Summary: The NMC has issued new guidelines restricting live surgery broadcasts to curb patient exploitation, ensure ethical safeguards, and prevent commercial misuse. The framework shifts focus towards pre-recorded simulations and controlled teaching environments to balance education with patient rights.
Introduction
On July 26, 2025, the National Medical Commission (“NMC”) issued comprehensive guidelines regulating live-surgical broadcasts[1] (“LSB”) following concerns regarding the commercial exploitation of patients. Healthcare institutions and medical professionals are now required to navigate through stricter compliance requirements that prioritise patient safety and medical education over promotional or commercial activities, fundamentally reshaping how medical education and surgical demonstrations are conducted. Private hospitals were viewed as commercially exploiting patients at the cost of their safety through live surgery broadcasts in conferences aimed at advertising sponsorship and professional showmanship and for healthcare facilities to showcase their capabilities, surgeons to flaunt their skills, and companies to promote their products.
The regulatory landscape for LSB has been transformed pursuant to a public interest writ petition filed in the Hon’ble Supreme Court in Rahil Chaudhary and Ors. v. Union of India and Ors.[2] The petitioners underlined concerns regarding the legal and ethical framework of LSB, highlighting the need for a revamped standard protocol balancing medical education and professional development against identified issues in obtaining informed patient consent, economic exploitation of the patient, increased patient safety incidents, and organisers’ commercial motivations to advertise and promote LSB to conference audiences.
The petitioners requested the Court to direct the NMC to establish a committee for regular monitoring LSBs to prevent abuse and develop comprehensive guidelines and regulatory frameworks governing the conduct of LSBs. The Court initiated discourse on identifying several critical concerns that necessitated regulatory intervention, and NMC has taken note of the following concerns:
- Compromised Patient Welfare: Patients frequently remain uninformed that their surgeon’s attention may be divided during LSBs, thereby creating potential risks to patient wellbeing and clinical safety. Additionally, the introduction of recording equipment and substantial viewing audiences can adversely affect patient comfort and the overall experience, possibly generating heightened anxiety or discomfort.
- Unethical Commercial Practices: Under the guise of LSBs, patients from economically disadvantaged backgrounds may be presented with surgical fee waivers and then used as models for LSB viewing, thereby fulfilling the ulterior motives of various companies. This practice sees marketing initiatives, corporate sponsorship arrangements, and professional theatrics demonstrating a fundamental disregard for the ethical principles governing surgical practice as envisaged by the NMC.
- Educational Effectiveness: Although LSBs may offer educational benefits, they frequently fail to deliver the comprehensive learning experience interactive or practical training methods provide. Viewers may overlook critical procedural elements or fail to comprehend the sophisticated technical aspects inherent in complex surgical interventions. Empirical evidence demonstrating live surgeries to be pedagogically superiority over pre-recorded surgical footage is insufficient. Pre-recorded materials provide enhanced opportunities for detailed frame-by-frame examination, sophisticated post-production editing capabilities, and comprehensive annotation systems that facilitate deeper understanding.
- Legal and Reputational Risks: Any issues that may arise during the live procedures could be scrutinised publicly and capable of inviting legal and reputational risks for the healthcare stakeholders and providers.
NMC Guidelines to regulate the conduct of LSBs
The NMC guidelines to regulate the conduct of LSBs (“Guidelines”) lays out responsibilities for institutions to increase infrastructure standards and safeguard patient interests. These Guidelines make an exception for live surgeries conducted in institutions listed in the Schedule of the NMC Act, 2019, when performed for their own students or registered medical practitioners (“RMP”), recognising that in controlled environments LSBs serve legitimate educational purposes. The framework outlines the following:
Guidelines Framework
- Organisational prerequisites and sponsorship requirements: Sponsors and supervisors are required to secure appropriate indemnity insurance coverage. Authorised supervisors from the organising institution must possess expertise within the same specialty and participate directly as active members of the surgical team alongside the primary operating surgeon. Live transmissions are strictly prohibited from serving promotional purposes for individual surgeons, medical facilities, or commercial products.
- Practitioner qualifications and foreign medical practitioners (“FMP”): LSBs may only be conducted by licences RMPs or FMPs specialising in contemporary modern medicine, possessing relevant surgical expertise with a minimum of five years’ post-specialisation experience.
- Infrastructure standards and emergency preparedness: Medical institutions must possess accreditation from recognised certification bodies to guarantee adherence to safety and hygiene protocols. Surgical facilities must be equipped with comprehensive pre-operative, intra-operative, anaesthetic, post-operative, radiological, diagnostic, imaging, and intensive care capabilities for complication management.
- Patient eligibility and safeguarding protocols: High-risk cases, patients with incomplete diagnostic evaluations, or those presenting anatomical anomalies are excluded from participation. Eligible patients must demonstrate medical fitness without surgical contraindications. Financial inducements for participation are strictly prohibited, although protective indemnity insurances may be established to address and compensate for any unexpected complications during such recordings/broadcasts
- Consent documentation requirements: The consent procedure must be personally administered by the primary surgeon or surgical team, explicitly detailing the educational objectives, associated risks and benefits, anonymity and confidentiality protections, and the unconditional right to withdraw participation without penalty. The organiser should obtain explicit, informed and written consent from patients before their appearance in LSBs, subject to the aforementioned details.
- Procedural conduct guidelines: While conducting broadcasts, operating surgeons must avoid audience interactions during procedures to ensure attention to patient safety. Step-by-step live commentary by operating surgeons may be permitted in exceptional circumstances without passage for a two-way communication.
- Financial and ethical considerations: Patients shall incur no financial obligations or costs for surgical interventions, including implants, medicines, consumables, and procedures. The operating team must directly supervise post-operative management to maintain absolute confidentiality.
- Regulatory supervision and compliance: Organisers must acquireprior authorisation from relevant regulatory authorities, professional associations, or institutions to conduct live surgical presentations. Depending on hospital sponsorship arrangements, additional approval may be required from appropriate bodies. An oversight committee must supervise arrangements to ensure ethical, safety, educational, professional standards compliance.
Looking forward and conclusion
The Guidelines aim to strike a delicate balance between advancing surgical education and protecting patient rights. These outline strict safeguards to prevent patient exploitation, while also allowing educational use in controlled circumstances. The Guidelines caution pharma companies and healthcare institutions against using LSBs to promote the operating surgeon, hospital, or product brand. The restrictions on sponsorship and commercial showcasing alert industry stakeholders against compromising patient safety and leveraging medical education as a marketing tool. It is a signal to RMPs to refrain from having any financial or commercial interest in the equipment or devices used during surgery / procedures and aim to check the trend of LSBs on social media channels and other forms of public broadcasts. While for healthcare providers, these act as a direction towards investing in compliance infrastructure, informed consent mechanisms, and ethically sound teaching modalities, for patients, the Guidelines are a commitment to dignity, transparency, and safety.
A step beyond regulatory development, the NMC Guidelines on LSBs attempt a systemic reorientation of medical education in India. These impose stricter safeguards, limit commercial incentives, and lay emphasis on pre-recorded, simulation-based training, highlighting the need to align professional advancement with patient welfare.
For further information, please contact:
Biplab Lenin, Partner, Cyril Amarchand Mangaldas
biplab.lenin@cyrilshroff.com
[1]https://www.nmc.org.in/MCIRest/open/getDocument?path=/Documents/Public/Portal/LatestNews/Public%20Notice%20dt%2026-07-2025%20with%20Live%20Surgery%20Guidelines.pdf
[2] W.P. (C) No. 1141/2023
