§ (1) The death of any person shall not be registered unless and until there has been delivered to the registrar of the district in which such death has occurred a certificate, signed by a medical practitioner, of the fact of death and of the cause of death, as respectively in this Act defined, and such certificate shall be given only after he has inspected the body.
§ (2) It shall be the duty of the General Medical Council to establish a fund by equal 949 annual contributions from all persons on the register who are actually practising, from which such fee as they may decide shall be paid to every medical practitioner for each inspection and certificate.
§ Motion made, and Question proposed [18th June], "That the Clause be read a Second time."—[Mr. Basil Peto.]
§ Question again proposed.
§ 9.0 P.M.
Mr. PETOI ask the leave of the House to make a brief statement on the proposed New Clause. The matter was last before the House as long ago as 18th June, and, therefore, it may be convenient to the House if I recall the situation which in my view justified me in submitting this Clause to the House. The Clause was intended to put into this Bill something which my hon. Friends and I regard as vital. In 1910 a Departmental Committee inquired into the law relating to coroners. That Committee declared that the present law of death certification afforded every opportunity for premature burial and every facility for the concealment of crime. Having that evidence and much more before them, the Federation of Medica and Allied Services some years ago appointed a special Committee to consider the law of death certification, and after many sittings they decided on the draft of a Bill, which in fact was introduced by the hon. and gallant Member for St. Albans (Lieut.-Colonel Fremantle) last year. The operative Clause in that Bill was:
A medical certificate of the fact of every death shall be given by a registered medical practitioner who has examined the body and is satisfied that life is extinct.In the present Bill there is no such Clause. We have here a Bill which involves an immense amount of machinery, somewhat costly to the taxpayers and ratepayers, and my friends and I thought we were justified in asking that this Bill should not be passed without an operative Clause in it such as that which I have quoted—a Clause which was the justification for a Bill introduced only last year, based upon expert investigation of the whole matter. Under the present Bill there can be no disposal of a body without a registrar's certificate, but the registrar's certificate-only states that he has registered the death. I do not see that it is worth while for that provision to pass the Bill through this House and impose all this 950 expense on the ratepayers and taxpayers. For that reason I ask the Parliamentary Secretary to the Ministry of Health to carry out his promise and to make a statement as to what are the powers which he can exercise under the existing law, and what he proposes to do by executive action to ensure that the fact. of death will be properly established in the case of a much larger proportion of people who are supposed to be dead so as to avoid as far as possible, all danger of premature burials. I hope the hon. Gentleman will give us an assurance that he possesses powers which will enable the Ministry to improve the present unsatisfactory condition of affairs in this respect either by the method of certification by a medical officer or some other means
§ Mr. GROVESAs I was the Seconder of the Motion for the adoption of the New Clause, it may save the time of the House if I intervene at this stage.
§ Mr. DEPUTY-SPEAKER (Mr. James Hope)I ought to point out that, strictly speaking, the hon. Member, unlike the Mover, is not allowed to speak a second time, but as the previous Debate took place so long ago as 18th June, I am sure the House will not refuse leave to the hon. Member to speak.
§ Mr. GROVESI think it will save time if I speak at this stage. This question, affects the public, and there is a growing, interest in the subject. Recently the view has been very widely expressed that there should be verification by a medical man of every death before the interment takes, place. We are prone to be facetious on these subjects, but this is a most serious matter and I desire to restate the position in order that the Parliamentary Secretary may give us the view of the Ministry on the question. It is announced by the Registrar-General that only 40 per cent. of the people buried in this country are certified on medical evidence actually to be dead, and therefore, we think, without interfering with the public purse, that we should make what suggestions occur to us to the. Ministry for their consideration and that we should see if we can introduce in this Bill some machinery whereby we can get this very unsatisfactory state of affairs remedied. There have been glaring: instances—and I do not want to fall into the fallacy of arguing from a particular 951 case to general principles—where funerals have actually been commenced before death has taken place. I read in Committee a letter from an undertaker in Hull—I have it in my hand now—who stated that he was called to measure the body of a woman one morning at 9.30 and was told she had died at 5 o'clock that morning, and had been laid out for burial. While at the bedside, he noticed a eight movement of the fingers and lips, and in consequence called the husband, who, however, said he must be mistaken, as she had been laid out nearly five hours. Not satisfied, he (the undertaker) asked that the doctor might be sent for at once. This was done, and after examination he was told that his services would not be required just then, but that they would ring him up later. As a matter of fact, the woman actually died that evening.
That is only an isolated case, but it proves that there is something in this question, and when, as I say, we learn that only 40 per cent. of the people buried in this country are actually certified by medical men, I think it is cause for alarm. Our suggestion in the Amendment definitely laid down that the onus of responsibility should be thrown on the medical men to certify death, and we put this point to the Minister himself, but the whole question is one of expense. Everything in the world depends on that, apparently. First of all, the Government honestly said they could not find the money to do what we required, and the medical men will not do it, apparently, without further money, but I feel, and I have said in this House before, that the provisions in this Amendment would not entail any additional expense on the part of the country. After all, a panel doctor is responsible for a panel patient until life is extinct, and surely it should be the responsibility of a panel doctor to certify that life is extinct, and no person should certify that without being positively sure. My humble submission is that it is a panel doctor's bounden duty to see the body of a, patient before he certifies that life has gone.
In Poor Law and public institutions, like hospitals, a similar rule should operate, and in private life, where families have private medical practitioners, there would be no trouble whatever for the latter just to add the cost 952 of that additional final visit. No one would be the worse off, and all things, in my opinion, would be properly adjusted. I think this Bill gives an opportunity to the Government to make the necessary representations to the British Medical Council seriously to consider this matter and to see that this longstanding grievance is put right. That is stating the case dispassionately. I hope that, following our interview with the Minister of Health, the Parliamentary Secretary will make a statement as to what power the Government have to do something in the direction we suggest. There are many provisions in this Bill which we want to see on the Statute Book, and we do not want to jeopardise them, because of their great value, but we feel that there is a strong case for action in the direction I have indicated.
§ Lieut.-Colonel FREMANTLEInas much as this Amendment is an alternative to the Amendment in my name, which was origiNally a substantive Clause of the Bill with which I am Personally associated, I should like to explain briefly the attitude I take in regard to this matter. I may say that in the previous Bills which I have introduced in previous Sessions on this subject, my object has been to meet the particular objection put forward by my hon. Friend the Member for Barnstaple (Mr. B. Peto). I, Personally, wished to satisfy those who fear that there is a danger of being buried alive, and I went into the matter thoroughly with them and with others concerned in order to see what could be done. Therefore, the stage that they have reached and put before the House is one through which I have myself passed, with many others, but they have not gone so deeply into the details as to why, in my own case, found it impracticable to proceed with the matter. The matter is not merely one of expense. It is put forward as being one of expense, but the real question is that it is impracticable from the point of view of a doctor's time. That really meets the figure that has been brought up by the hon. Member for Stratford (Mr. Groves), and what appears, at first sight, to be the appalling statement that only 40 per cent. of deaths are certified after verification by the personal view of the doctor, but, after all, if we refer to the experience of cur own lives, we can understand that, if a doctor is visit- 953 ing a patient regularly, over and over again, and the patient is gradually going downhill, the doctor cannot wait and be there, and is not wished to be there, every minute right up to the very last. The doctor sees the end coming, and he naturally discreetly retires. He comes and calls in the course of his round, and then he retires.
There can be no question about the end in any case, and in regard to those 60 per cent. of cases that are certified without actual view of the body, I think you may take it that in practically every case the doctor is quite assured in his own mind, when he signs the certificate, that death has supervened, as it was bound to supervene. There might be a case of an hour here or an hour there, but look at the doctor's practice. The doctor in ordinary practice is going round, and is busy from the time he finishes with his morning surgery in the morning till the time of his evening surgery in the evening, and all who know anything about a doctor's life know that he has no time even for meals, as a rule. He has scratch meals and a scratch life, and every now and then he takes what he can, when he can, in the way of an hour off, and enjoys it thoroughly. Then there are some who are infinitely more hardly pressed for time than others, and hon. Members opposite know very well that they are constantly raising the question of doctors being over-occupied and having too large a panel, while others are not sufficiently occupied. But this proposal is based on the idea that all doctors have a certain time free when they could attend to a patient, and could go and see that a body is dead, when they know very well that death has supervened, and everybody knows that it must supervene. I am afraid the proposal is impracticable. I admit that it would give greater confidence to the public if the proposal were accepted, but it is impracticable, from the simple fact that there are only a certain number of doctors in this country, and in a very large number of areas they are occupied practically their whole time.
If this duty were thrown upon them, they would undertake it, but it would be at the expense of their other patients. It is all a question of proportion, and of the two I think this is unnecessary. The only way to meet it is the way suggested in my Amendment, namely, after consulta- 954 tion with the Government Department. That was a possibility. You might have got a special officer appointed for this special purpose. It is proposed in my Amendment that county boroughs might, where they wished, appoint a special officer, and I have not the least doubt some of the boroughs—I am sure the London County Council—would have appointed a man who would help very materially in the worst cases under the consideration of the House at the present time. That would have been a trial experiment of infinite value. I am sorry the society that has this fear upon them did not accept the half-measure, but, instead, went for the whole proposal. That is impracticable, and, as so often happens in aiming at the impracticable, they have lost the half-loaf I put before them. As this proposal is impracticable, I Personally oppose it. I hope that its supporters may withdraw it, and that the Government will suggest some alternative in the matter.
Dr. VERNON DAVIESI have the greatest sympathy with this Amendment, but, to my mind, there seem to be two distinct objections. First of all, there is the country practice. In certain parts of the country, I understand, doctors can only see their patients once in a month. If the doctor happens to go on a Monday, and the patient dies on a Tuesday, he might have to go 20 or 30 miles to certify that the patient is dead. I think some provision ought to be made for these very scattered country districts. Then, as regards signs of death, it sometimes happens that it is impossible to say for certain that death has occurred until signs of decomposition appear. In some cases it may be three or four days, and, in such cases, it would hold up insurance money and cause a great deal of inconvenience. In town, or the vicinity of towns, it is perfectly feasible for medical men to do it. I was in practice for 23 years, and during the whole of that time I only missed seeing one patient who had died. If a medical man visits a private patient, he makes his ordinary charge; if it is a panel patient, he draws his panel payment at the end of the quarter. If it is a Poor Law patient, he still gets his fee, whether the patient is living or dead. In the case of a town or the vicinity of a town, it simply means that the doctor will have to pay one extra visit, which he 955 would have to pay if the patient did not 'die. Therefore, if anything can be brought in to safeguard the country practice, I would support this Clause.
§ The PARLIAMENTARY SECRETARY to the MINISTRY of HEALTH (Sir Kingsley Wood)I think the House must realise from the discussion we have had to-night some of the difficulties of this subject, and I have been asked tonight to state, first, the present legal position, and, secondly, to make a statement as far as the Government are concerned as to what they propose to do in the circumstances of the Bill not having any Clause dealing with the present matter. Under the 1874 Act, the doctor in attendance upon the deceased in his last illness, is required to give his certificate of the cause of death to the best of his knowledge and belief, and this certificate goes to the Registrar, and is an important factor in the system of safeguards in the interest of public safety. If there is no medical certificate, the Registrar refers the question at once to the coroner. If the certificate discloses an accident, an industrial disease, or any of a number of circumstances which may be described as appropriate for the consideration of the coroner, the Registrar refers to the coroner before registration. A certificate of death is thus, even in present circumstances, an important element in the evidence determining how the case is to be treated. The doctor is not required by this provision to see the deceased person after death before he certifies; nor is it necessary for the purpose of this certificate that he should do so. In an ordinary case, in which he has attended a deceased person until shortly before death, and is then informed by the relatives that death has taken place, that knowledge would enable him to certify the cause of death, provided the occurrence of death was consistent with the opinion he had formed.
That is a very brief and, perhaps, a very imperfect summary of the present law in regard to the matter. My hon. Friend and a good many others who have spoken to-day have put forward the view that in every case of death, inspection should take place by a medical man before a certificate is given, and it was with the view, of course, of meeting that situation, that my hon. and gallant 956 Friend endeavoured to meet the position by an Amendment which practically gave to the county council power, in certain cases, to direct a specially qualified medical man to make an inspection.
§ Lieut.-Colonel FREMANTLEMay I say that it was not an Amendment, but was origiNally in the Bill?
§ Sir K. WOODYes, it was origiNally put in the Bill, really on the suggestion of my hon. Friend, in consultation with many people who have considered this matter. In Committee, this matter was very much debated, and, in the result, that particular Clause, which my hon. Friend has put down as an Amendment to-day, was deleted from the Bill. In those circumstances, I think everyone will agree that it would be a very great pity, indeed, to imperil the very useful provisions of this Bill, which is supported by all parties, and in Committee received the support of everybody, on a matter of this kind. My right hon. Friend and myself, therefore, have considered what steps could be taken to meet my hon. Friend and others who hold very strong opinions upon this matter. It is true, as has been said, that in about 40 per cent. of cases of death the doctors do see the deceased after death, but the difficulty in meeting the present situation is very largely in the rural areas. It is very difficult to impose not only upon medical men but, in many cases, upon families charges and expenses which in many cases they would resent. The difficulty is that, in the result, somebody, in fact, has to pay for the medical inspection. Where you impose further duties on professional men, they naturally expect further remuneration for those extra duties.
That is the difficulty which confronts the Government in the suggestions made. It is true that they provide for inspection of the body in every case, but they have thrown the expense of inspection upon people who have not been consulted, and who, I think, would not readily accept the extra duty without payment. In these circumstances, the Government have considered what had best be done, and this is exactly what we propose. The plan of the General Register Office has been to meet this case by extending the system of references by the Registrar to coroners on the facts as disclosed by 957 the medical certificate of the cause of death, and if that policy is pursued, as we intend it shall be, the certificate will show whether the doctor has seen the deceased after death and how long before death he last saw him alive. It will thus be possible to secure that any cases not seen after death or a reasonably short period before death come under review by a coroner before registration or burial.
It is confidently anticipated that these arrangements, in addition to bringing a large class of the more doubtful cases under special review, will greatly increase the proportion of cases which are seen by a doctor after death, and that the improvement in this respect will be progressive to the extent of reaching by stages a standard which the hon. Member who moved the Amendment would be willing 1:0 regard as satisfactory. In order that the progress and success of this course of action may be properly watched, the Registrar-General has arranged to obtain statistics showing annually the proportion of deaths certified by doctors who have seen the deceased after death, and I will undertake that these figures shall be published in the Registrar-General's annual publication. My right hen. Friend is further prepared to say that, should the results show that the action now proposed is ineffective and unavailing, he will be prepared to reconsider the whole question with a view to securing the objects which we all have in common by other means, either by executive action or legislation.
I believe that this undertaking, which has been very carefully considered, will meet the views of my hon. Friend and I hope he will be satisfied and that all Members who are quite properly interested in this matter will be satisfied and will be content with this statement and will on this assurance withdraw the Amendment, because they will agree that there are very many valuable provisions in this Bill which all of us desire to see become law at the earliest possible moment.
§ Mr. B. PETOI beg leave to withdraw the Motion.
§ Mr. DEPUTY-SPEAKERPerhaps I may say that the Clause would not he in 'Order, as it would throw a charge on the rates.
§ Motion and Clause, by leave, withdrawn.
§ Mr. DEPUTY-SPEAKERThe next New Clause—(provisions as to registration, certificate—standing in the name of the hon. Member for Stratford (Mr. Groves) is practically identical with a part of that which has been withdrawn. The hon. Member's second New Clause—(general provisions as to verification and costs—would also throw a charge on the rates.
§ Mr. GROVESMay I ask Mr. Deputy-Speaker to explain why he considers that my second Amendment would throw a charge on the rates?
§ Mr. DEPUTY-SPEAKERThe Amendment says:
Where the local authority is satisfied that owing to lack of means it mould be a hardship for the relatives, the cost shall be met by the local authority, etc.
§ Mr. GROVESThat is very hypothetical.
§ Mr. DEPUTY-SPEAKERThere is an hypothesis I agree, but the fact remains that there is a charge imposed.