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Periviable birth: Legal landscape in Indian jurisprudence
Shivashankar Diggikar1,2,3, Karthik Nagesh4, Nanditta Batra3,5
1Department of Paediatrics, Oyster Mother and Child Hospital, Bengaluru, India shiv.diggikar@oysterhospital.org.
Insights
Indian law grants personhood and constitutional protection to all neonates at birth, regardless of gestational age. However, legal and ethical challenges persist in managing periviable infants due to lack of guidelines and resource inequity.
Area of Science:
- Medical Ethics
- Neonatal Law
- Indian Jurisprudence
Background:
- Periviability, the threshold for neonatal survival, presents complex medical, ethical, and legal issues, particularly in India with high preterm birth rates.
- Managing infants born at the margins of viability (<28 weeks gestation) in India faces significant legal and ethical hurdles.
- Current Indian legal framework lacks uniform consensus on viability thresholds.
Purpose of the Study:
- To critically examine the legal landscape surrounding the care of periviable neonates in India.
- To explore the medico-legal challenges faced by healthcare providers and families in neonatal resuscitation decisions.
- To analyze the implications of Indian jurisprudence and constitutional rights on periviable infant care.
Main Methods:
- Medico-legal analysis of Indian statutes and judicial precedents.
- Exploration of ethical considerations in neonatal resuscitation.
- Discussion of legal doctrines and their applicability to neonates.
Main Results:
- Indian law recognizes personhood and constitutional rights (Article 21) for all neonates at birth, irrespective of gestational age.
- Judicial precedents support life-saving interventions for viable neonates, affirming the right to care.
- Significant challenges exist due to lack of explicit guidelines, systemic infrastructure, cost constraints, and evolving tort liability.
Conclusions:
- Despite legal recognition of neonatal rights, navigating periviable infant care in India is complex due to legal uncertainty and resource disparities.
- Physicians and families face moral and legal dilemmas in resuscitation decisions without clear national guidelines.
- Addressing resource inequity and establishing clear legal frameworks are crucial for improving care for periviable neonates in India.
Abstract:
Periviability represents a complex threshold where there is a triangulation of medical capabilities, ethical judgement and the right of the infant to live. In India, with its disproportionate burden of preterm births, the management of infants born at the margins of viability (typically <28 weeks of gestation) remains fraught with legal and ethical challenges. We critically explore the legal contours surrounding the care of periviable neonates from an Indian medico-legal perspective in this article. Despite lacking a uniform national consensus on viability thresholds, Indian jurisprudence confers personhood to neonates at birth, irrespective of gestational age, thereby guaranteeing constitutional protection under Article 21. However, in the absence of explicit guidelines and robust systemic infrastructure, physicians and families must navigate resuscitation decisions amid legal uncertainty, cost constraints and moral complexity. Judicial precedents have mandated life-saving interventions for viable neonates born alive post medical termination attempts, reinforcing the right to care. We discuss the limitations of legal doctrines such as parental autonomy, leave against medical advice and advance directives when applied to neonates who cannot consent for obvious reasons. We also highlight challenges arising from evolving tort liability, procedural lapses and resource inequity in neonatal care.
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