A landslide occurred in the middle of the night on 20th July, 2023 in a remote mountain hamlet, approximately 60 kilometres from Uttarkashi. The landslide was caused by torrential rains and has resulted in large-scale destruction of property and life. You, as District Magistrate of that area, have rushed to the spot with a team of doctors, NGOs, media and police along with numerous support staff to oversee the rescue operations.
A man came running to you with a request for urgent medical help for his pregnant wife who is in labour and is losing blood. You directed your medical team to examine his wife. They return and convey to you that this woman needs blood transfusion immediately. Upon enquiry, you come to know that a few blood collection bags and blood group test kits are available in the ambulance accompanying your team. Few people of your team have already volunteered to donate blood.
Being a physician who has graduated from AIIMS, you know that blood for transfusion needs to be procured only through a recognized blood bank. Your team members are divided on this issue; some favour transfusion, while some others oppose it. The doctors in the team are ready to facilitate the delivery provided they are not penalized for transfusion. Now you are in a dilemma. Your professional training emphasizes on prioritising service to humanity and saving lives of individuals.
(a) What are the ethical issues involved in this case? (b) Evaluate the options available to you, being District Magistrate of the area.
Approach · directive: “what / evaluate”
What it asks · (a) Name the ethical issues (saving life versus procedure, safety, liability, a divided team); (b) weigh the DM's options and choose a course.
The question has 2 parts — answer each
- (a) Identify the ethical issues in the case
- (b) Evaluate the options available to me as District Magistrate and choose a course
Open with · In Parmanand Katara (1989) the Supreme Court read Article 21 to mean that every doctor must extend services to protect life; the blood-bank rule protects patients and was never meant to let a mother bleed to death.
Cover
- Stakeholders: the woman and her unborn child, her husband, the medical team and volunteer donors, other victims, the district administration and me.
- (a) Issues: right to life versus safety procedure, duty to save life versus fear of penalty, risk of infection versus risk of death, informed consent, and my accountability as DM.
- (b) Option 1, refuse and follow the rule: procedurally safe but likely to cost two lives, and hard to defend morally.
- (b) Option 2, transfuse with safeguards: cross-match and test the volunteers' blood with the kits, take the husband's consent, record everything and own the decision; saves lives but leaves some risk.
- (b) Option 3, move her out: air or road evacuation and blood from the nearest bank; within the rules, but delay may be fatal with heavy bleeding and difficult terrain.
- (b) Option 4, seek orders first: inform the CMO and state authorities by any working link; shares responsibility but cannot wait if her condition is critical.
- Recommended: begin emergency transfusion with safeguards and consent while arranging evacuation and blood from a bank in parallel, and report at once; the DM's emergency powers under the Disaster Management Act support this.
- Long term: pre-positioned blood units, a field-transfusion protocol and helicopter evacuation tie-ups for disaster-prone districts.
Close with · When no lawful alternative can arrive in time, life comes first; a DM who acts with safeguards, consent and transparency, and then reports, honours the rule's purpose and Article 21.
Add value (verified)
- Parmanand Katara v Union of India (28 August 1989): under Article 21 the State must preserve life; every doctor has a professional obligation to extend services to protect life. Pt. Parmanand Katara vs Union of India & Ors, Supreme Court, 28 August 1989 — Indian Kanoon ↗“Article 21-- Obligation on the State to preserve life--Every doctor has professional obligation to extend services to protect life--All Govern- ment hospitals/Medical institutions to pro vide immediate medical aid in all cases.”
- IPC section 81 (necessity): no offence merely because an act is done knowing it is likely to cause harm, if done without criminal intention and in good faith to prevent other harm to person or property. Section 81 in The Indian Penal Code, 1860 — Indian Kanoon ↗“Nothing is an offence merely by reason of its being done with the knowledge that it is likely to cause harm, if it be done without any criminal intention to cause harm, and in good faith for the purpose of preventing or avoiding other harm to person or property.”
- e-RaktKosh, inaugurated on 7 April 2016, connects, digitises and streamlines the workflow of blood banks and blood storage centres across India. All for a Better Healthcare — MyGov blog (Team MyGov, Ministry of Health and Family Welfare initiatives), 19 July 2018 ↗“e-RaktKosh, inaugurated on April 7, 2016, is a Government of India initiative which connects, digitises and streamlines the workflow of blood banks and blood storage centres across India in a transparent way”
Question: UPSC's CS (Main) 2023, GS Paper IV — paper ↗. Approach: Minimalist IAS, checked 1 Oct 2026 (how we verify) — UPSC publishes no model answers. ·
Model answer · 362 words (UPSC limit 250) · Minimalist IAS
In Parmanand Katara (1989), the Supreme Court held that Article 21 obliges the State to preserve life and that every doctor has a professional obligation to extend services to protect life. The blood-bank rule protects patients; it was never meant to let a mother bleed to death where no bank can be reached.
Stakeholders
- People involved: the woman and her unborn child; her husband; the doctors and volunteer donors; other victims awaiting rescue; the administration; and I, as DM and physician.
(a) Ethical issues involved
- Right to life versus procedure: two lives now, against a rule written for normal conditions.
- Safety (non-maleficence): untested blood risks infection and mismatch; the kits allow grouping, not full screening.
- Duty versus fear of penalty: the doctors' hesitation reflects a system that punishes deviation more than inaction.
- Informed consent: the husband, and the woman if conscious, must know the risks and agree.
- Leadership: a divided team needs a decision, and I must own it rather than pass the burden to the doctors.
(b) Options available to me as District Magistrate
| Option | For | Against |
|---|---|---|
| Refuse, follow the rule | Legally safe | Two lives likely lost |
| Evacuate first | Within the rules | Night, landslide, fatal delay |
| Transfuse with safeguards | Saves life now | Some infection risk |
- Seek orders first: informing the CMO and state authorities shares responsibility, but a bleeding patient cannot wait for a reply.
- Recommended: transfuse with safeguards while calling for evacuation and bank blood: group and cross-match donors, take written consent, issue a written direction that protects the doctors, and inform superiors at once.
- Justification: IPC section 81 excuses an act done in good faith, without criminal intent, to prevent other harm; the DM's emergency powers under the Disaster Management Act support extraordinary measures. The values served are life, compassion, courage and accountability.
Long-term fix
- Preparedness: pre-positioned blood units in disaster-prone districts, a protocol for emergency field transfusion, helicopter tie-ups, and links to e-RaktKosh, which since 2016 has digitised blood banks' workflow nationwide.
When no lawful alternative can arrive in time, life comes first. A DM who acts with safeguards, consent and transparency, and then reports, honours both the purpose of the rule and the promise of Article 21.
Written by Minimalist IAS from facts checked at source (how we verify) — a little fuller than exam length, so every part of the question is covered; in the hall, keep the structure and trim the detail. UPSC publishes no model answers: compare your structure and coverage with this, then write your own.