Ethical Challenges Faced by Individuals with Disabilities in Accessing Healthcare: A Systematic Review of Barriers, Discrimination, and Autonomy in Decision-Making.

Background: Despite progressive legal frameworks such as the Rights of Persons with Disabilities (RPwD) Act, 2016, and India's ratification of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), persons with disabilities (PWD) continue to face ethical challenges in accessing equitable healthcare in India. The objective of the study is to systematically synthesize evidence on ethical issues related to healthcare access, specifically barriers, discrimination, and autonomy in decision-making affecting PWD in India. Methodology: A systematic search of seven electronic databases and grey literature sources was conducted for studies published between January 2005 and March 2025. Peer-reviewed quantitative, qualitative, and mixed-methods studies, along with relevant policy and advocacy reports, were eligible. Study quality was appraised using STROBE and CASP checklists for peer-reviewed literature, while grey literature was assessed based on source credibility and methodological transparency. The review protocol was registered with PROSPERO (CRD420251028645). Results: Thirty sources were included, comprising 22 peer-reviewed studies and 8 grey literature or policy documents. Most peer-reviewed studies were of moderate methodological quality. The synthesis revealed persistent physical, financial, informational, and communication barriers to healthcare access. Attitudinal and institutional discrimination by healthcare providers was commonly reported, and autonomy was frequently compromised through substituted decision-making and inaccessible consent processes, particularly among individuals with intellectual or psychosocial disabilities. Ethical challenges were more pronounced in rural, tribal, and socio-economically marginalized populations. Conclusion: Despite legal protections, significant ethical inequities in healthcare access for PWD persist in India. Strengthening implementation of existing laws, promoting disability-inclusive healthcare training, operationalizing supported decision-making, and improving disability-disaggregated health data are critical to advancing ethical, equitable, and inclusive healthcare.