have a common law duty to treat all patients who are brought to them.

"AIDS Capital"

Though AIDS was first reported in U.S.A. in 1981, and the first AIDS patients were spotted in Bombay and Madras only in 1986, India has already earned the distinction of being the "AIDS Capital", and it is bound to cause a major socio-economic disaster in the next decade. With more than three to five million people harbouring the deadly HIV, India has no choice but to accept this bitter truth. The number of those contracting HIV will double every 18 months, and will be around 16 and 40 millions in the next five years. The death toll can then be as high as 10,000 a day29. In Manipur, the rate of infection among intravenous drug users has trebled to 65% since 1991. In Bombay, nearly 60 per cent of the 70,000 odd sex workers carry HIV. Statistics clearly show that the predominant mode of spread of AIDS, except in Manipur, is unguarded sex, while in Manipur it is intravenous drug abuse. The current data on the prevalence of AIDS in India is startling. Of the 2,854,963 blood samples screened as of June 1996, HIV positive cases reported were 23,147; the percentage of HIV positive cases was 0.08; and the number of AIDS cases reported was 262130. The Government's efforts to educate the masses and create mass awareness of the dangers of AIDS also have been half-hearted, though India has been getting liberal aid and loans since 1992, including $85 billion from the World Bank, and $10 million from the U.S.A.I.D. Doctors contend that sex as a subject is still not taught in schools and colleges, and that boys and girls have unprotected sex frequently, which reflects in the rise in teenage pregnancies. Prevention being better than cure, what is needed is an effective multidisciplinal, multipronged, preventive approach.

Conclusion

Humans being what they are, in the context of a general patient refusing to be treated by an AIDS-afflicted physician or clinician, and as no law can compel him to subject himself to such treatment in the background of Articles 19(1)(g) and 21 of the Constitution, which are equally guaranteed to the physician too; on the moral plane, it is difficult to answer whether a physician can be compelled to render medical service to an AIDS patient. But any decision should rest on the premise that most (at least, many) of the AIDS patients and HIV carriers are the innocent victims of an indifferent system (donees of blood, child in the womb) or the inadvertent sufferers of sexual perversions (HIV positive child prostitutes, innocent housewives), and trade and trap victims (the adolescent drug addict and the intravenous drug abuser), and therefore deserve to be considered as part of humanity, and on sufficient precaution, given medical treatment, without being discriminated and ostracised.

* Advocate, High Court of Kerala Return to Text

1. See Richard Wagman (Ed.), Medical and Health Encyclopaedia, Vol. II, p. 584 Return to Text
2. Vishwas R. Gaitonde: "Hope and Despair" (Frontline), 6-9-1996, p. 86; and Christine Gorman: "What I'm Gonna Live?" (Time), 14-9-1996, p. 46 Return to Text
3. Harold M. Ginzburg and Mark J. Rosen: "Legal Aspects of Human Immunodeficiency Virus Infection-Testing and Discrimination", in James R. Vervaina et al (Ed.): Legal Aspects of Medicine (1988) p. 252, quoting J.W. Curran et al: "Epidemiology of HIV infection and AIDS in the United States", Science (1988) 239, pp. 610-616 Return to Text
4. Dr Joga Rao: "Should We Distribute Syringes to Intravenous Drug Abusers?", in Law and Medicine (1996), Vol. 2, p. 21 Return to Text
5. Vincent v. Union of India, (1987) 2 SCC 165 (per Ranganath Misra, J.) Return to Text
6. Parmanand Kataria v. Union of India, (1989) 4 SCC 286 (per Ranganath Misra, J.) Return to Text
7. Gian Kaur v. State of Punjab, (1996) 2 SCC 648 (per J.S. Verma, J.) Return to Text
8. Jasbir Kaur v. State of Punjab, AIR 1995 P&H 278 Return to Text
9. Davis v. Rodman, (1921) 227 Southwestern Reporter 612 (Arkansas), quoted by Ginzburg & Rosen, supra, N.3 Return to Text
10. 61 Am. Jur. 2d, Physicians and Surgeons, Sections 170 & 245 Return to Text
11. In Re Estate of Votteler, (1982) 327 N.W. 2d. 759 (Iowa) Return to Text
12. Kathleen K. v. Robert, (1984) 198 California Reporter 273 Return to Text
13. Crowell v. Crowell, (1920) 105 South-Eastern Reporter, 206. (North Carolina) Return to Text
14. CDC : "Acquired Immuno Deficiency Syndrome (AIDS) : Precautions for Clinical and Laboratory Staffs", Morbid Mortal Weekly Rep. (1982) 577 Return to Text
15. Morbid Mortal Weekly Rep. (1983) 450 Return to Text
16. New York Times, 11-7-1987, p.1 (quoted by Ginzburg & Rosen: op.cit., p. 257) Return to Text
17. Harold M. Ginzburg and Mark J. Rosen, op.cit., p. 258 Return to Text
18. Syed Ishtaq Ahmed: "Refugee Settlement and Aids", in The Lawyers, May 1996, p. 28 Return to Text
19. Harold M. Ginzburg and Mark J. Rosen, op.cit., p. 260 Return to Text
20. Anand Grover & Priti Patel: "Legal Aspects in the Relationship Between Doctors, Patients and HIV/AIDS" in The Lawyers, September 1995, p. 21 Return to Text
21. Lucy v. State of Goa, 1990 Mah LJ 714 Return to Text
22. W. v. Egdell, (1990) 1 All ER 835 Return to Text
23. X. v. Y., (1982) 2 All ER 648 Return to Text
24. Tarasoff v. The Regents of the University of California, (1976) 131 California Reporter 14 Return to Text
25. Doe v. Equifax Service, (1989) WL 57348, ED.Pa., quoted by Ginzburg & Rosen, supra, N. 3 Return to Text
26. The Hindu, 25-8-1996 (p. 10) Return to Text
27. The Hindu, 27-10-1996 (p. 4) Return to Text
28. Doe v. Centinela Hospital, (1983) 57 USLW 2934 Return to Text
29. The Hindu (Editorial), 7-9-1996 Return to Text
30. S. Ramasundaram: "The Spectre of AIDS", (The Hindu), 1-12-1996 Return to Text