Principles & Doctrine of Medical Necessity: A Global Perspective and Its Relevance in India

A doctrine is a principle, theory, or position usually applied and upheld by courts of law. The doctrine of medical necessity is a fundamental legal and ethical principle in healthcare. It allows for medical interventions that may otherwise be restricted if they are essential to saving a patient’s life, preventing serious harm, or promoting public health. This doctrine is recognized worldwide and is crucial in shaping healthcare policies, medical ethics, and legal frameworks. The principle of medical necessity is not applied universally for the same issue across all countries. While the core idea remains consistent—allowing medical interventions when necessary to save lives, prevent harm, or support public health—the interpretation, legal backing, and application vary widely based on local laws, healthcare policies, and ethical considerations.

A. Definition & Implementation of Doctrine of Medical Necessity 

B. Practical applications of the Doctrine of Medical Necessity

1. Legal Justification for Treatment
   • In many legal systems, specific medical procedures (like emergency care without consent) are permitted under the principle of medical necessity.
   • Example: Performing surgery on an unconscious patient in a life-threatening condition without waiting for explicit consent.
2. Defense Against Criminal or Civil Liability
   • Healthcare providers may invoke medical necessity as a defense in cases where a law technically prohibits an action. Still, the procedure was required to save a life or prevent serious health risks.
   • Example: A doctor administering an emergency abortion in a country where abortion laws are restrictive, but the pregnancy endangers the mother’s life.
3. Medical Necessity in Insurance & Healthcare Policies
   • Insurance companies and healthcare regulators often assess whether a treatment is “medically necessary” to determine coverage eligibility.
   • Example: A patient may be denied insurance coverage for a cosmetic surgery unless it is deemed medically necessary (e.g., reconstructive surgery after an accident).
4. Public Health & Government Policies
   • Medical necessity shapes public health laws—such as mandatory vaccinations, quarantine measures, or emergency medical interventions.
   • Example: During the COVID-19 pandemic, lockdowns, emergency medical approvals, and vaccine mandates were justified based on medical necessity.

C. How the Legal Principle of Medical Necessity Can Safeguard Patient Rights

Suppose the principle of medical necessity is legally recognized. In that case, it can significantly enhance patient rights by ensuring access to essential treatments, protecting against unfair denial of care, and holding medical institutions accountable.

1. Prevents Unjust Denial of Insurance Claims

• Insurance companies often reject claims, arguing that specific treatments are unnecessary. A codified principle of medical necessity would require insurers to cover treatments deemed necessary by medical standards. Example: A court could rule in favor of a patient if an insurer denies life-saving surgery despite a doctor’s recommendation.

2. Strengthens the Right to Healthcare (Article 21 – Right to Life)

• Indian courts have recognized healthcare as a fundamental right, but access is often denied due to financial or administrative barriers. The legal principle could compel government hospitals to provide necessary treatments, reinforcing the state’s duty to ensure healthcare access. Example: A government hospital refusing free emergency care could be held accountable under this doctrine.

3. Prevents Medical Negligence & Arbitrary Denial of Treatment

• Some hospitals refuse treatment for financial reasons or lack of consent in emergencies. A legal obligation to provide medically necessary care would prevent such denials. For example, if a hospital denies urgent surgery to a road accident victim, the legal principle would hold them liable for negligence.

4. Regulates End-of-Life Care & Euthanasia Decisions

• In cases of passive euthanasia or withdrawal of life support, the doctrine can guide whether discontinuing treatment is legally justified. Example: The Aruna Shanbaug case (2011) led to the legalization of passive euthanasia under court supervision.

5. Strengthens Reproductive & Mental Health Rights

• Ensures access to abortion under the MTP Act by defining when termination is medically necessary. Protects mentally ill patients under the Mental Healthcare Act, 2017, ensuring they receive essential treatments without discrimination.

6. Creates a Legal Basis for Challenging Unjust Policies

• Patients can challenge healthcare policies or hospital guidelines that deny essential treatments. Courts can intervene and set precedents ensuring consistent healthcare delivery.

A. Global Recognition & Applications

• United States – Used as a standard for determining insurance coverage (Medicare, Medicaid). Legal defense in emergency medical procedures.
• United Kingdom – Applied in cases of euthanasia debates, abortion laws, and public health interventions.
• European Union – Incorporated into healthcare rights under the European Convention on Human Rights (ECHR).
• India – The Supreme Court recognizes medical necessity as a valid defense in cases like emergency abortions, euthanasia (under specific conditions), and life-saving medical procedures.

B. Example Cases & Precedents

1. Ireland’s Abortion Case (Savita Halappanavar, 2012) – A woman died after being denied an abortion despite life-threatening complications. This case led to legal reforms allowing abortion based on medical necessity.
2. India’s Passive Euthanasia Judgment (Aruna Shanbaug Case, 2011) – The Supreme Court allowed passive euthanasia in some instances where continuing medical care was not in the patient’s best interest.
3. U.S. Medicaid and Medicare: Coverage is granted only if a procedure is medically necessary, preventing insurance fraud.

Conclusion

The doctrine of medical necessity is a globally accepted legal principle that balances healthcare access, patient rights, and ethical considerations. While its application varies by country, it is a critical safeguard in medical decision-making, insurance claims, and legal defenses. The article focuses on the need for judicial principle. This distinction helps clarify that while medical necessity is a guiding principle/doctrine in India, it has not fully developed into a standalone law.