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41. The Indian Constitution guarantees Right to Life with Dignity under Article 21. It reads that "No person shall be deprived of his life or personal liberty except through procedure established by law." Till 1970s the courts, by and large, had interpreted „life‟ literally i.e. right to exist- right not to be killed. In late 1970s, the Supreme Court expanded the meaning to the term „life‟ appearing in Article 21. Over the years it has come to be accepted that life does not only mean animal existence but the life of a dignified human being with all its concomitant attributes. This would include a healthy environment, effective and adequate health care facilities. Today, the health care is a fundamental right to life in the broader perspective of the „life‟ under the term „life‟ under Article 21 of the Constitution of India.

42. Fundamental Rights are enforceable by and large only against the State and it is the duty and obligation of the State to provide adequate health care to its citizens. The „Right to Health‟ is inseparable from „Right to Life‟, and the „Right to Medical Facilities‟ as a concomitant of „Right to Health‟ is also part and parcel of Right to Life. In a welfare state, the corresponding duty to the right to health and medical facility lies with the State.

CJ & MSM,J WP (PIL)_164_2019 & WP (PIL)_236_2021

63. Environment Pollution is linked to Health and effect of violation was dealt in T. Ramakrishna Rao vs. Hyderabad Development 1989 AIR 2039 1997 (2) SCC 83 CJ & MSM,J WP (PIL)_164_2019 & WP (PIL)_236_2021 Authority15, the Andhra Pradesh High Court observed that protection of the environment is not only the duty of the citizens but also the obligation of the State and it‟s all other organs including the Courts. The enjoyment of life and its attainment and fulfillment guaranteed by Article 21 of the Constitution embraces the protection and preservation of nature‟s gift without which life cannot be enjoyed fruitfully. The slow poisoning of the atmosphere caused by the environmental pollution and spoliation should be regarded as amounting to violation of Article 21 of the Constitution of India. It is therefore, as held in T. Damodar Rao and others vs. Special Officer, Municipal Corporation of Hyderabad16, the legitimate duty of the Courts as the enforcing organs of the constitutional objectives to forbid all actions of the State and the citizens from upsetting the ecological and environmental balance. In Virender Gaur vs. State of Haryana17, the Supreme Court held that environmental, ecological, air and water pollution, etc., should be regarded as amounting to violation of right to health guaranteed by Article 21 of the Constitution. It is right to state that hygienic environment is an integral facet of the right to healthy life and it would not be possible to live with human dignity without a humane and healthy environment. In Consumer Education and Research Centre vs. Union of India18, Kirloskar Brothers Ltd. vs. Employees' State Insurance Corporation19, the Supreme Court held that right to health and medical care is a fundamental fight under Article 21 read with Articles 39(e), 41 and 43. In Subhash Kumar vs. State of W.P.No.36929 of 1998 dated 20.07.2001 AIR 1987 AP 171 1995 (2) SCC 577 (1995) 3 SCC 42 AIR 1996 SC 3261 CJ & MSM,J WP (PIL)_164_2019 & WP (PIL)_236_2021 Bihar20, the Supreme Court held that right to pollution-free water and air is an enforceable fundamental right guaranteed under Article 21. Similarly in Shantistar Builders v. Narayan Khimalal Totame21, the Supreme Court opined that the right to decent environment is covered by the right guaranteed under Article 21. Further, in M.C. Mehta vs. Union of India22, Rural Litigation and Entitlement Kendra v. State of U.P23, Subhash Kumar vs. State of Bihar (supra), the Supreme Court imposed a positive obligation upon the State to take steps for ensuring to the individual a better enjoyment of life and dignity and for elimination of water and air pollution. It is also relevant to notice as per the judgment of the Supreme Court in Vincent Panikurlangara vs. Union of India24, Unnikrishnan, J.P vs. State of A.P25, the maintenance and improvement of public health is the duty of the State to fulfill its constitutional obligations cast on it under Article 21 of the Constitution. Adequate and Quality medical care is part of Right to Health and Right to Life: The Allahabad High Court in S.K. Garg vs. State of U.P26 was dealing with conditions of public hospitals. The Petition had been filed raising concerns about the pitiable nature of services available in public hospitals in Allahabad. Complaints were made concerning inadequacy of blood banks, worn down X- ray equipment, unavailability of essential drugs and unhygienic conditions. The Court appointed a Committee to go into these aspects and report back to the Court. The High Court held: "In our opinion, the allegations in the petition are serious. The Supreme AIR 1991 SC 420 AIR 1990 SC 630 AIR 1988 SC 1037 AIR 1987 SC 359 AIR 1987 SC 990 AIR 1993 SC 2178 1999 (1) AWC 847 CJ & MSM,J WP (PIL)_164_2019 & WP (PIL)_236_2021 Court in Consumer Education and Research Centre and others v. Union of India and others27, similarly in State of Punjab and others v. Mohinder Singh Chawla and others28 Courts are of the view that the right to health is a part of the right to life guaranteed by Article 21 of the Constitution. It is indeed true that most of the Government Hospitals are in a very bad shape and need drastic improvement so that the Public is given proper medical treatment. Anyone who goes to the Government Hospitals in the State will find distressing sanitary and hygienic conditions. The poor people, particularly, are not properly looked after and not given proper medical treatment. Consequently, most of the people who can afford it go to private nursing homes or private clinics. This is a welfare State, and the people have a right to get proper medical treatment. In this connection, it may be mentioned that in U.S.A. and Canada there is a law that no hospital can refuse medical treatment of a person on the ground of his poverty or inability to pay. In our opinion. Article 21 of the Constitution, as interpreted in a series of judgments of the Supreme Court, has the same legal effect." Can the State be compelled to start hospitals or primary health care centres?: No direct guidelines are available on this issue. But somewhat similar cases are cited below In Paschim Banga Khet Mazdoor Samiti vs. State of West Bengal29 the Supreme Court though primarily dealing with the issue of obligation of the State to provide emergency health care to patients made a general observation of significance: "Providing adequate medical facilities is an essential part of the obligation undertaken by the State in a welfare state. The Government discharges this obligation by running 27 1995 (3) SCC 42 28 1997 (2) SCC 83 29 (1996) 4 SCC 37 CJ & MSM,J WP (PIL)_164_2019 & WP (PIL)_236_2021 hospitals and health centres. Article 21 imposes an obligation on the State to safeguard right to life of every person." In Re Human Rights Perspective:

66. When we look at "right to health" and "healthcare" in the legal and constitutional framework, it is clearly evident that the Constitution and laws of the land do not in any way accord health and healthcare, the status of rights. There are instances in case law where, for instance the right to life, Article 21 of the Constitution, or various Directive Principles have been used to demand access to healthcare, especially in emergency situations or references made to the International Covenants. These are exceptional cases, and even if the Supreme Court or the high courts have upheld some decisions as being a right, for instance getting at least first aid in emergency situations from private clinics or hospitals, or access to public medical care as a right, in life threatening situations, or right to healthy and safe working environment and medical care for workers etc., the orders are rarely respected in day to day practice unless one goes back to the courts to reiterate the orders. In fact, this is often the case CJ & MSM,J WP (PIL)_164_2019 & WP (PIL)_236_2021 even with Fundamental Rights, which the State has failed to respect, protect, or fulfill as a routine, and one has to go to the courts to demand them. For a population, which is predominantly at the poverty or subsistence level, expecting people to go to the courts to seek justice for what is constitutionally ordained as a right is unrealistic as well as discriminatory. The mere constitutional provision is not a sufficient condition to guarantee a right, and more so in a situation like health and healthcare wherein provisions in the form of services and commitment of vast resources are necessary to fulfill the right. Despite the above, it is still important to have health and healthcare instituted as a right within the Constitution and/or established by a specific Act of Parliament guaranteeing the right. Ruth Roemer discussing this issue observed that: