Page 24 - Learnwell EVS
P. 24
p://JUDIS.NIC.IN SUPREME COURT OF INDIA Page 23 of 25
diagnose endometriosis is diagnostic laparoscopy; that the presence of
endometrial tissue anywhere outside the uterus is called Endometriosis;
that the Histopathology report did not confirm endometriosis in the case
of appellant; and that the mode of treatment for endometriosis would
depend on the existing extent of the disease. He also stated that removal
of uterus results in abrupt menopause. In natural menopause, which is a
slow process, the body gets time to acclimatize to the low level of
hormones gradually. On the other hand when the ovaries are removed,
there is an abrupt stoppage of natural hormones and therefore Hormone
Replacement Therapy is necessary to make up the loss of natural
hormones. Hormone Replacement Therapy is also given even when there
is a natural menopause. But hormone replacement therapy has side effects
and complications. He also stated that on the basis of materials available
on the file, he was of the view that Hysterectomy was not called for
immediately. But if endometriosis had been proven from history and
following diagnostic laparoscopy, hysterectomy could be considered as a
last resort if all other medical methods failed. What is relevant from the
evidence of Dr. Puneet Bedi, is that he does not say that hysterectomy is
not the remedy for endometriosis, but only that it is a procedure that has
to be considered as a last resort.
50. On the other hand, the respondent who is herself a experienced
Obstetrician and Gynaecologist has given detailed evidence, giving the
reasons for diagnosing the problem of appellant as endometriosis and has
referred to in detail, the need for the surgery. She stated that having
regard to the medical condition of complainant, her decision to perform
hysterectomy was medically correct. The complainant wanted a cure for
her problem and the AH-BSO surgery provided her such cure, apart from
protecting her against any future damage to intestines, bladder and ureter.
She explained that if the uterus and ovaries had not been removed there
was a likelihood of lesion extending to the intestines causing bleedings,
fibrosis and narrowing of the gut; the lesion could also go to the surface
of the bladder penetrating the wall and causing haematuria and the ureter
could be damaged due to fibrosis leading to damage of the kidney; there
was also a chance of development of cancer also. She also pointed out
that the complainant being 44 years of age, was in the pre-menopausal
period and had menorrhagia which prevented regular ovulation which
was necessary for pregnancy; that endometriosis also prevented
fertilization and produced reaction in the pelvis which increased
lymphocytes and macrophages which destroy the ova and sperm; and
that the state of bodily health did not depend upon the existence of uterus
and ovaries.
51. The respondent also examined Dr. Sudha Salhan, Professor and
Head of Department (Obstetrics and Gynaecology) and President of the
Association of Obstetricians and Gynaecologists of Delhi. Having seen
the records relating to appellant including the record pertaining to clinical
and ultra-sound examinations, she was of the view that the treatment
given to appellant was correct and appropriate to appellant’s medical
condition. She stated that the treatment is determined by severity of the
disease and hysterectomy was not an unreasonable option as there was no
scope left for fecundability in a woman aged 44 years suffering from
endometriosis. She also stated that the histopathology report dated
15.5.1995 confirmed the diagnosis of endometriosis made by respondent.
She also stated that she saw video-tape of the laparoscopic examination
and concurred that the opinion of respondent that the lesion being
extensive conservation surgery was not possible and the problem could
effectively be addressed only by more extensive surgery that is removal
of the uterus and ovaries. She also stated that the presence of chocolate
cyst was indicative of endometriosis. She also stated that medication
merely suppresses endometriosis and the definitive treatment was surgical
removal of the uterus and both the ovaries. She also stated that
hysterectomy is done when uterus comes out from a prolapse and the
woman is elderly, or when there is a cancer of the uterus, or when there
are massive fibroids or when a severe grade of endometriosis along with
diagnose endometriosis is diagnostic laparoscopy; that the presence of
endometrial tissue anywhere outside the uterus is called Endometriosis;
that the Histopathology report did not confirm endometriosis in the case
of appellant; and that the mode of treatment for endometriosis would
depend on the existing extent of the disease. He also stated that removal
of uterus results in abrupt menopause. In natural menopause, which is a
slow process, the body gets time to acclimatize to the low level of
hormones gradually. On the other hand when the ovaries are removed,
there is an abrupt stoppage of natural hormones and therefore Hormone
Replacement Therapy is necessary to make up the loss of natural
hormones. Hormone Replacement Therapy is also given even when there
is a natural menopause. But hormone replacement therapy has side effects
and complications. He also stated that on the basis of materials available
on the file, he was of the view that Hysterectomy was not called for
immediately. But if endometriosis had been proven from history and
following diagnostic laparoscopy, hysterectomy could be considered as a
last resort if all other medical methods failed. What is relevant from the
evidence of Dr. Puneet Bedi, is that he does not say that hysterectomy is
not the remedy for endometriosis, but only that it is a procedure that has
to be considered as a last resort.
50. On the other hand, the respondent who is herself a experienced
Obstetrician and Gynaecologist has given detailed evidence, giving the
reasons for diagnosing the problem of appellant as endometriosis and has
referred to in detail, the need for the surgery. She stated that having
regard to the medical condition of complainant, her decision to perform
hysterectomy was medically correct. The complainant wanted a cure for
her problem and the AH-BSO surgery provided her such cure, apart from
protecting her against any future damage to intestines, bladder and ureter.
She explained that if the uterus and ovaries had not been removed there
was a likelihood of lesion extending to the intestines causing bleedings,
fibrosis and narrowing of the gut; the lesion could also go to the surface
of the bladder penetrating the wall and causing haematuria and the ureter
could be damaged due to fibrosis leading to damage of the kidney; there
was also a chance of development of cancer also. She also pointed out
that the complainant being 44 years of age, was in the pre-menopausal
period and had menorrhagia which prevented regular ovulation which
was necessary for pregnancy; that endometriosis also prevented
fertilization and produced reaction in the pelvis which increased
lymphocytes and macrophages which destroy the ova and sperm; and
that the state of bodily health did not depend upon the existence of uterus
and ovaries.
51. The respondent also examined Dr. Sudha Salhan, Professor and
Head of Department (Obstetrics and Gynaecology) and President of the
Association of Obstetricians and Gynaecologists of Delhi. Having seen
the records relating to appellant including the record pertaining to clinical
and ultra-sound examinations, she was of the view that the treatment
given to appellant was correct and appropriate to appellant’s medical
condition. She stated that the treatment is determined by severity of the
disease and hysterectomy was not an unreasonable option as there was no
scope left for fecundability in a woman aged 44 years suffering from
endometriosis. She also stated that the histopathology report dated
15.5.1995 confirmed the diagnosis of endometriosis made by respondent.
She also stated that she saw video-tape of the laparoscopic examination
and concurred that the opinion of respondent that the lesion being
extensive conservation surgery was not possible and the problem could
effectively be addressed only by more extensive surgery that is removal
of the uterus and ovaries. She also stated that the presence of chocolate
cyst was indicative of endometriosis. She also stated that medication
merely suppresses endometriosis and the definitive treatment was surgical
removal of the uterus and both the ovaries. She also stated that
hysterectomy is done when uterus comes out from a prolapse and the
woman is elderly, or when there is a cancer of the uterus, or when there
are massive fibroids or when a severe grade of endometriosis along with
