MENTAL DEFICIENCY. (Hansard, 28 February 1934)

§ Mr. MOLSON

I beg to move, That this House considers that the facts set out in the Report of the Departmental Committee on Sterilisation indicate a state of affairs calling for action, and respectfully requests His Majesty's Government to give immediate consideration to the unanimous recommendation of the committee in favour of legislation permitting voluntary sterilisation in certain classes of cases. Eugenic sterilisation has been discussed in this country and elsewhere for many years past, but it has only recently become a question of practical politics owing to the publication of the report of the Departmental Committee upon this subject. I should like, if I may, to congratulate the Minister of Health on the foresight he displayed in setting up that committee and in securing the services of such distinguished men and women to serve upon it. What, however, is most remarkable is that this committee has presented a unanimous report upon what is admittedly a most controversial subject, although unanimity among medical persons is not very common.

The report unanimously recommends that voluntary sterilisation should be legalised subject to certain safeguards. The persons who may be sterilized are first, either mental defectives or persons who have suffered from mental disorder; secondly, those who suffer from some grave physical disability which has been shown to be transmissible; and, thirdly, persons in whose case there is evidence that he or she is likely to transmit mental defect or disorder. Sterilization in these cases is to be permissible, in the first place, if the patient makes applica- 1180 tion for it; secondly, if it is recommended by two medical practitioners; and thirdly, if the Minister of Health, after considering their certificates, gives his approval.

In this House we are divided into parties, largely because we disagree among ourselves on what kind of social and political organisation is most likely to reduce the amount of human suffering in the world. This afternoon we are discussing the question of those who come into the world and start life without the normal equipment with which most men and women are endowed; people who would not be able to live a normal life in any conceivable organisation of society, however it might be reformed and improved. We are discussing to-night the question of those of whom it might be said, Good were it for that man if he had never been born. The first point which I wish to establish is that mental deficiency or disorder is to a large extent hereditary. There is already a great volume of evidence both in this country and abroad which tends to show that there is a likelihood of mental defect being transmitted. In view of this evidence it is not surprising that all the witnesses who appeared before the Departmental Committee were of opinion that heredity was an important factor in bringing about these conditions. Certain researches have been made in foreign countries, and I will quote a couple of examples. At Rostock in Mecklenburg it was found that 67.6 per cent. of the inmates of an institution had one or two parents mentally defective. At Renton, in the United States of America, out of 1,000 cases of mental deficiency, only 350 had both parents normal.

Not satisfied with this, however, the Departmental Committee made an investigation itself, one which was of special interest because most of the researches that had been made before had investigated the parentage of mental defectives. This research was carried out through the agency of local authorities in England, who investigated the children of mental defectives, and produced some figures which are of extraordinary interest. A group of 3,733 parents investigated had 8,841 children. Of these no less than 2,001, or 22.5 per cent., had died. If I may make a slight 1181 digression in passing, apart from the question of mental deficiency, we find among the children of mental defectives this abnormally high rate of mortality. Of those who survive, grouping together defective and retarded children between the ages of 7 and 13, the percentage of sub-normal children was 40.4 In the group of children over 13 that proportion had risen to 45.4 per cent.

It may be said that all this evidence only goes to show that in point of fact a large proportion of the children of mental defectives are themselves mentally defective, and that it does not prove that it is due to heredity. The suggestion may be put forward that the condition may to some extent be due to environment. In the first place, there is no antithesis at all between heredity and environment. It is recognised that in the majority of cases there is some predisposition which has been acquired by heredity, and then, where the environment is unfavourable, complete mental deficiency occurs. Drs. Penrose and Turner made a special investigation of a number of cases and found that in their opinion 9 per cent. only were defective for purely environmental reasons; 29 per cent. were defective for reasons of heredity only, and the remaining 62 per cent. were mentally defective on account of a combination of heredity and environment.

Heredity and environment go hand in hand. The child is born with some predisposition to mental deficiency, and then the sordid, the squalid, in many cases the appalling environment of a house looked after and kept by a mentally defective woman or man results in a child being stunted in mind as well as in body. It is therefore a part of my case that even if it were not the fact—which, I think, I have shown—that mental deficiency is largely hereditary, it would still be undesirable for mentally defective persons to have children. Upon this point the Report of the Board of Control for the year 1928 is almost conclusive: It can hardly be denied that the 200,000 defectives who must remain in the community are wholly unfitted for parentage. Though it does not necessarily follow that the children of defective parents will themselves be defective, they are liable to be exposed to the miseries and hardship of being brought up by a mother or father incapable of self-control, who will almost certainly neglect them and may, by reason 1182 of mental instability and ungovernable temper, aggravate by cruelty the results of ignorance and neglect. I claim that it is right that the State should not only enable but encourage parents of that kind to refrain from incurring the responsibility of having children.

Perhaps I might give one striking case where environment and heredity have gone hand in hand. I will quote from the memorandum submitted to the Committee by the National Society for the Prevention of Cruelty to Children. In this case the family consisted of mother, father and six children. The mother was mentally affected and also two of the children, and a boy aged 13 and a girl of 11 were mentally deficient and suffering from paralysis. In the case of the boy the society was able to put him into a home and the result is that he has improved both mentally and physically. No home could be found for the girl and the result is that she has grown steadily worse. She is now almost completely paralysed and has become practically an imbecile.

Although it is not part of my case to prove that mental deficients are more fertile than other people, perhaps I might be allowed to quote the case of a family where there was a strong taint of mental deficiency, insanity and epilepsy. The mother had 17 children. The first two, who were illegitimate, died of convulsions in infancy. The third, a daughter, was mentally deficient and is now in an institution. The fourth, a son, was certified as an imbecile and died at the age of 11. The fifth was a son, certified as a mental defective and is now in an institution. The sixth was a daughter, an imbecile. The seventh was a daughter, who died at the age of 11 months. The eighth was a son, certified as an imbecile. It is only at the ninth child that we find the child living and in service. The tenth child died in infancy. The eleventh child is of low mentality, the twelfth is of average intelligence, the thirteenth is now in an institution, the fourteenth is in an institution, the fifteenth was recently admitted to an institution, and the sixteenth and the seventeenth children are so small that it is not yet known whether or not they are normal.

Apart from the strong tendency to mental deficiency, it is from these same stocks that there come those who com- 1183 pose our social problem group. They not only contribute to those who are filling our mental homes, our asylums, our hospitals, our infirmaries, our gaols and our workhouses, but they are also contributing a large proportion of the criminal element of the population, especially of those who are charged with offences most repellent to ordinary people. Of the cases of criminal and indecent assault dealt with by the Society for the Prevention of Cruelty to Children, about one-half of the girls involved were feeble-minded, while in the case of the males it was exactly one-half. As will be recognised by anyone who has sat on a public assistance committee, it is these stocks which contribute a vast quantity of the unorganised, unskilled casual labour which is so often upon the rates and which so often undercuts a higher, more skilled and better type of labour. So much for the question of mental deficiency.

Cases where the mind and the intelligence have fully developed raise an entirely separate question. I mean cases where the mind has developed normally up to a certain point and then has become disordered. In this class there are two particular forms of insanity, both of them fairly common, in which it has been almost proved—I do not wish to overstate my case—that the taint is hereditary. In the case of schizophrenia, in Bavaria 5.8 per thousand of the population are affected, and it has been shown there by figures that where one parent is affected 10 per cent. of the offspring are insane and 34 to 40 per cent. are mildly affected. Therefore, half the offspring of one single person suffering from schizophrenia are to a greater or lesser extent affected, and these in turn are likely to transmit the taint to another generation. In the case of another common form of insanity, manic depressive insanity, the proportion is slightly less, but still high, 4.1 per thousand. Sixty to 66 per cent. of the children are likely to be affected if one parent suffers from this form of insanity, but if both are affected probably 100 per cent. will be affected.

Let me say a few words about the giving of valid consent on the part of the patient. In the case of manic depressive insanity there is, first of all, mania, then acute depression, and then a normal and 1184 lucid interval, during which time there is no question that the patient is able fully to understand what is involved by sterilisation, and in such cases perfectly valid consent could be given. In the case of schizophrenia it is not suggested that any sterilisation could take place to the person actually suffering from that disease. It can only be when such person can be safely released from the institution that the question of a voluntary operation for sterilisation will arise.

I have referred to cases of mental deficiency and insanity, but there is a third class of people concerned, and I am not sure that they do not present the strongest case of all for legalising sterilisation. I refer to the carriers who, in the words of the report, are "persons whose family history gives reasonable grounds for belief that they may transmit mental disorder or defect." Those are the same people in whose family there is some taint of insanity. Carriers are probably 10 times as numerous as affected people. In their case there can be no question of the reality of consent. The safeguard that a certificate of two medical practitioners is needed will make certain that it will not be undue sensitiveness on the part of these persons which causes them to apply for sterilisation. I have no doubt that most hon. Members know of cases of people, perfectly normal and perfectly sane, who refrain from marriage and from having children because they know that some parent or some uncle or other relative has suffered from insanity, and they feel very strongly the responsibility and the danger of transmitting to offspring the misfortune that they have seen in their parents or relatives. In regard to people with so high a sense of civic and parental responsibility, who do not desire to have children to whom they might unwittingly transmit so appalling an affliction, are we justified in refusing them the right to save themselves and their possible children from any such danger?

There is also the question of physical infirmity—deaf mutes and blind persons. I went over a school for deaf mutes and discussed this matter of sterilisation long before the Report of the Commission came out, with a gentleman who had given up the whole of his life to devoted service in the interests of one of the most unfortunate communities in our midst, and he told me that, from his own 1185 personal experience and observation, he thought the danger of these disabilities being transmitted was very great and that he was strongly in favour of legalising sterilisation. My hon. and gallant Friend who will second the Motion, if time allows later in the evening, will deal in some detail with the procedure recommended by the committee and the safeguards against abuses.

I see that on the Order Paper, in the name of my hon. Friend the Member for Mile End (Dr. O'Donovan), there is a reasoned Amendment which suggests that what is needed is a further Departmental Committee to investigate the present legal position in regard to sterilisation. I could have wished and expected that my hon. Friend's Amendment would be less timid than it appears to be. Whether one is opposed to the principle of sterilisation or not, I cannot see that any good purpose would be served by having a further inquiry, more particularly as there will be no chance of that inquiry being conclusive. Whether voluntary eugenic sterilisation is legal or not is not known, because there is no decided case upon the subject. Therefore, no inquiry could make the law on the subject certain. If we are in favour of eugenic sterilisation, let us legislate and make the law certain. If we are against it, then let us equally legislate and make the law certain.

In the Motion which my friends and I are putting before the House we do not put foremost in our arguments the consideration of the cost to the community of the increasing number of mental defectives and insane persons, great as that burden is. The capital cost of a bed for each person in one of these institutions is about £400 and the weekly cost of maintaining them there is 25s., or more than an unemployed man and his wife cost. The cost of mental deficiency service last year was over £1,800,000 and of mental hospitals over £8,000,000. Important as that point is, we do not over stress it. Nor do we emphasise over much the position of the potential parent. We are not in any way seeking to restrict the right of the individual to parenthood, much as we may desire them to regard it less as a right than as a responsibility. Rather we make our appeal to the House in the name of the children, the unborn children. We ask that an operation, 1186 which even now is legal and not uncommon, if the purpose of it is to prevent danger to the life of the mother, should be equally made legal if the purpose of the operation is to prevent the danger of being born to the afflicted and unwanted child, whose whole life in this world must be one of misery and humiliation.