§ Order for Second Reading read.
I beg to move, "That the Bill be now read a Second time."
This Bill is promoted with the object set forth in the Memorandum, namely,to render more complete and effective the safeguards afforded by the law of registration in relation to the disposal of the dead, with a view to eliminating, so far as possible, any element of risk or opportunity for the concealment of crime.There is an additional object which affects a good many people, and concerning which the promoters have had a good deal of correspondence at one time and another, and that is the matter of premature burial:Provision is made enabling local authorities to arrange for the medical inspection in certain instances of the body of the deceased person, and for regulating certain means of disposal. Still-births are required under the Bill to be registered as a measure of additional safeguard for the protection of infant life.The subject matter of this Bill is no new one. A Select Committee reported in 1893 with a number of recommendations, which are embodied in the present Bill, which is by no means the first. The present edition, however, has sought to get over one of the objections of previous ones, by eliminating an objectionable Clause as to the universal medical inspection of bodies before burial. The new Clause 7 in this Bill gets over that by making itlawful for a county council or a county borough council, or in London, for the common council of the City of London or for a metropolitan borough council, with the approval of the Minister of Health, to make such arrangements as they may think fit whereby, in any case where the body of a deceased person has not been seen by a registered medical practitioner since the death, the services of a registered medical practitioner are made available for the purpose of verifying, upon the request and authorisation of a coroner, the death of any deceased person dying within such coroner's jurisdiction.That gets over the difficulty of the universal medical inspection, and one 978 hopes that it will get rid of a lot of objections of previous editions of this Bill. With regard to the matter of the prevention of crime, under the present law there is no restriction, except upon burial or cremation, as to the disposal of the body in any other way. That is to say, bodies may be taken out to sea and put overboard without possible detection if there has been any criminal action in connection with them.
Turning to the structure of the Bill, the first four Clauses deal with legislation in regard to coroners' law, and the disposal of the dead generally. These Clauses, i think, are all plain-sailing. There is nothing in the Bill which needs explanation, and no-one reading it through can find anything therein to which to object. With regard to still births, which are dealt with in Clauses 5 to 8, it is proposed in future that any birth, whether still or live, will have to be registered, and the body of no still-born child may be disposed of without the production of the proper certificate. Clauses 6 and 7 deal with the matter of certifying the cause of death. Here there has been a good deal of trouble in regard to medical certificates, as in the past, though the registrar could send a particular form of certificate to a doctor who had attended a patient in his last illness, it has not been necessary that the doctor should use that form of certificate. Under the proposed law one hopes that that difficulty will be got over. I commend this Bill to the House. There is nothing really controversial about it. It has been before the House many times in other forms, and my hon. and gallant Friend the Member for St. Albans (Lieut.-Colonel Fre mantle) who has brought it forward on previous occasions, will, no doubt, trace out its history far better than I can.
§ Lieut.-Colonel FREMANTLE
I beg to second the Motion.
The history of this Bill is rather indicative of the work of the Houses of Parliament. It dates back first, as my hon. Friend has intimated, to a Select Committee of 1893—and, indeed, before it. Who says that the Reports of Select Committees and Royal Commissions are pigeon-holed and nothing done? Here the 1893 vintage has just matured after a period of 33 years and we see it now being brought before the House; and I have no doubt that the House of 979 Commons will relish the bush that it has acquired during the period, and will straightway put it into law ! There was another Departmental Committee in 1909. I suppose it was thought advisable to have a fresh vintage, though the other one was only half-matured after 16 years. The Report of both of these Committees showed what grave defects there were in the law of death registration. The Report of the 1893 Committee said most clearly:It is a most important duty of society to guard its members against foul play, and it appears to your Committee that, so far as may be, it should be made impossible for any person to disappear from his place in the community without any satisfactory evidence being obtained as to the cause of his disappearance.I think we all agree with that—Your Committee, fortified with weighty evidence, have arrived at the conclusion that uncertified deaths as a class should cease to exist, and that means should be devised whereby a medical certificate should be obtained in every case from a medical practitioner.This was, in effect, that there were many gaps in the certification of death, and that these should be filled up. Practically all cases of uncertified death "as a class" should cease to exist. There was no impossible optimism about the Report. The Committee did not say that every death would have to be certified. They said "uncertified deaths as a class" should cease to exist. There are certain instances where it is inconceivable that no certification should be possible. These are cases returned to a coroner and dealt with by him. The Departmental Committee on the Law relating to Coroners, which sat in 1909, in their Second Report, went further and said:It is no fault of the law if premature burials do not take place. The present law of death certification affords every opportunity for premature burial and every facility for the concealment of crime.So they went on to make certain suggestions. They said:At present a coroner may certify merely on the information given to him by a medical practitioner. We have had evidence that many certificates have been carelessly or even heedlessly given.Everybody will recognise these cases. Every now and again really they crop up in. public, and the Courts. Naturally enough our friends of the Press make the very utmost use of such instances, 980 for they make really good copy, provide splendid headlines, and lose nothing in the telling. The result is that they have a very serious effect upon a large number of the community who, naturally enough, are inclined as they get on in life to think mainly of their mode of passing into the next stage of existence and are rather anxious as regards that method of passing.
We see that over and over again, how in wills there are stipulations laid down, definitely to ensure that the person shall be dead. I must say that it rather surprises me most to realise the mentality of those who think it necessary to provide for surgical operations being made upon their reputed corpse after death to ensure their death. Personally I think, if I may say so, if one cannot be seen to be perfectly dead it would probably be an easy way, and preferable to any other alternative, of passing into the next world to be buried and so lose life suddenly. At the same time I realise that a large number of people think otherwise. Speaking as a medical man, and recognising how seldom it can be necessary, I believe, from the evidence of the facts, that the matter is exaggerated. I come across people, however, who are convinced as to the possibility of it. There is no question about it that instances do occur occasionally where persons are disposed of, or steps are taken to dispose of them unwittingly, it being thought that they are dead before death has occurred.
Curiously enough as I came to the House to-day I received a letter from a friend, a much valued colleague of mine in the north of England, a county medical officer of health, who sent me a cutting from a northern paper relating to an instance which occurred actually last week. On Saturday morning, the paragraph ran—and this is in a place that has been heard of recently in this House, namely Darlington:At Darlington last week an infant was born prematurely. The midwife who was undertaking charge of the operation at once said that the infant was dead, and ought to be buried. The infant was put into a small coffin and was taken by two friends to the cemetery. On the way to the cemetery—it was a stormy night—one friend said to the other that she heard something moving. The other replied that it was the wind. When they got to the cemetery and went into the superintendent's room, where 981 all was quiet, the noise was heard again. The coffin was opened and the baby was found to be still alive. The baby was then saved from immediate burial and was taken and warmed before the fire. It was seen by a medical man.It had the rather unfortunate experience, I imagine, to live for a few hours longer, and then it did die. But, of course, it died under such circumstances that a certificate could be signed by a medical man. But that infant would not have had suffered any more, I believe, if matters had taken their course. There was no negligence in the matter. But it points the fact that a large number of people are obsessed by the idea that instances may occur in which premature burial may take place. Obviously, as the Departmental Committee on Coroners' Law reported, instances have occurred where there was a possible opportunity for crime to be perpetrated. With a view to averting this several attempts have been made to amend and make the law comprehensive.
The first one that I remember since i have been in this House was the Bill introduced in 1923 by an old friend and colleague, then Member, I think, for Southport. That 1923 Bill had been prepared under the auspices of the British Medical Association. That Bill was backed by myself and my hon. Friend the Member for Withington (Dr. Watts), but it never got any further. A little later a Bill was introduced by the hon. Member for West Bermondsey (Dr. Salter) but it met the same fate. Both these Bills attacked the same problem but in slightly different ways. Then a body called the Federation of Medical and Allied Societies appointed a Committee of representative medical men and coroners, and undertakers and other persons, and the result of their deliberations was a Bill which I had the honour of presenting in this House in 1924. The then Minister of Health, the right hon. Member for Shettleston (Mr. Wheatley), wrote me a private letter saying that he was in favour of the Measure but, unfortunately, owing to the state of Government business, it could not be allowed further progress and he would have to drop it. It showed at any rate that the party opposite were in favour of the principle of the Measure.
I introduced the same Bill last year and the Minister of Health then accepted, 982 with very great kindness, the general principle of the Measure and the object sought to be attained, but he felt there were certain points which would make it impracticable and unacceptable to the House. In view of this he suggested that I should meet the officials of his Department, and in that way manage to draft a Bill which would be acceptable to the House. The result is the present Bill, which I hope the Government will see their way to support this afternoon. We have been sailing during these years between Scylla and Charybdis, and the voyage has been rather difficult. In our previous efforts we have steered clear of the Charybdis of public life, but have bumped on the Government rocks of Scylla. I have steered my boat to-day, I hope, carefully past the Scylla rocks as represented by the hon. Member the Parliamentary Secretary to the Ministry of Health (Sir Kingsley Wood), who, I hope, is powerless to arrest its passage any more, but I am somewhat afraid of Charybdis, as represented by hon. Members on the other side of the House.
Let me anticipate some of the chief objections which may be raised against this Bill by hon. Members opposite. I am sure the Government would not give further support to a Bill if it is to be arraigned from outside by those persons who will have to carry it out. There are two points which the previous Bills desire to secure, and neither of them is completely reached in this Bill. The first is this. It was shown over and over again that the cause of death was not completely notified in the certificate. The certificate very often gave a very inexact idea of the cause of death and was therefore dangerous from two points of view. It was dangerous from the point of view of the possibility of carelessness, it might act as a shelter to crime; and dangerous from the point of view of those who wanted to make a scientific study of the statistics of disease, from which a large proportion of our legislation and administration is derived for the good of the community generally. For both these reasons it is necessary to try and improve the certificate giving the cause of death.
The Registrar-General at Somerset House and his officials throughout the country have been working by admin- 983 istrative measures for a long time in this direction, and by their steady work they have improved the certification of deaths very materially. The figures are of immense value to those who are trying to obtain useful scientific conclusions from them. Still there is a gap, and that gap is especially prevalent in certain cases where the feelings of the relatives are concerned. Obviously it is difficult for a medical man to sign a death certificate for a person who has died ultimately and in the first instance from causes that are commonly associated with vice and self indulgence. It is natural for him to try and spare the feelings of the relatives by giving the terminable result that has caused the death and assign it as due to bronchitis or heart failure instead of to the primary and original cause. In this way our statistics of syphilis and alcoholism are quite unreliable, and for obvious reasons, and it has been suggested that we should have a system of confidential certification, that there should be two certificates for the medical man to give—one a certificate of the fact of death and the other a certificate of the cause of death. He would give the certificate of the fact of death to the relative, and that would be sufficient authorisation for burial, and the second certificate of the actual cause of death would be sent confidentially to the Registrar-General for statistical use.
I know this Bill is being criticised because it does not make much advance from the point of view of science and medical statistics which would have been attained in that way, and cannot be attained in any other way. But what would have been the result if we had inserted such a provision as this? If you had a confidential certification of that sort it could not have remained confidential. It could not have remained confidential for purposes of insurance. The cause of death has to be ascertained for insurance purposes, and the cause of death can only be ascertained by certificate. Therefore, a certificate of the fact of death would not be sufficient for the purpose of insurance. A confidential certification of the cause of death is therefore out of the question. There is a further difficulty. If you have a kind of certification of the cause of death on the public certificate and the real and 984 true and more intimate certificate goes to the Registrar-General, you do not meet the difficulty, because the insurance company would still want to see the more intimate and accurate certificate. And if you had two certificates of that sort it would complicate the system.
I am afraid doctors are not Very fond of filling up forms, and if you give them two forms to fill up in connection with any one incident you are not likely to get either form correct, and neither set of figures, therefore, would be trustworthy or of any practical use. What we have done here is to make it essential that the medical man, in giving his one certificate, shall give it on the prescribed form, which is a very thorough form, which goes to the Registrar-General. As a matter of fact, as a result of what one may call the very fine official work on the part of the Civil Service which deals with these matters, the use that is made of these forms and the help given by doctors who sign them, that by correspondence and by purely voluntary efforts, the system of certification has been made much more efficient than if you had a compulsory system such as has been suggested. I believe it is by improving on the present system, and gaining more experience from registrars on the one hand and medical men on the other, that we shall secure the system of certification which is desired. It is only gradual improvement that will be helpful in the long run.
Another point to which I wish to draw attention is the proposal that every death should be verified and a medical certificate given only after a medical man has inspected the body after death. Everybody feels, I think, that it would not cast much extra trouble upon a medical man to see the body in every case, and therefore that this ought to be made compulsory. My right hon. Friend the Minister of Health and his officials, in talking this over with me, showed quite clearly that there were a very large number of cases where it could not be done. At the present time in only about 30 per cent. of cases is it certified that the bodies were seen by the medical man after death. We have to bear in mind the conditions under which death occurs. The doctor has been going to the house day after day for a long time in order to see what can be done to the patient. In those households 985 which can afford it a nurse is installed, and acts under the doctor's orders, the doctor knows he can trust the nurse, and his visits naturally get fewer and fewer. He goes only at such times as are necessary because the case has become chronic, and he knows that it has passed beyond his aid. He may go once a week; and perhaps a day or two after his last visit he receives a letter from the husband or father to say that the patient has passed away, and asking him kindly to send a certificate. It was a case in which, as everybody knew, death was inevitable, the cause of death is known, and the doctor on his own responsibility signs the certificate.
Would it be an advantage to require the doctor to visit the body? It would give confidence to everybody, undoubtedly, but doctors are busy men and do not care to do totally unnecessary work. Any such proposal would be quite unnecessary from the point of view of the patient, who is dead; quite unnecessary from the point of view of the relatives, who, perhaps in a spirit of sympathy with the sufferings of the patient, feel relief that the end has come; and quite unnecessary from the point of view of the doctor. If the State nevertheless insists upon it, the State would naturally have to pay the fees for the doctor's time and his travelling expenses. Very often it is not a case of travelling a mile or so, but of going five or 10 miles, taking up an hour or two of the doctor's time, and the cost of it would have to fall on the Treasury or on the rates. Accordingly, such a proposal could not be introduced in a private Member's Bill, and could not be included in this Bill, and anyhow I think the House would recognise that it would be unnecessary expenditure in a very large number of cases.
Then we should have to look round and see how many cases would have to be exempted, and in what way they could be exempted, and we should come back to the conclusion that is so general in professional matters, that we must rely on professional honour. If we cannot trust professional men, and try to put them, into a strait waistcoat, we shall be cheated perhaps just as much by the black sheep there are in every flock as we should be otherwise. There would still be ways in which criminals could get through your 986 strait waistcoat to defeat the law. I think the right way is to trust the medical man, and by all means give them every facility and every opportunity encouraging them to see what is unnecessary. In 99 cases out of 1,000 the medical man does what is intended, and we shall not be able to get the precautions desired against premature birth by the means suggested. It is not necessary in many cases to provide for the medical man to inspect the body, but it is proposed that the larger local authorities like the councils of county boroughs shall have the power to arrange for a medical man to view the body in any case when it appears necessary.
It will be necessary by the machinery of this Bill because this Measure completes a system of certification so that no body can be buried until the death has been properly registered, or the Coroner has given the necessary order for burial, and the Registrar will know that death has taken place because the certificate has to be returned so that he will know that the procedure has Been carried out completely.
If you adopt this registration by the Registrar or the Coroner and it develops into a case which has not been seen by a medical man it is referred to the local authority, and they will commission some medical officer or perhaps an assistant medical officer to go and view the body. In that case they will have the machinery set up which will enable all cases of death to be seen when necessary if the local authority thinks fit. That is a new suggestion and I think it is an ingenious one which appeals to me, and I hope it will appeal to the House. It is one way of getting over this particular difficulty. I appeal to the House also to support that particular Clause which for the first time makes it essential to register still-births, because they have escaped the law hitherto.
A child may be born in the morning, and if it lives but a few seconds its birth and death have to be registered. On the other hand, if it died just before or in process of birth there is no such necessity. In so many sad cases of which we are cognisant there is nothing to prevent an infant born alive from being publicly represented, if publicity is found necessary, as never having lived at all, and it can be disposed of in various ways 987 within the law. This Clause proposes definitely that any infants that shall have been born, whether still or alive, shall be registered. It is possible still, of course, for the law to be defeated, but I think most of the kind of cases which we have in this connection are clearly those of deliberately breaking the law to which penalties are attached, and in which they have no scruples of concealing a thing which they look upon as being a misfortune and accidental. I hope the House, for this and other reasons, will give a Second Reading to this Measure, not as one of out-and-out revolutionary reform, not as one which will be acclaimed by the one side as being the Eldorado of their desires and condemned by the other side as being revolutionary Bolshevism, but as having the attributes, which I am always glad to see, of all true reform—of being a very carefully-guarded measure of slow but steady improvement.
§ Mr. ARTHUR GREENWOOD
After the exhaustive arguments that we have heard from the hon. and gallant Member for St. Albans (Lieut.-Colonel Fremantle) little needs to be said in favour of this Bill. I imagine, and hope, that the Bill will meet with the full approval of the House. I do not myself think that it deals with a very large trouble in point of numbers. I do not believe that large numbers of people, whether young or old, are done to death mysteriously, but it is most unsatisfactory that in any country there should not be complete certification of all deaths. It is unsatisfactory that there may be irregularities which occur because the law is not effective. It is undoubtedly true that there is a widespread fear among large numbers of people of premature burial. I do not know what the statistics are, and I am not concerned for the moment with the very small number of people who do happen to be buried alive; the important thing is that this fear exists, and, in the interests of the happiness of large numbers of people, this Bill is worthy of support. It is one of the very few Bills of which, I think, it could be said that it would directly contribute to the happiness of the people if it were passed into law, because it would ensure that the fears of many people need exist no more.
One wants the Bill because, I think, it will end possible irregularities. One 988 wants it because it will minimise the number of undisclosed crimes and because it will be a safeguard of life, not only infant lives, but other lives. The fact that the general line of policy, although not the details, has been settled for so long, for over 30 years, ought, I think, to be sufficient to convince the House that it is about time this Bill was placed on the Statute Book. It is true, as the hon. and gallant Gentleman has said, that two years ago he got sympathetic words but no practical assistance. That was due, quite frankly, to the political situation in the House and the exigencies of the Government, and was not due to any opposition to his Bill. I hope that we may on this occasion proceed further, and that my hon. Friend the Parliamentary Secretary to the Ministry of Health will indicate that the Government are prepared to give this Bill their assistance, and that it may very soon appear before a Committee of the House and be placed upon the Statute Book this Session.
The Bill departs in certain minor details from previous Bills for the same purpose, but, so far as my memory serves me, this is an improvement on the earlier editions, particularly in the case of Clause 7, which provides quite new machinery which will go a long way towards meeting the objects of the Bill, and, at the same time of meeting the objections of those people to whom the hon. and gallant Gentleman referred. It is because I think the Bill is long overdue, and is a Measure which would meet with general public support—I cannot conceive it as being in any way controversial, at any rate politically—that I hope the House will give it its Second Reading to-day.
§ The PARLIAMENTARY SECRETARY to the MINISTRY of HEALTH (Sir Kingsley Wood)
I should like to make some observations on this Bill from the standpoint of my Department, and, subject to examination during the Committee stage, both by the Home Office and by the Ministry of Health, to commend it to the favourable judgment of the House. Certainly, in the opinion of my Department, it is unquestionable that the safeguards afforded by the registration laws in this country in connection with burial are incomplete, and not only incomplete, 989 but ineffective, such as they are, for lack of the machinery and the power to enforce them. It is well worth while looking at the Report—which has already been referred to by my Hon. and gallant Friend the Member for St. Albans (Lieut.-Colonel Fremantle), who has done so much in connection with this matter—of the Committee which sat in 1893. In looking at the Report, and observing their recommendations, one sees that the position as demonstrated in 1893 is exactly the same as at the present day. Really no progress has been made with regard to most of those recommendations, a good many of which, certainly in my judgment, are very necessary indeed.
It is noteworthy to observe that the Committee stated that at that time there were to be found, among certified deaths, many deaths attended by unqualified assistants and certified by qualified practitioners who may never have seen the cases; deaths certified by medical practitioners who had not seen the patients for weeks or months before death occurred, and who only knew by hearsay of the death; and deaths the true cause of which was suppressed in deference to the feelings of the survivors. Such cases, at any rate at that time, were numerous, but, in addition, evidence was given as to cases actually brought to light of deaths registered, with a view to insurance or other frauds, of persons afterwards discovered in some cases to have been murdered, and in other cases to be still alive. There were deaths registered in circumstances suggestive of fraud, where it was not known whether the subjects had or had not died; coffins were buried which were alleged to have contained the corpses of people whose deaths had not been registered, and concerning which it was known that no such persons as those alleged to have been buried had died at the address given to the burial authorities.
Of course, the standard of the medical profession, always high, is higher still to-day than it was then, and it is also fair to say that the great body of the people who have to carry out a necessary work, the great body of undertakers, certainly have a much higher and better standard to-day, and I gladly recognise that myself. This Committee, which came to the conclusions to which I have just referred, was certainly an influen- 990 tial Committee. I see that it included Sir Walter Foster, Sir Stafford North-cote, and others, and they came to the conclusion that there were certain defects in the law and that amendments of the law were urgently necessary.
There are two opinions which we can all endorse and which are dealt with in the Bill. They came to the opinion that, both as far as recording the true cause of death and of detection of it in cases where death may have been due to violence or criminal neglect, there was very much to be desired, and some figures were given then which, I suppose, could be supported to-day showing the necessity, so far as the deaths of children were concerned for an exact system of registration, and for an alteration being made in the law. They call attention to the fact that in the ages between 20 and 40, the period of maximum economic value, the percentage of uncertified deaths was 3.2, which they took as the normal figure. Among deaths between 46 and 60 years of age it was 5 per cent., and on the other side of the normal point, the deaths of persons between 5 and 20 years of age, the percentage of uncertified deaths was 4.8, or nearly half as much again as the normal figure. Between the ages of one and five—this is a very striking figure—it was 10.8 per cent., or more than treble, and between one month and one year it was more than six times the normal percentage, being 20.6. In the case of infants under one month the ratio was more than 12 times as great as it was between 20 and 40, being no less than 41.2.
Another reference in the Committee's Report which I think remains true to-day deals with the matter of registration that takes place upon the information of what is called a qualified informant, and it is, I think, worthy of attention that the registrar, for instance, may take information from a person who has no medical knowledge of the matter. As it states in this report, he could not refuse to register a death and, unless a case had been reported to the coroner there was no authority for delaying registration in order that inquiries may be made. But in regard to this and to my previous statement respecting uncertificated deaths, I may say that the position was greatly improved in 1914, when the 991 Registrar-General made a Regulation requiring all deaths not medically certified to be reported to the Coroner.
It is stated in this report that they are impressed with the possibilities implied in a system which permits death and burial to take place without the production of satisfactory medical evidence of death. One of the advantages of this Bill will be to put an end to that unsatisfactory state of affairs. It is true that the Registrar's certificate for registration or the coroner's order for burial are sufficient authority for burial to-day, but when we know that the non-production of either document does not prevent a burial from proceeding, and all that is necessary is for the person who buries or performs the funeral or religious service to give notice afterwards of the burial to the registrar, it certainly shows a very strong case for an alteration in the law. The registrar in most of these cases does not know whether either of these documents has been produced, and he does not know in many cases whether to expect a notification of burial or not.
The Bill provides a system of machinery which extends to all forms of disposal and provides that disposal can only take place on the production of the registrar's certificate or the coroner's order, and that portions of the document should be filled in and sent back to the registrar in every case, notifying the date and manner of the disposal. This is, I think, good machinery for preventing a body from being surreptitiously buried under an authority which relates to another body. That may not be a very frequent case, but, according to the Report of the Committee to which I have referred, cases have been known where one body has been buried under an authority which relates to another body. The system set out in this Bill, and in the particular Clause to which I am referring, will put the registrar on inquiry if he does not get notification of the disposal within the prescribed period which will be laid down in the Regulations.
Another feature of the Bill which, I think the House will agree, requires attention is that it puts duties upon certain persons "effecting the disposal" of a body. In that connection I must tell the promoters that when we come to the Committee stage, the Department will have to look into that 992 matter. I shall ask the Committee to look into it further, because these persons are not sufficiently defined in the Bill. It is difficult to define them, but inasmuch as a penalty is placed upon persons who effect the disposal, it may be open to objection that we are prescribing penalties upon persons who are not defined. That would be an undesirable thing to do.
My hon. Friend also referred to a very important matter which I think this Bill, in the interests of the community generally, should put right, and if it is passed into law it will put right, by Clauses 5 and 9, which refer to still-births. At the present time, still-births are not registered, and there are no restrictions upon the disposal of the body, save that it must not be buried in a burial ground without either a medical certificate that the child was not born alive or a declaration to that effect by a relative. There is no doubt that in the case of children who die very shortly after birth, a good deal of reform is necessary. There is suspicion that in many cases live-born children are disposed of as though they were still-born. The Bill requires that all still births should be registered, and a certificate of registration will be necessary before burial. We hope that by that means many improper practices in this connection may be ended.
Another matter in the Bill relates to the certificate of the cause of death. The Registrar-General has not hitherto been able to insist upon a particular form of certificate. I think it very desirable, and I hope the House will agree, that all certificates of death should follow a common form. The Registrar-General has the duty of issuing forms, but the medical profession are not required by law to use them. Under the Bill the form of certificate of death would be prescribed, and another important alteration in the law is that the doctor will be required to send his certificate directly to the registrar. That is a very necessary change from the present practice of generally handing the certificate to the relative. The alteration will prevent delay or the improper use of certificates. At present, if a certificate of death is suppressed, the registrar may never hear of the death at all. A second advantage in asking the medical man to send the certificate directly to the registrar, is that we shall no doubt have much im- 993 proved medical information as to the causes of death. In many cases doctors who have to hand certificates to relatives naturally do not desire to make the full statement which they would be able to make if the certificate was sent directly to the registrar.
The hon. and gallant Member for St. Albans also raised the question of the medical inspection of deceased persons. A doctor in most cases now states the cause of death to the best of his knowledge and belief. He can accept the statement of a relative that the death has taken place. It is true that in about 30 per cent. of cases the body is seen after death, but in a very small number of cases there may be certain incidents, criminal or otherwise, which ought to be brought to light and would be brought to light if there were a medical inspection. But if we had a complete medical inspection in every case, as some people desire, it would mean very considerable expense; it would set up a universal and compulsory requirement for the sake of a very small chance indeed; and it would probably be unworkable in sparsely populated rural areas. The arrangement suggested in the Bill will go a long way to meet the wishes of the large body of opinion on the subject.
It is now proposed that the registrar shall refer to the Coroner suitable cases for the purpose e.g. those in which the doctor has not seen the deceased after death, and not seen him alive within so many days of death. Under Clause 7 local authorities are enabled to take action by providing the services of medical men for visiting and inspecting in such cases. I think the condition in the Bill is most reasonable and is likely to work. I conclude by briefly stating the experience of the Registrar-General and the Department in regard to the necessity for this Bill. It is true, in the first place, that instances are constantly occurring in the ordinary course, in which errors and confusions arise offering opportunities for crime in connection with the treatment of still-born children, as distinct from the conditions applicable to live-born children who die shortly after birth. Secondly, as regards defects in the present safeguards as to deaths, it is true that no criminal cases are within the present recollection of the Department, but as the Select Committee found, 994 the existing law makes it. perfectly easy for the body of a murdered person to be disposed of by means of collusion, despite registrars and coroners, with comparatively little risk, and as regards the importance of certificates of the cause of death being transmitted direct to the registrar I can say there are numerous cases in actual experience which point to the necessity for this change.
A case is at the present moment under investigation in which the relatives of a deceased child, on receipt of a certificate of the cause of death from the doctor, instead of taking it as by law required to the registrar, used it as a sort of authority for burial, and apparently induced a sexton to bury the child on that authority. The registrar learned of the facts by accident and referred the case to the coroner, who was certainly hampered in the performance of his duty by the fact that the child was already buried. I should say there is no evidence at present to suggest that there was any criminal action or intention in the matter, but these cases show the necessity for some alteration in the law. Finally, there appears to be general support for the Bill. Representations have been received from the British Science Guild in favour of these reforms. The Cemeteries' Association, representing 10 cemetery companies, asked in connection with the last Bill for some minor Amendments, but raised no general objection.
§ Sir K. WOOD
I hope so. Generally the substantial provisions of the Bill are believed to be favoured by the medical profession, both general practitioners and medical officers of health. I submit this is a good Bill. We shall have to examine it carefully in Committee, but I now venture to commend it to the support of the House.
§ Major-General Sir RICHARD LUCE
Though fully agreeing with the objects of this Bill which are in every way commendable, it does not seem to me that the Bill has the merit of doing very much towards carrying out those objects which it has in view. The Seconder of the Motion said he was trying to steer between Scylla and Charybdis, and in doing so I think he has knocked the bottom out of his ship. The chief object 995 of the Bill should be to prevent any person being buried without proper knowledge of the immediate cause of death being available. There are two reasons, which have already been referred to. One is the prevention of crime, and the other the prevention of premature burial. The methods adopted in this Bill to secure those objects seem to me to be totally inadequate. There has been for a long time a general body of feeling that it is absolutely essential to prevent those things that there should be a compulsory view of the body, after death and before burial, by a qualified person, but, as far as I can make out, the method suggested in this Bill in Clause 7 seems to be totally inadequate. The idea that it should be in the power of a county council or borough council to authorise a visit at that stage seems to me to be quite useless, as that can already be done by an order of the Coroner, if it is known that there is a case in which there is any doubt. What is wanted is some method by which, when doubt has not come to light in the ordinary way, there should be some power of examining the body so as to certify that it is dead, and that there is no obviously violent cause of death.
No attempt has been made in this case to utilise the most valuable opportunity presented by the Bill to increase the scientific knowledge of the cause of death. As has been already said, it is quite true that in many cases the medical man does not give an absolutely complete account of the cause of death, owing to his desire not to hurt the feelings of the relations. The only method suggested here to get over that difficulty is that the certificate should in future be sent direct to the registrar, but it will be the duty of the registrar, as it is at present, if the relatives ask for it, to send them a copy of the certificate, so that there will be no difference made to the medical man, and there will be no confidential relations between him and the registrar, any more than there is at present. It seems as if that was a totally insufficient method of establishing that confidential and Very necessary scientific report on the cause of death in these cases.
There is another omission from the Bill, and that is the question of the relations 996 of the medical practitioner and the coroner in cases in which there is a certain doubt as to the cause of death or in which there is some question of violence or accident. At present, as far as I know the law, the whole duty of the medical man is to give a certificate of death to the registrar or through the relations to the registrar. That makes no provision for the coroner being made cognisant of the cause of death in cases of violence or accident or foul play. There ought, therefore, to be, either in this Bill or in the Coroners Bill which is already in another place, some arrangement by which it is definitely stated that, in cases of doubt on the part of the medical man as to the cause of death, or in cases where he believes the death was due to violence or accident, it should be his duty to inform the coroner in order that the coroner may at once take up the case.
In these cases it should not be the duty of the medical man to give a certificate of death, but the duty of the coroner. At the present time there is no definite ruling on this matter. It is the custom, of course, for coroners to find fault with medical men who do give certificates in those cases, but by the law it seems to be definitely laid down that it is his duty to give a certificate, and I think that either in this Bill or the Coroners Bill there should be some arrangement made by which that matter is cleared up, because undoubtedly there is a different procedure by some coroners from that of others.
Perhaps, many of these points are very difficult to get over without raising the question of expenditure of money. It is undoubted that if the medical man has to visit in all cases the body after death he will have to be paid to do so. If that be so, I quite realise that it will be difficult to get any amendment of this Bill that will produce these effects, which, I think, are absolutely essential to any improvement in the Registration Act. At the same time, as these objects are partially brought forward in this Bill, and in so far as I hope it may not prejudice a more complete Bill in the future, I do not propose actually to oppose the Second Reading of this Bill.
§ Sir DOUGLAS NEWTON
There are some matters upon which we are prepared to take a chance. There are many things in which we glory in taking a chance, but I think there is unanimity 997 of feeling that no one wants to take any unnecessary chance of being buried alive. For that reason, if for no other, I venture to support this Bill. But there are one or two questions I would like to ask the Parliamentary Secretary to the Ministry of Health. The first is as to the penalty imposed in Clause 4. It does seem to me that if a penalty is to be imposed at all, it should be a fine of a larger amount than £10, and if the Bill is to be made workable and to be effective, I think the fine should be proportionate to the enormity of the offence. Then there is the question of the administration of this Bill. Under Clause 7, Sub-section (2), I observe thatThe expenses incurred by any local authority under this Section may be defrayed in the case of a county council out of the county rate,and in the case of other authorities also out of the local rate. What expenditure is likely to be incurred by local authorities, and what will be the position if the local authorities do not adopt this Measure? In that case, who will be responsible for the administration of the Act? Subject to these one or two questions, I would like most heartily to support this Bill.
§ Mr. GROTRIAN
It occurs to me that though this Bill may hope to achieve its object, there are many inadequate penalties provided for offences under the Bill. Take, for instance, Clause 10, which says:Any person contravening any of the provisions of this Act in respect of which no penalty is expressly imposed shall be liable on summary conviction to a fine not exceeding forty shillings.That is an altogether ridiculous penalty for an offence under a Bill of this sort. It is a sort of penalty that one has to pay for not having a rear light to one's motor car. This is a serious offence. However, that is a matter that can be quite well attended to in Committee. There is another Clause in the Bill which has mystified me altogether. I refer to Clause 11, in which a definition is as follows:' Still-born' and 'still-birth' shall apply to any child which has issued forth from its mother after the twenty-eight weeks of pregnancy and which did at any time after being completely expelled from its mother, breathe or show any other signs of life.There are many hon. Members in this House who breathe and show quite dis- 998 tinct signs of life, especially hon. Members from the North of the Tweed. If this Bill passes in its present form I am sorry to say that they will in future be classed as "still-born" and so on. No doubt this also is a defect which can be remedied when the Bill gets into Committee. With these few words I wish to give my support to this humane Measure.
§ Mr. DENNIS HERBERT
There are one or two points that I think hon. Members ought to consider very carefully in a Bill of this nature. I think I am right in saying that this Bill is the product of a great deal of very useful work which has been done almost entirely by the medical profession, but so far as I know the Bill has not received any very careful attention from any of the lawyers in the country, or any of the bodies recognising lawyers.
I would suggest to my hon. Friends that they should be very careful to have the Bill, if I may use an expression known to the law, as backed. Points can be raised in Committee. I have not had the time at present to study the Bill very carefully in detail, but there are points which occur to me in regard to this question of stillbirth. It is of importance that if the birth of a still-born child is to be registered, just as in the case of a child born alive, that there should be in that registration a very careful distinction made between still-birth and birth alive. It might have very serious evil consequences as to whether the particular child had died. I will not detain the House further, because I want to see the Bill pass, and I will say no more except that on general principles I give it my hearty support.
§ Question, "That the Bill be now read a Second time," put, and agreed to.
§ Bill read a Second time, and committed to a Standing Committee.
§ The remaining Orders were read, and postponed.
§ Whereupon Mr. SPEAKER adjourned the House, without Question put, pursuant to Standing Order No. 3.
§ Adjourned at Four o'Clock until Monday next (1st March).