Revised medical curriculum should reflect evolving progressive practices, changing scientific discourse

Further revisions to the medical curriculum should recognise that queer and trans persons, and persons with disabilities are equal and valued members of society

The past few weeks have been a busy time for the country’s top medical education regulator, the National Medical Commission (NMC). On August 31, the NMC revised the forensic medicine curriculum – the Competency-Based Medical Education Curriculum, 2024 (CBME) – for undergraduate medical students, re-introducing “sodomy and lesbianism” under the category of “unnatural sexual offences” and terming “transvestism” (cross-dressing) as a “sexual perversion” (along with necrophilia). It also brought back topics such as the importance of the hymen and the definition of virginity and defloration. At the same time, it removed the seven-hour training on disability competencies.

The National Medical Commission (REPRESENTATIVE IMAGE )

The revised guidelines were predictably met with outrage, considering that they seem to have been drafted keeping in mind conservative Victorian moralities; and were contrary to all medical, scientific, and psychological evidence. Treating consensual same-sex relations on par with bestiality undermined the (slow) progress that has been made by the country on the issue of queer rights and trans rights in one fell swoop.

The CBME Guidelines were also contrary to the Supreme Court’s recognition of the importance of the dignity of LGBTQIA+ persons and the fact that criminalisation of behaviour that did not conform to traditional heterosexual expectations of society was unconstitutional. As far back as 2014, the Supreme Court in the NALSA judgment, recognised that gender identity and sexual orientation are different. An individual’s self-defined sexual orientation and gender identity is integral to her personality and is an aspect of self-determination, dignity and freedom.

While striking down Section 377, IPC (insofar as it applied to consensual same-sex relations), the Court in Navtej Johar (2018) noted “the intersectional nature of sex discrimination, which cannot be said to operate in isolation of other identities, especially from the socio-political and economic context.”

In fact, the Madras High Court in 2021 built on the Supreme Court’s dicta when it issued expansive guidelines to eliminate the prejudice against the LGBTQIA+ community and laid the blueprint for their de-stigmatisation and inclusion in society. The judgment was also noteworthy because the judge voluntarily underwent a session of psycho-education with a counselling psychologist to help him understand same-sex relations “better” to pave the way for his “evolution”.

He also extracted the entire report of this counselling session in his judgment, which, among other things, addressed the pathologisation of any other gender or sexuality that lies outside the binary system. It recognised that existing diagnostic guidelines and medical interventions were “built on the false belief that homosexuality is a ‘condition’, that the problem was either in the person’s genitals or their brain and that it can be ‘cured’”.

The judgment also noted that our medical textbooks are just as draconian as our laws, given that the then-prevailing forensic medicine curriculum prescribed for medical students described sodomy and lesbianism and oral sex as sexual offences and transvestism as a “sexual perversion”.

The impact of the Madras High Court’s judgment was profound and immediate. It resulted in the NMC removing these subjects from its curriculum in 2022 – only to reintroduce them two years later in August 2024.

One week later, after protracted media outrage and protests, the NMC withdrew the Guidelines on September 4.

While the NMC may have withdrawn the curriculum for now, it has clarified that the guidelines will be revised “in due course”. Revision in the medical and medico-legal curriculum is welcome and should take into account evolving progressive practices and changing medical and scientific discourse. But such revisions should not set us back decades by adopting unscientific and discriminatory approaches towards queer and trans persons and persons with disabilities.

The CBME Guidelines are important because they send a message to young MBBS students about what is considered ‘natural’ or ‘unnatural’, and what is an acceptable forensic practice. For decades, the proforma for medical examination of rape victims involved the “two-finger test”, an unscientific and invasive practice being used to determine the sexual history of the woman.

The Supreme Court repeatedly criticised this practice, recognising that it re-traumatised the woman and did not prove nor disprove the allegations of rape in any manner. In 2022, the Court even directed the Government to review the curriculum in medical schools to ensure that the two-finger test” was not prescribed as part of the procedure to examine survivors of rape and sexual assault.

But the CBME Guidelines also have an impact far beyond the medico-legal, forensic context. These guidelines directly impact the ability of queer and trans people to access health care. If medical professionals are taught and believe, -that cross-dressing is a “sexual perversion” or engaging in same-sex relations is “unnatural”, what is to stop them from trying to “cure” persons of the LGBTQIA+ community or subjecting them to harmful conversion therapy? What is to stop a therapist from dismissing the mental health concerns of a young queer teen, coming to terms with her sexuality, and instead, laying the blame on her doorstep?

At the same time, removing the seven-hour disabilities competency training results in doctors being profoundly ill-equipped to provide health care services to persons with disabilities in a way that recognises their dignity and autonomy.

The NMC now has an opportunity to correct historic injustices. Further revisions to the CBME curriculum should proactively recognise that queer and trans persons, and persons with disabilities, are equal and valued members of society, and must be treated with dignity. Only then can the promise of transformative constitutionalism be achieved in practice.

Vrinda Bhandari is a practising Advocate at the Supreme Court of India. The views expressed are personal