The National Medical Commission (NMC) in India has stirred up quite a controversy by bringing back "sodomy and lesbianism" as unnatural sexual offenses in its medical curriculum. This decision, along with the revival of outdated ideas like the importance of the hymen, raises a lot of questions about LGBTQ+ rights and whether our medical education is keeping up with the times.
On August 31, 2024, the National Medical Council (NMC) published its new Competency-Based Medical Education (CBME) Regulations 2024, for the forensic medicine curriculum for undergraduate medical students. This new curriculum brings back the outdated ideas of ‘Lesbianism’ and ‘Sodomy’ as sexual offenses, the importance of hymen and virginity, and a lot more.
This curriculum completely ignores the Supreme Court's 2018 ruling that decriminalized homosexuality under Section 377 of IPC. Also, it reverses the 2022 changes that the Madras High Court directed, done to make medical education more inclusive and scientifically accurate.
While the CBME guidelines are aimed to offer essential skills to the medical students and address India’s overall healthcare needs, they clearly don’t align with the values, ideas & the evolving society.
What Are These New Changes?
The updated curriculum includes discussions on sexual perversions, fetishism, transvestism, voyeurism, sadism, necrophagia, masochism, exhibitionism, frotteurism, and necrophilia. It also lists adultery, incest, and bestiality as unnatural sexual offences. The distinction between consensual sex among queer individuals has been removed.
On top of that, the revised syllabus has eliminated the seven-hour disability training from its medical ethics module. The updated psychiatry module no longer covers the differences between sex and gender identity or addresses common myths and misconceptions, and it has removed the requirement to educate students about “gender identity disorders.”
They wish to reintroduce the importance of the hymen, the definition of virginity and defloration, and its legitimacy and medico-legal importance.
It includes new laws: "Describe legal competencies including Bharatiya Nagarika Suraksha Sanhita (BNSS), Bharatiya Nyay Sanhita (BNS), Bharatiya Sakshya Adhiniyam (BSA)" besides "Protection of Children from Sexual Offences Act (POCSO), Civil and Criminal Cases, Inquest (Police Inquest and Magistrate's Inquest), cognisable and Non-cognisable offences".
Over a period of 4.5 years, the curriculum is divided into three sections. Twelve months are dedicated to the core courses of anatomy, physiology, and biochemistry in phase I, and twelve months to pathology, microbiology, and pharmacology in phase II. Part I and Part II of Phase III, which lasts 30 months, cover clinical topics such as general medicine, surgery, pediatrics, and forensic medicine.
After five years of putting the CBME framework into practice, this update takes feedback into account to improve learner-centricity and ‘match with international standards,’ which is questionable.
Interestingly, despite the 2018 Supreme Court ruling, numerous forensic medical textbooks still cover unnatural sexual offenses such as sodomy, buccal/oral coitus, bestiality, and tribadism/lesbianism. YouTube instructional videos also depict these actions as ‘unnatural’ or ‘offensive’.
Violation of Transgender Persons Protection Act, 2019
Three years ago, after being admonished by the Madras and Kerala High Courts, the NMC had advised all medical universities to not approve content that contains ‘unscientific, derogatory, and discriminatory’ information on the LGBTQ community, but now by putting cross-dressing, BDSM, and fetishes as sexual perversions and being gay as crimes, it goes back to the outdated mindset.
A topic from the new CBME guideline reads: “FM8.4: Describe and discuss adultery and unnatural sexual offences—sodomy, incest, lesbianism, buccal coitus, bestiality, indecent assault—and the preparation of reports, framing of opinions, and preservation and dispatch of trace evidence in such cases.”
There were zero health professionals from the LGBTQIA+ community involved in this NMC committee who could address queer issues.
“Social Responsiveness is MISSING from the NMC’s new CBME 2024 Curriculum. This is a significant letdown in terms of social responsibility,” said Dr Satendra Singh, a disability rights activist.
Omitted the rights of disabled people
The NMC has suddenly removed the mandatory 7 hours of Disability Competencies from the Foundation Course, violating Section 39(2)(f) of the Rights of Persons with Disabilities Act (RPDA) 2016, which mandates the inclusion of the rights of disabled persons in the curriculum of universities, colleges, and schools.
Dr. Singh also stated “Section 47(1)(b) further requires the integration of disability as a component in all educational courses for university teachers, doctors, nurses, and paramedical personnel. The curriculum’s sole focus on the ‘management of disabilities’ reinforces the NMC’s outdated and archaic views.”
The focus is now on the "medical model" of disability - treating it as a medical issue and not on the "human rights model," which sees disability as a matter of social justice and equal rights & is in fact the core of a Viksit Bharat.
These laws already exist, so the need for the disabled & trans community to constantly take the NMC to court to ask for their mere rights is highly concerning.
Immediate need for the Home Ministry to intervene
On September 3, two organizations, Doctors with Disabilities: Agents of Change and the Association for Transgender Health in India— internationally involved in the inclusion of people with disability and transgender persons in medical education, have called on the Health Minister to urgently address these 2024 medical education guidelines.
They argue that these new rules are not only blatantly queerphobic & ableist but also contradict judgments by the Chennai and Kerala High Courts, as well as the World Health Organization’s (WHO) Global Report on Health Equity for Persons with Disabilities, 2022 and the World Federation for Medical Education’s (WFME) Global Standards for Quality Improvement: Basic Medical Education, 2020.
If nothing changes, they’re ready to escalate to the World Federation for Medical Education (WFME) and push for a temporary suspension of NMC’s recognition.
Now, the time is ticking for the NMC to act.
NCM stands its ground
“At the end of teaching-learning in forensic medicine and toxicology, the student should be able to understand the medico-legal framework of medical practice, codes of conduct, medical ethics, professional misconduct and medical negligence, conducting medico-legal examination and documentation of various medico-legal cases and understand latest Acts and laws related to medical professional including related court judgements,” the NMC said in its document.
It says undergraduate medical education programme is designed to create an ‘Indian medical graduate’ possessing the knowledge, skills, attitudes, values and responsiveness to function effectively as a physician of first contact for the community, while being globally relevant.
The guidelines are uploaded on the National Medical Commission’s (NMC) website.
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