How does the NMC’s latest directive on live surgeries regulate ethical considerations, protect patient welfare: Explained

The story so far

The Central Government recently issued detailed guidelines stating that live broadcasts should not be used for promotion of the operating surgeon, hospital or product brand, and surgeons should not have a financial or commercial interest in the equipment or devices used during the surgery/ procedures. The order issued by the National Medical Commission (NMC) will regulate conduct and broadcast of live surgeries across India.

What the rules state

The Commission has specified that surgeons are responsible for adhering to professional and ethical standards during the live broadcast. It added that they must prioritise patient welfare over any other considerations. Surgeons are also required to be involved in pre-operative discussions and post-operative treatment for at least 24 hours after surgery/ procedures.

Secondly, it has stated that all live broadcasts should strictly serve educational purposes and must not be for commercial gain or promotion; surgeons should avoid glorification, and the focus should be on surgical techniques and patient care.

Patients with high-risk procedures, incomplete investigations, or unusual anatomy should not be included. Also, financial incentives for participation should not be permitted, noted the regulatory body.

The Commission has made several observations about live surgeries. It noted that while live surgeries can be educational, they may not provide the same depth of learning as interactive or hands-on training.

Observers might miss key details or fail to grasp complex nuances of the procedure, the NMC said, adding that live surgeries may seem valuable for experiential learning, however, there is a lack of concrete evidence supporting their educational effectiveness when compared to pre-recorded surgical videos. Pre-recorded videos offer better frame-by-frame analysis, video editing, and labelling, enhancing the educational experience.

The NMC said however that it was in favour of promoting recorded videos, wet lab, cadaveric and simulation-based surgeries/procedures as these entailed no risk to the patient.

Why have the rules been brought in now?

This latest directive comes after a writ petition (civil) was filed in the Supreme Court. The petitioner stated that many private hospitals were commercially exploiting patients and using them as models to fulfill their ulterior motives through live surgery broadcasts during conferences. Various companies were promoting themselves and making a fortune out of the miseries of the exploited patients. Advertising sponsorship and professional showmanship overshadowed the true purpose of these broadcasts. Healthcare facilities showcased their capabilities, surgeons flaunted their skills and companies promoted their products at the expense of patient safety, the petitioner complained.

In pursuance of the petitioner’s prayer, a committee was constituted by the NMC to give recommendations to ensure that guidelines and regulatory frameworks were formed to regulate the conducting of live surgery broadcast. Accordingly, on the basis of the report of the committee, detailed guidelines were formulated to regulate the conduct and broadcast of live surgeries.

What are the safety measures incorporated for patients?

For all live surgeries, an informed consent process should be conducted by the operating surgeon/team and the surgical procedure should be clearly explained. The patient has the right to withdraw consent at any time, as per the guidelines.

Live broadcasts can be done for new procedures, while recordings are preferred for established procedures or high-risk cases. Also, during surgeries/procedures the operating doctor can broadcast but should not interact with the audience to maintain focus on the patient’s safety.

“Relevant step-wise live commentary by an operating surgeon can be permitted without any two-way communication with the audience in special situations,’’ notes the directive adding that complications and risks associated with live broadcasts should be addressed through stringent regulations and insurance coverage.

Recordings of procedures should be used for educational purposes in closed groups, with live demonstrations reserved for vetted new procedures and the unedited recordings of the procedure should be preserved for at least two years, in case of no litigation, the guidelines state.