A CRITICAL ANALYSIS OF THE ETHICAL AND LEGAL DILEMMAS WITH REGARDS TO ASSISTED REPRODUCTIVE TECHNOLOGY. BY - SITARA ANIL SIVADAS,

A CRITICAL ANALYSIS OF THE ETHICAL AND LEGAL DILEMMAS WITH REGARDS TO ASSISTED REPRODUCTIVE TECHNOLOGY.

 

AUTHORED BY - SITARA ANIL SIVADAS,

SCHOOL OF LAW, CHRIST DEEMED TO BE UNIVERSITY

 

 

ABSTRACT

Assisted reproductive technology (ART) is a medical practice that helps individuals or couples who are facing infertility issues to conceive a child. In India, ART has been gaining widespread popularity due to increasing infertility rates, changing lifestyles, and increasing awareness among people. However, with the growing use of ART, there has been a significant increase in legal and ethical concerns that require attention.

 

From a legal perspective, the regulation of ART in India is governed by the Indian Council of Medical Research (ICMR) guidelines, which provide a framework for the use of ART, donor gametes, and surrogacy. The guidelines stipulate that ART can only be performed by registered clinics and require informed consent from patients. However, there have been several instances of malpractice, such as unauthorized surrogacy and illegal import of gametes, which have raised concerns about the regulation and enforcement of the guidelines.

 

Another significant legal concern is the lack of clarity in the laws related to surrogacy in India. Commercial surrogacy was legalized in India in 2002, leading to a flourishing industry that catered to international clients. However, the industry was plagued by issues such as exploitation of surrogate mothers, abandonment of babies, and trafficking of women. In 2019, the Surrogacy (Regulation) Bill was introduced, which banned commercial surrogacy and allowed only altruistic surrogacy for Indian couples. However, the bill has been criticized for its narrow definition of family and the exclusion of single parents, same-sex couples, and foreign nationals.

 

From an ethical perspective, ART raises several concerns, such as the commodification of gametes and surrogacy, the impact of technology on the natural process of reproduction, and the potential for genetic screening and selection. In India, the use of ART has led to a rise in the demand for donor gametes, particularly from women who are paid for their eggs. This has led to concerns about the exploitation of vulnerable women and the commodification of human reproductive material.

 

Another significant ethical concern is the impact of ART on the natural process of reproduction. ART involves the use of drugs and procedures that mimic or override the natural process of reproduction. This has led to questions about the ethical implications of altering the natural course of human reproduction.

 

Finally, there is the potential for genetic screening and selection through ART. With the use of pre-implantation genetic testing, it is possible to screen embryos for genetic disorders and select those that are free from such disorders. However, this raises concerns about the potential for eugenics and the ethical implications of selecting certain traits over others.

 

In conclusion, the legal and ethical perspectives of ART in India require careful consideration and attention. While the ICMR guidelines provide a framework for the use of ART, there is a need for better regulation and enforcement of the guidelines. Additionally, the ethical implications of ART require ongoing debate and discussion to ensure that the use of technology in reproduction is consistent with ethical principles and values.

 

AN INTRODUCTION TO ASSISTED REPRODUCTIVE TECHNOLOGY

Assisted reproductive technology refers to fertility treatments used to help individuals or couples who are unable or choose not to procreate through the natural reproductive method. ART includes a range of procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT). Both males and females can develop or have genetic diseases that cause infertility. Some of the diseases that cause infertility are-

 

• Fallopian tube damage or blockage. This makes it difficult for the egg to get fertilised or the embryo to travel to the uterus and thus causes difficulties in pregnancy.
• Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.
• Endometriosis. It is a condition that occurs when a lining similar to the uterus develops outside it.
• Uterine fibroids. These fibroids are benign tumors in the uterus of the women. Such tumors intefer with the pregnancy of the woman.
• Previous tubal sterilization or removal. This is a sterilisation process that permanently prevents pregnancy.
• Impaired sperm production or function. Poor sperm mobility, abnormal sperm size, can all lead to infertility.
• Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.
• A genetic disorder. In IVF a genetic disorder can be screened for by using pre screening processes. Thus if the parents have any genetic disorders that can be passed on to their offsprings, IVF is a good medium to reduce the likelihood of that possibility.
• Fertility preservation for cancer or other health conditions. If a woman has to go through any sort of cancer treatement such as chemotherapy or any radiation therapy. Their fertitliy may be affected. By way of ART tehy can freeze their eggs and have it implanted post their cancer treatment. Women who have further issues may chose a gestational carrier to carry the embryo to term. [1]

All the diseases mentioned above cause infertility and prevent a couple from being able to reproduce. Therefore they are forced to look at options such as ART.

 

DIFFERENT TYPES OF ART

The different kinds of ART are as follows-

 

1. IN VITRO FERTILISATION (IVF):

This is the most common type of ART. It is a long drawn process, the first step to which is hormone injections given to the egg donor to prepare her for extraction of the donor egg. Upon completion of the course of injections the eggs are extracted. At the same time a sperm donor is chosen. The egg is then fertilised within the labrotary using a specialised medical procedure. The resulting embryo is then transferred by way of an embryo transfer (ET) into the uterus of the person who is to give birth.

 

The Centers for Disease Control and Prevention (CDC) lists the 2018 success rates of IVF treatments for one oocyte retrieval from people using their own eggs as:

 

• • 52% for people aged 35 or younger
  • 38.1% for people aged 35–37
  • 23.5% for people aged 38–40
  • 7.6% for those over the age of 402[2]COST OF IVF

The cost for one cycle of IVF is around Rs. 1,50,000- 3,00,000 in India. However that does not include any of the other medical tests or procedures that need to be done along with this IVF process. The cost of IVF is a huge factor to consider while taking into account the legal and ethical issues related to ART.

 

DISADVANTAGES OF IVF

One cycle of IVF in no way guarantees pregnancy. Further IVF comes with a whole load of negatives as well.

 

• MULTIPLE PREGNANCIES- IVF can lead to multiple pregnancies. The process of IVF is a very tedious and expensive process with a moderate success rate. This means that couples/ individuals will choose to transfer multiple embryos in order to increase their chances of pregnancy. This then in turn leads to multiple pregnancies. Multiples pregnancies is a condition where in more than one embryo embeds itself onto the uterus. Thus leading to multiple births. The human uterus is meant to carry one embryo to term, increasing the number of embryos opens the door to a plethora of medical complications such as premature birth, low birth weight, life threatening maternal complications, four times higher maternal death rates, pre eclampsia or twin to twin transfusion syndrome.
• OVARIAN HYPERSTIMULATION SYNDROME- The fertility drug called the human chorionic gonadotropin is used to stimulate the ovaries into producing more eggs for the extraction. However when such drugs are used, it may cause ovarian hyperstimulation syndrome in which the ovaries swell up and cause very painful side effects that include nasuea and shortness of breath.
• ECTOPIC PREGNANCY- These are pregnancies where the embryo implants itself outside the uterus. The embryo cannot survive outside the uterus thus there are huge complications and the pregnancy cannot continue. [3]

These are just a few complications in the whole IVF process, there are many more that may occur during the procedure. Some studies even link cancer to IVF treatements.

 

1. INTRACYTOPLASMIC SPERM INJECTION (ICSI): This is a specialized form of IVF that involves injecting a single sperm directly into an egg.

 

1. GAMETE INTRAFALLOPIAN TRANSFER (GIFT): This involves transferring eggs and sperm into the fallopian tubes, where fertilization can occur naturally.

 

1. ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT): This is similar to GIFT, but the fertilized egg (zygote) is transferred to the fallopian tube rather than eggs and sperm.

 

1. DONOR EGGS OR SPERM

In cases where one partner is unable to produce viable eggs or sperm, donor eggs or sperm can be used in IVF or ICSI. Egg donation and sperm donation are two very important processes that facilitate IVF or ICSI. Very often the couple that is going through with IVF, is infertile and either both partners or one of the two are unable to produce viable genetic material. These couples can approach sperm banks or egg donation facilities that allow for them to buy anonymously donated genetic material at random. This however is a topic that will be addressed further on in the scope of this project for commodification of genetic material is a very important ethical and legal issue.

 

1. SURROGACY:

 

This involves using a surrogate to carry the pregnancy for the intended parents. The surrogate can be genetically related to the child or not, depending on the type of surrogacy. There are two types of surrogacy-

 

• Traditional Surrogacy
• Gestational Surrogacy

Traditional surrogacy is a process by which the surrogate also provide the eggs or the oocytes. She is artificially inseminated with the sperm but she herself provides the egg. However in gestational surrogacy the surrogate only carries the embryo to term. She does not provide any genetic material. The difference between the two types of surrogacy is very important when it comes to legal questions about parenthood.

 

This is a brief understanding of the different types of Assisted Reproductive Technogies. Along with all these medical advances, there also comes a myriad of legal and ethical issues with regards to ART procedures. India’s legal system is still adapting to the speedily evolving medical field. At present there are two main legislations that take care of ART and Surrogacy. That is the Artificial Reproductive Technology Act 2021[4] and the Surrogacy Bill 2019[5].

 

These were two legislations that were brought out to counter the numerous issues that were highlighted by this new section of medicine. However not all issues are covered by these legisaltions. Further it is necessary to look at the roots of these issues which are ethical in nature. Starting all the way from whether these procedures are safe to whether monitising on them can lead to the furtherance of the development of the medical tourism industry in India.[6]

 

 

ISSUES RELATING TO ART

 

1. COMMODIFICATION OF SPERM AND EGG DONATION:

There are many reasons as to why a person would want to donate their genetic material, however it boils down to whether they are doing it altrusitically or are they doing it for the money. Nowadays most donations are done for money. In India a male can get around Rs. 20,000- 30,000 for donating a sample and can even run into lakhs of rupees for females. It is a known fact that egg retrieval is a more intense process and it requires a lot more commitment in terms of time and energy in comparison to sperm donation. Which is why certain women while undergoing IVF choose to donate their extra eggs to other couples. The main question here is twofold-

 

• • Whether the donors must be compensated for their donations.
  • Whether donor anonymity must be maintained.

 

With regards to the first question, compensation of donors for their genetic material leads to the commodification of genetic material. Which basically means that we are putting a price on genetic material. In theory it doesnt sound bad but the repercussions of the same are manifold.

To begin with, it means we are putting a price on genetic material which inturn shows that such material can be traded like goods. One of the fundamental reasons as to why organs are not allowe to be traded in India is because of the fear that it will become a mode of human exploitation. Especially with regards to the poorer and more vulnerable sections of the population. Its the same reason why prostitution is not yet made legal. Similiary genetic material being traded for compensation opens up an avenue for exploitation. However on the flip side we have the issue of the very low supply of genetic material. Now if compensation is also taken away, the pool of donors will reduce drastically. This is a strong reason to commodify genetic material as without it there will be barely any donors but the reason that stands against commodification seems to present a more compelling case. Another issue is that of young women and men selling their genetic material without realising the consequences.

 

When a women donates her genetic material, she is informed of the entire medical procedure and also asked to sign a consent form. Thus getting the informed consent of a donor is essential when it comes to the whole process of donation. However there have been very few studies that have been done to understand the long term effects of the hormone injections given to these donors. The main reason being that the technology is so new that there has not been opportunity to observe the long term effects. Thus when the donor's consent is being taken is it really informed consent if she is not fully informed when she makes her decision? This then opens up a new avenue for exploitation. Thankfully however this is where the Assisted Reproductive Technology Act 2021 comes into effect. According to the act, a woman can donate only once in her lifetime and only 7 eggs at a time. This is to ensure that the women are not exploited and their bodies are not unnecessarily exposed to these procedures that are not fully tested.

 

The other main issue is that nowadays a lot of clinics even though they are not supposed to, allow for the intended parents to chose the perm or egg by way of looking at the donors qualifications or physical appearance. This is a very slippery slope as some traits maybe be preferred over others. Thus some genetic material will be valued at a higher price over others. This in turn will only reenforce biases and discrimntaory practices that our society has been trying so hard to fight.

 

This brings us to the question as to whether sperm donor anonymity should be maintained. ART Act 2021 states that any donation of genetic material must remain anonymous. The reason for the same is manifold. It stands as a barrier against discriminatory practices such as trait selection. Further it also deals with the isseu of parenthood. There are multiple cases in the past that have dealt with the parenthood of a child who has been brought to life via sperm donation. These are usually twofold-

 

1. The sperm donor wants contact with the child and wants to claim parenthood of the child.- Even ART Act 2021 states that the donor must be counciled before they are allowed to donate. This is so that they
2. The intended parent wants child support and thus claims the sperm donor as the child.
3. The child wants contact with the sperm donor.

 

In all three cases sperm donor anonymity must be broken. This will then again lead to a myriad of problems.

 

1. COMMODIFICATION OF SURROGACY

The commodification of surrogacy means that we are putting a price on the usage of a womens body. This leads to major problems. One such problem is called surrogacy tourism. Especially in India surrogacy tourism is becoming very popular. There are even villages that cater specifically to surrogacy tourism. Rajasthan surrogacy village, also known as the Akanksha Infertility Clinic, is situated in the Indian state of Rajasthan. It is a unique village that has been established to provide surrogacy services to couples who are unable to conceive naturally. It is said to be the first of its kind in India, where surrogacy has become a booming industry in recent years. The village is equipped with state-of-the-art medical facilities and is staffed by expert medical professionals, who have made it a hub for surrogacy service providers.

 

The village has been designed to cater to various types of couples, ranging from heterosexual couples to same-sex couples, and even single parents. The cost of the surrogacy services is relatively cheaper here than in Western countries. Foreign couples come here in large numbers since surrogacy is either illegal or cost-prohibitive in their home countries. However, this has

 

given rise to other ethical issues, such as the exploitation of surrogate mothers and the need to regulate the industry.

 

Despite these concerns, the Rajasthan surrogacy village has been credited with providing an invaluable service to couples who are looking to start families. It has helped to create a new life for many infertile couples, who otherwise would have had no alternative. The village has been instrumental in giving more women the opportunity to become surrogate mothers, providing them with an income and financial independence. Overall, while the practice of surrogacy has its challenges, the Rajasthan surrogacy village has provided hope to many, changing lives and bringing happiness to hundreds of families.[7]

 

Surrogacy tourism is the process of seeking assisted reproductive services from a surrogate outside of one's country of residence. This practice has gained significant popularity in recent years, especially for individuals or couples who face challenges conceiving a child or carrying a pregnancy to term. The primary drivers of surrogacy tourism are the different legal frameworks and availability of surrogacy services across different regions.

 

While surrogacy tourism offers the opportunity of parenthood to couples or individuals, there are many ethical dilemmas surrounding the practice. One concern is the exploitation of surrogates, many of whom come from lower-income countries and may be taken advantage of by agents or clinics. Another issue is the lack of regulation, which leaves room for malpractice and abuse by those in the surrogacy industry. There is also a moral question of whether it is right to use women's bodies as a means to an end, with some critics arguing that surrogacy commodifies women's reproductive capabilities.

 

In conclusion, surrogacy tourism is a complex issue that pits the desire for parenthood against ethical and moral concerns. While it provides an opportunity for individuals and couples who might otherwise be unable to have a child, it also raises challenging ethical dilemmas. As the popularity of surrogacy tourism continues to grow, there is a need for a regulatory framework that balances the rights of those seeking surrogacy services with the well-being and autonomy of surrogates.

1. PREIMPLANTATION GENETIC TECHNOLOGY

Preimplantation genetic testing (PGT) is a technique used to test embryos for genetic disorders before they are implanted into a woman's uterus during assisted reproductive technology (ART). The technique involves removing one or a few cells from an embryo and analyzing them for genetic mutations or chromosomal abnormalities. Although PGT can help prevent the transfer of certain genetic disorders to offspring, it also raises some ethical and societal issues.

 

One of the major ethical issues with PGT is the potential for sex selection. PGT can determine the sex of an embryo, which means that couples may use PGT to select embryos based on their desired gender. This could lead to a preference for one gender over the other and contribute to gender inequality. Additionally, PGT can be used to select embryos for certain traits such as eye color, height, or intelligence, which raises concerns about eugenics.

 

Another ethical issue surrounding PGT is the possibility of creating "designer babies," where parents use PGT to select embryos based on physical or intellectual traits they desire for their future child. This could perpetuate a societal pressure to conform to certain physical or intellectual standards and further widen the gap between wealthy and poor families or groups.

 

In conclusion, while PGT can be an incredibly useful tool in preventing the transfer of certain genetic disorders, it also raises complex ethical and societal issues. As this technology advances, it is important to consider how it can be used responsibly and avoid contributing to inequalities or harmful social norms.[8]

 

India has emerged as one of the global leaders in the ART domain. Despite the positive impact of ART, there are ethical concerns concerning its use. One of the primary concerns is the misuse of ART technology for sex selection. In India, the preference for a male child results in a skewed gender ratio; consequently, ART is currently banned for such purposes. ART clinics must ensure that the gender of the child is not disclosed to the parents during the pregnancy. Another concern is the possibility of multiple pregnancies due to embryos transferred during the IVF process bearing the risk of maternal death due to complicated pregnancy. Thus, it is imperative that ART treatment is carried out under conducive medical and ethical conditions.

 

Since infertility constitutes a significant challenge in India, the increasing popularity of assisted reproductive technology provides tremendous hope to infertile individuals. Despite the need for ethical considerations, the benefits of ART have been significant in many couples who have experienced infertility. With technological advancement, it is expected that ART will not only become more accessible and affordable to patients but also be utilized for the treatment of other medical conditions.

 

1. REGULATION OF NUMBER OF DONATIONS-

Assisted reproductive technology (ART) treatments have become increasingly popular over the years, with more and more couples facing infertility issues. With the growing demand for such treatments, concerns have arisen regarding the regulation of the number of donations in ART. Several countries have already imposed regulations on the number of donations, while others are contemplating doing the same. There are several reasons behind this move, including concerns about the health of donors, the possibility of consanguineous relationships, and the ethics of using donated gametes.

 

One of the primary reasons for the regulation of the number of donations in ART is to ensure the health and well-being of the donors. Donating sperm or eggs can be a taxing process, and it can take a significant toll on the donor's physical and mental health. Bearing this in mind, many countries have decided to limit the number of times a donor can donate their gametes. This ensures that donors are not overburdened by the donation process, which, in turn, can increase the number of gamete donors in the long run.

 

 

Another concern regarding the regulation of the number of donations in ART is the possibility of consanguineous relationships. When multiple children are conceived from the same donor, it increases the likelihood of these children being related to each other. While doctors take steps to prevent such situations, it is impossible to control the choices of the individuals who choose to use donor gametes to conceive. By regulating the number of donations, countries aim to reduce the number of children conceived from the same donor, thereby reducing the chances of consanguineous relationships.

 

In conclusion, the regulation of the number of donations in ART is a crucial issue that needs to be addressed. There are several reasons behind this move, including concerns about the health of donors, the possibility of consanguineous relationships, and the ethics of using donated gametes. While countries have different regulations regarding the number of donations that a donor can make, it is essential to ensure that these regulations are in place to protect the physical and mental well-being of donors and the health of the children conceived using donated gametes.

In order to ensure the safety and ethical use of these donations, many countries have implemented a registry of donors. This registry serves as a central database of anonymous donors and provides a level of transparency in the ART process.

 

The primary purpose of a registry of donors is to protect the health and well-being of offspring conceived through ART. Donors are required to provide detailed medical and genetic information to be included in the registry. This information is used to screen for hereditary diseases and other genetic disorders that could be passed on to the child. This information is also used to inform prospective parents of any potential risks associated with the use of donor material.

 

In addition to providing important health and genetic information, a registry of donors can also protect the rights of donors and their offspring. Many registries have strict guidelines for the anonymity and confidentiality of donors. This information is only shared with prospective parents and is not made publicly available. This protects the privacy of donors who may not want to be contacted by offspring later in life. It also protects the rights of offspring who have a right to know their genetic heritage but may not want to have contact with their biological parent. Ultimately, a registry of donors serves as an important safeguard for the ethical and safe use of ART. In india The National Registry of ART collects data on ART cycles conducted in the USA every year. This data is used by the government to monitor and regulate ART cycles and ensure its safety.

 

The National ART registry was established in 1992 to keep track of ART cycles performed in the US. The registry comprises ART clinics, fertility clinics, and hospitals dealing with the treatment of infertility. The primary objective of the registry is to gather vital information related to ART cycles' success rates, complications, and adverse outcomes. The registry's data is used to monitor the safety and efficacy of ART, safeguard patient health, and improve the quality of care.

 

The data collected from the ART registry is extremely valuable for policymakers, legislators, and healthcare providers. The information helps healthcare providers improve their practice, continuously monitor the quality of patient care, and recognize emerging trends that lead to better outcomes for patients. The National Registry for Assisted Reproductive Technology (ART) in India is an initiative that was launched in 2009 by the Indian Council of Medical Research. The registry aims to collect data on all ART procedures taking place in the country and make it available for public use. This initiative is an important step towards regulating the use of ART procedures and ensuring that patients receive safe and effective treatment.

 

The registry collects data on all ART procedures, including in vitro fertilization (IVF), surrogacy, and intrauterine insemination (IUI). The data collected includes details about the patient, their medical history, the ART procedure used, and the outcome of the treatment. This information is then used to monitor the safety and efficacy of ART procedures in India, improve the quality of care provided, and inform future policies and guidelines.

 

The National Registry for ART in India also plays an important role in reducing the practice of illegal and unsafe ART procedures in the country. By collecting and analyzing data on all ART procedures, the registry provides a crucial mechanism for monitoring the quality of care provided and identifying any deficiencies in the system. This, in turn, helps to prevent the use of unsafe and unregulated ART procedures that can cause harm to patients and their children. Overall, the National Registry for ART is a much-needed initiative that will help to ensure that patients in India receive safe and effective ART treatment.[9]

 

CONCLUSION-

Assisted reproductive technology (ART) has revolutionized the way people have children. With advancements in technology and medical science, people who previously would have been unable to conceive now have options available to them. However, despite the many benefits of ART, it is not without its controversies. There are concerns around ethical, legal and moral issues, as well as physical and emotional risks to patients.

One of the key ethical issues around ART is the question of whether it is right to create life in a lab. Critics argue that this goes against the natural order of things and that embryos created through ART should be given the same rights as those conceived naturally. Additionally, there are concerns around genetic manipulation and the potential for children to be born with disabilities or medical problems due to the process.

 

Despite these controversies, ART has given hope to millions of people who have struggled with infertility. For many, it is the only way they can have children and build a family. With careful consideration of the ethical issues involved and proper medical oversight, it is possible for ART to continue to assist couples and individuals in creating families while minimizing the risks and drawbacks. Overall, the conclusion on assisted reproductive technology is that while it is not a perfect solution, it is an important tool that has had a significant positive impact on many people's lives.

 

 

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[1] In vitro fertilization (IVF) - Mayo Clinic. (2021, September 10). In Vitro Fertilization (IVF) - Mayo Clinic. https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716

[2] 2Assisted reproductive technology: Definition, types, and ethics. (n.d.). Assisted Reproductive Technology: Definition, Types, and Ethics. https://www.medicalnewstoday.com/articles/assisted-reproductive-technology

[3] Institute of New Orleans, T. F. (2020, March 22). Understanding The Risks Of IVF Twins And Multiples | Fertility Institute. The Fertility Institute of New Orleans.

https://fertilityinstitute.com/blog/the-risk-of-multiples-pregnancy-with-ivf/

[4] The Assisted Reproductive Technology Act 2021.

[5] The Surrogacy (Regulation) Bill, 2019. (2019, July 15). The Surrogacy (Regulation) Bill, 2019. https://prsindia.org/billtrack/the-surrogacy-regulation-bill-2019

[6] In vitro fertilization (IVF) - Mayo Clinic. (2021, September 10). In Vitro Fertilization (IVF) - Mayo Clinic. https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716

[7] The Baby Factory: Surrogacy, the blooming business in Gujarat. (2013, August 23). India Today. https://www.indiatoday.in/magazine/cover-story/story/20130902-surrogacy-blooming-business-in-gujarat-s hah-rukh-aamir-khan-765351-2013-08-22

[8] Flinter, F. A. (n.d.). Preimplantation genetic diagnosis : Needs to be tightly regulated. PubMed Central (PMC). https://doi.org/10.1136/bmj.322.7293.1008

[9] https://main.icmr.nic.in/sites/default/files/art/Doc_6.pdf