Our guest column this week is my Dr Upreet Dhaliwal, Visiting
Scholar, Institute for Medical Humanities, UTMB, Galveston and Former
Director-Professor of Ophthalmology, University College of Medical Sciences,
University of Delhi. In her column, she makes an eloquent argument against
the new Medical Council of India guidelines regarding disabled medical
aspirants.
The Medical Council of India (MCI)’s new guidelines
regarding disabled medical aspirants is unfair for a variety of reasons.
It states that those with 40-80% locomotor disability will be eligible for
the medical course. Even better, they add that “Persons with more than 80%
disability may also be allowed; but after their selection, their functional
competency will be determined with the aid of assistive devices.”
This sounds like a progressive way to view disability, but then, in the very
next column (Not Eligible for Medical Course), the MCI contradicts itself by
stating that those with more than 80% locomotor disability will not be
eligible.
A self-confounding document such as this one, which both enables and disables
a person with more than 80% disability from being eligible can only confuse
admissions committees. Denying admission to students who fall in the category
of “more than 80%” locomotor disability without considering functional
competence is unfair to the student.
A footnote in the above document states that: *Persons with disabilities of
40% or more may be allowed to pursue medical education, if the extent of
disability can be brought down to below 40% with aid of assistive devices.”
How is this to be assessed? Do we need to bring down the ‘extent of the
disability’ or improve the ‘ease of accessibility’?
Medicine is increasingly being aided by technology. Newer advances have
made it easier for medical students and doctors with disability to
negotiate the medical course and medical practice with the help of
assistive devices. The problem is not with the disability but with the
absence of accessible spaces and with the lack of will on the part of
institutions and regulatory bodies to make reasonable accommodations for
the disability.
With technological advancements, it has become easier to make accommodations
that are reasonable and affordable. In the West, it is recognized that
disability does not prevent learning – and there is no reason why medical
students with locomotor disability cannot learn how to provide competent
care. Denying them the opportunity is untenable from the point of view of
social justice.
In accessible spaces, it is not impossible to imagine that a medical
practitioner in a motorized wheelchair may, in response to an urgent call,
reach the emergency department sooner than a colleague who goes on foot. By
the same reasoning, a student who is a wheelchair user may have no difficulty
in getting to the learning spaces in a timely manner. The problem, clearly,
is not the disability but the inability or unwillingness of the teaching
institution to provide reasonable accommodation. Teaching institutions should
take the lead in this area and should consider it a matter of pride that they
are providers of equal opportunity and are accessible in the real sense.
Functional competence is the keyword to determine if a person with greater
than 80% disability can fulfil the arduous physical requirements of the
profession.
How is it to be measured? Do we have guidelines? Is it appropriate and fair
to have blanket guidelines that apply to all disciplines across the board?
Apparently not – some medical schools in the United States, in response to
the Americans with Disabilities Act (ADA), are beginning to
orient themselves towards a more liberal interpretation of
functional competence or technical standards depending on the specialty in
question. This flexibility is in line with disability accommodation and
policy makers recognize that, while learners must learn a little bit about
everything, they will eventually specialize in only one discipline.
Thus, during rotations through different disciplines, a medical student may
be given as much accommodation as is appropriate, but when choosing a subject
of specialization, the student must consider if she can possibly acquire the
expected competencies – with the degree of accommodation that is allowable in
that discipline – keeping in mind patient safety.
Guided by the curriculum objectives, and aided by ethical and compassionate
faculty who have an understanding of the social model of disability, it is
only fair that the student herself decide if a specialty is the right fit for
her. She can base her final decision on her own experience with her
disability and on the accommodations that the institution is willing to make.
The institution must display their requirements (must be able to perform
cardio-pulmonary resuscitation, for example) and the accommodations they will
offer (a convertible wheelchair that allows a learner with paraplegia to
stand) so as to better inform applicants of what to expect.
As per Office of the Registrar General & Census Commissioner,
India, more than 21 million people in India have a disability of
some kind. These are people who are expected to need greater healthcare but
are likely to find it harder to receive it because of accessibility problems
and due to financial and other disparities resulting from their disability.
The disabled are thus already vulnerable, and, as patients, their
vulnerability is magnified when their bodies are misunderstood and lived
experiences, disregarded. This will continue to happen as long as we see
disability as a weakness and as a deficiency.
For healthcare providers and policy makers to understand and to see the
potential or ‘ability’ in people with disability, it is important to recruit
more people with disability into the healthcare scenario. True inclusion is
more than just lip service. Integrating people with and without disability
into the same spaces can, over a period of time, change our understanding of
disability. True inclusion is to make the people visible and their assistive
devices (and hence their disabilities) invisible.
One may ask why the MCI has drawn up a document that causes as much confusion
as it seeks to clear up with regard to disability of more than 80%. One
simple answer would be that the people drafting the advisory are not coming
from a place of understanding. They have not lived the socio-scientific
reality of disability.
It is not entirely their fault. Do we know how many doctors have disability?
No, because there is no data in our country. Are there any studies on how a
particular disability affects a doctor’s ability to perform in her chosen
field? Not in our country, although guidelines were formulated nearly a year
ago by the Association of American Medical Colleges (AAMC)
in collaboration with the University of California, San Francisco,
School of Medicine.
The AAMC guidelines were based on the experiences of students with
disabilities, which begs the question in the case of the MCI guidelines – on
what basis is a person without disability competent to decide what a person
with disability can or cannot perform with competence? This is ableism and it
is unfair when policy decisions about people with a particular disability are
made without involving the people who have that disability.
The message that people with disability may get is that they are not
welcome in medicine or that they cannot possibly contribute in a meaningful
way. Nothing could be further from the truth. By denying people with
disability their right to train as doctors, we deny patients with
disabilities access to medical professionals who understand their bodies
and their reality from first-hand experience.
The literature, especially in our country, is replete with instances of how
people with disability work for the benefit of others with disability.
Clearly, it would be in tandem with the ethos of the country’s policy towards
the disabled community to have more physicians with disabilities on the
workforce. Further, medical professionals – who are currently ‘temporarily
able’ – are denied a chance to understand disability in the real sense if we
don’t facilitate the sharing of workspaces which allow them to bear witness
to the lived experience of colleagues with disability.
Source links:
Increasing the Number of Doctors With Disabilities Would Improve Medical
Care, Not Weaken It
Paving the Way for Medical Students, Physicians With Disabilities
Accessibility, Inclusion, and Action in Medical Education: Lived Experiences
of Learners and Physicians with Disabilities
Source: https://newzhook.com/story/21551
