The Supreme Court on Tuesday indicated that it may lay down constitutional principles to guide policies requiring medical graduates to serve in rural areas, citing the need for clarity on the Centre’s position on a nationwide framework.

A bench comprising Justices P S Narasimha and Alok Aradhe said the issue required consideration in view of the absence of a clear national policy on compulsory rural service for doctors. The court is hearing a petition challenging a Karnataka government notification that extended the one-year rural service requirement to medical students admitted to private seats in private and deemed universities.

Appearing for the Centre, Additional Solicitor General Aishwarya Bhati told the court that while postgraduate medical students are required to undertake compulsory service on a rotational basis, no comparable requirement exists at the undergraduate level.

She said health is a state subject and several states have introduced bonds requiring doctors to serve in specified areas. A committee has also recommended that states adopt such bonds uniformly, she added.

Senior advocate Raju Ramachandran, assisting the court as amicus curiae, proposed that the court lay down guidelines drawing on Article 21 of the Constitution, which protects the right to life, and the Directive Principles of State Policy.

Bhati, however, said the Centre could undertake consultations with stakeholders to develop a national framework, adding that a judicial directive might affect medical institutions across the country.

Justice Narasimha said the court’s consideration of the issue could have far-reaching consequences for healthcare delivery in India. Observing that there appeared to be a gap in policymaking, he asked the Centre to clarify whether compulsory rural service was necessary as a matter of principle to improve access to healthcare.

The judge said the immediate question was whether rural service should be recognised as a necessary requirement for strengthening public health, while the method of enforcing it, through bonds or regulations, could be considered separately.

He also cautioned that as healthcare increasingly came to be delivered through private hospitals, rural populations could risk being left without adequate access to medical facilities.

The bench adjourned the matter until next week and asked the Centre to state whether it intended to formulate a policy and which stakeholders it proposed to consult.

Justice Narasimha indicated that the court could articulate the constitutional principles underlying such a policy, leaving its detailed formulation to the states in consultation with the relevant commission.

The petition challenges the Karnataka Compulsory Service Training by Candidates Completed Medical Courses Act, 2012, and the rules framed under it in 2015.

Under the scheme, MBBS graduates, postgraduate medical degree and diploma holders, and super-speciality candidates who studied in government institutions or occupied government seats in private or deemed universities must complete one year of compulsory public rural service.

Compliance is required before they can obtain a no-objection certificate (NOC) necessary for permanent registration with the Karnataka Medical Council.