§ Order for Second Reading.
§ 10.56 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)
I beg to move, That the Bill be now read a Second time.
I commend the Bill to the House. It is a relatively short Bill, but it is important, and even at this late hour I hope the House will bear with me if I explain the details in order theft they be on the record.
The Bill is one which is mainly concerned with the removal of doubt, but it may nevertheless be described as wholly beneficial and in some cases a life-saving measure. The Bill authorises, subject to a number of reasonable safeguards, the removal of parts of human bodies after death for use for therapeutic purposes or purposes of medical education or research. Without the Bill such removal would be in danger of being held to be unlawful.
Some hon. Members may find the subject a little distasteful, but the Bill is a logical extension and, thanks to advances in medical science, a practical extension of such familiar processes as blood transfusion and the grafting of skin from one part of a person's body to another. In these cases the material comes from the living donor. In recent years it has become possible to make use of some material from dead bodies.
The Corneal Grafting Act, 1952, which will be repealed by the Bill, legalised the removal of eyes from bodies for grafting, and the sight of many has been saved or restored by this process. Now it is medically possible for other tissues, such as skin, arteries and bones, to be successfully grafted. Such material is particularly valuable in serious accident cases and for patients with severe burns, where grafting may save their lives or reduce the disability.
In future it may be possible for other materials, including whole organs, to be grafted with similar success. Because the Corneal Grafting Act specifically authorised the removal of eyes, there has been a natural doubt about the legality of removing other parts. This is acting as a deterrent to progress in this important 1232 field of surgery. The Bill, therefore, authorises in Clause 1 the removal of any part of a body for therapeutic purposes. It also similarly authorises removal for the purposes of medical education and research.
It is important that the dissemination of knowledge and the progress of research should be encouraged. The study and, if need be, the retention of parts of the body are essential for this purpose. The Bill removes whatever doubt there may be as to the legality of this at the present time so long as the conditions in the Bill are complied with.
The person lawfully in possession of a body may authorise the removal of parts of it—subject to one of two methods of agreement. By Clause 1 (1) a request may have been expressed orally (in the presence of two or more witnesses) during the deceased's last illness or in writing by the deceased at any time before his death.
By Clause 1 (2) the person in possession of the body may also authorise removal of the parts unless—having made such reasonable inquiry as may be practicable—he has reason to believe that the deceased had expressed an objection to this or that the surviving spouse or any surviving relative of the deceased so objects. This wording is slightly different from that relating to the removal of eyes under the 1952 Act.
The requirement to make such reasonable inquiry as may be practicable is new, but I am sure it is justifiable. When the Corneal Grafting Act was passed it was thought wise to issue advice on this aspect to hospital management committees and boards of governors who are the parties "lawfully in possession" of the bodies of deceased in-patients.
The Minister advised them strongly not to rely on the power given in the Act to remove eyes in the absence of any known objection, but, wherever relatives were available, to seek their consent. It is proposed to recommend hospital authorities to adopt the same procedure of obtaining the consent of relatives where they are available in relation to the removal of any part of the body as authorised by this Bill.
The hospital authorities will also be recommended to ask the available relatives whether they know of others who might object. Any relative will be able 1233 to object to the removal, and this will override the consent of any other relative, but not the deceased person's own wishes if he has expressed them in the way indicated in Clause 1 (1). This is felt to be a wise precaution to avoid the risk of causing offence to the feelings of any known relatives. It is to be hoped, however, that public feeling will come more and more to accept the very great benefits which this Bill can give to the living. This advance will be helped considerably if more people are willing during their lifetime to make known their willingness that their bodies may be used for therapeutic, educational or research purposes.
Clause 1 (4) of the Bill requires the removal of parts of the body to be undertaken by a fully registered medical practitioner. Clause 1 (5) deals with the position of bodies which may be subject to an inquest or coroner's post mortem examination. The person empowered to authorise removal of the parts of the body, or the doctor who would do so, can take action only with the consent of the coroner when they have reason to believe that an inquest or coroner's post mortem may be required. This is, of course, a necessary safeguard to ensure that the coroner's work is in no way prejudiced, but it is believed that many coroners will be glad to co-operate by giving their consent whenever possible. The consents in Clause 1 (1) and (2) will still be necessary.
This is an improvement on the Corneal Grafting Act, which precluded the giving of an authorisation for removal of eyes where an inquest might be held. It is an important improvement because, in the present state of knowledge, the removal of certain parts of the body must be carried out within a few hours of death if the use of them is to be successful.
The other main proposal of the Bill concerns post mortem examinations. It makes it clear that post mortem examinations carried out by or in accordance with the instructions of a doctor are entirely lawful for the purposes specified in the Clause and subject to there being no known objection from relatives. Clause 2 sets at rest the doubts that have been raised on this score.
1234 It is true that very many such examinations have been and are carried out for very proper reasons, but the provisions of the Anatomy Act, 1832, are such that it is not clear whether or not the Act applies to such examinations. It is true that Section 15 of that Act makes a saving in respect of post mortem examinations required or directed to be made by "any competent legal authority", but this refers mainly to coroners.
It is possible, too, that the Act does not apply at all to ordinary post mortem examinations, but with all these doubts and possibilities it is clearly best to put the position beyond question. Clause 2, therefore, states that Section 15 of the Anatomy Act, 1832, shall not be construed as applying to any post mortem examination carried out for the purpose of establishing the cause of death or of investigating the existence of any abnormal condition of the body.
There is also the same conditions as for the removal of parts of a body—that any relative of the deceased may object to a post mortem examination, and the person lawfully in possession of the body must be satisfied, after having made such reasonable enquiry as may be practicable, that there are no such objections. There is the same need to obtain the coroner's consent in the case of bodies which may be subject to an inquest or coroner's post-mortem examination.
Clause 3 makes a minor improvement to the Anatomy Act, 1832, by allowing for the cremation, as well as burial, of a body which has been used for anatomical examination under that Act.
The provisions in the Bill relating to the removal and use of parts of the body have the wholehearted support of the leading members of the medical profession. It was in another place, during the passing of the Anatomy Bill in 1831, that a noble Lord said that although Parliament had a right to legislate for the people of this country while living it had no right to pursue people beyond the limits of the grave. Some people may still have a reluctant sympathy for this view of the extent to which Parliament interferes. But here certainly is an example of the House being asked with good reason to interfere for the benefit of the living and to put beyond 1235 doubt what the medical profession requires for the improvement of treatment, education and research.
I hope that the House will give the Bill a Second Reading.
§ 11.7 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
I am sure that the House would wish to thank the hon. Lady the Parliamentary Secretary for her lucid explanation of this short, important but not entirely simple Bill. It is, on a superficial view, rather a macabre Bill, but that is so only on a superficial view, and we on this side of the House, broadly speaking, welcome it. I am not sure that it is wholly appropriate as the last legislative Measure to be dealt with before we rise for the Christmas Recess, but no doubt that could not be helped.
I welcome the Bill from another point of view. I think that it marks a change of climate. I should like to say a word or two to the House about the circumstances that preceded the passage of the Corneal Grafting Act. My hon. Friend the Member for Southampton, Itchen (Dr. King) knows a good deal more about the matter than I. About ten years ago I was approached by certain members of the medical profession about the difficulties of getting sufficient corneas for grafting. I spoke to the then Minister of Health and asked whether there was anything I could do by way of publicity and Parliamentary Questions. The right hon. Gentleman went away and, having seen his advisers, came back and said to me, "For heaven's sake do not raise this matter. Corneal grafting is going on, but the moment we give it any publicity there will be religious objections and the whole matter may come to an end. So please leave it alone."
In those days I was a fairly new and, consequently, very docile Member of the House, and I complied with the Minister's request. Nothing was done. But along came my hon. Friend the Member for Itchen, who was, I am happy to say, rather less docile. He had received similar representations, and he went ahead in conjunction with the then hon. Member for Tonbridge, Mr. Gerald Williams. He ignored the official discouragement which he received and eventually leave was sought to introduce the Corneal Grafting Bill.
1236 This was done in a six minutes' speech by Mr. Gerald Williams and the House gave leave to introduce the Bill. Such was the reality of the opposition that had been feared that the Bill a week or two later passed through its Second Reading, its Committee stage, its Report stage and its Third Reading in the space of thirty seconds, without a single word being uttered on either side of the House.
We have come some way in that today this Bill is being brought forward openly and officially by the Minister of Health as a Government Measure. This is a revolution in thought that we can all welcome. Many of us are lost in wonder at the strides that have been made in recent years in plastic surgery and grafts of all kinds. I think that we would all wish to facilitate a Bill which makes it legally possible beyond doubt to use deceased human bodies for this purpose, subject of course to the proper safeguards.
I think that most people would be willing to co-operate in this way, but it is a fact, as the hon. Lady said, that all too few of them—of us I should say because I have done nothing myself about it so far—take the trouble to express willingness in its proper form during their lifetime. I echo the hopes of the hon. Lady that the Bill and the publicity attending it will stimulate people to express their willingness for their bodies to be used in this way after death. Perhaps it is something of a comfort to those of us who feel that we have been pretty useless in our lifetime to think that we will be positively and practically useful after death. But more seriously, it is a satisfying and I think in some ways an inspired thought that the dead can help the living in this way.
I understand that there are possibly some quarters in which there are religious objections to the Bill and its provisions. Some of us who do not share those objections may feel that they are in some way obscurantist, but nevertheless it is proper that they should be taken into account, and I think that those objectors, who are numerically very few, can be satisfied that the Bill fully safeguards their position.
I would like to ask the Minister one or two questions. First, can he say a word about the supply of corneas? 1237 There were some rather disturbing exchanges in another place as recently as April of this year when it was stated that many hospitals, including Moorfields, were suffering from a serious shortage of corneas for grafts. I think it was suggested that at Moorfields there were 100 people on the waiting list, and that people were having to wait eighteen months before they could have a corneal graft, and that is eighteen months of unnecessary blindness.
Also, will the Minister amplify what the hon. Lady said about the effect of the Anatomy Act? I have gone into this, and I cannot at the moment see how the Anatomy Act, with Section 15 in particular in mind, casts doubt on the legality of the practice at the moment. It may be that it attaches conditions to hospital post mortems which are rather too onerous, but possibly the Minister could expand that point a little.
I think that the Anatomy Act is most fascinating. It followed the 1828 Select Committee to which the hon. Lady referred. That Committee, I gather, followed the scandalous and widespread practice of body snatching, of which the most notorious exponents were Messrs. Burke and Hare. But this practice grew up only in response to the increasing demand for corpses by the medical students of that time, and there is at this moment exhibited in the Library the Minutes of that Select Committee. They certainly make fascinating, if somewhat gruesome, reading. There is on the page which happens to be open the examination of a witness who prudently conceals his identity as "Mr. A. B." because he was by trade a body snatcher. He tells of the bribing of gravediggers and sextons, and boasts of an average of 50 to 60 bodies snatched in a year, and up to 100 in a single good year.
The last question that I want to ask the Minister is about this legal entity,the person lawfully in possession of the body.I have not been able to discover very much about this person who appears for the first time in the Anatomy Act. All that one can gather is that though he is not, as one might imagine, the next-of-kin, he can be the executor; he can be a group of persons, or a body corporate. He can be, I gather, the master of a 1238 workhouse in which somebody dies. The hon. Lady told us that in the case of a hospitalthe person lawfully in possession of the bodyis the management committee, or presumably the secretary to the management committee acting on its behalf. I understand that it was recently held in connection with a rather unpleasant case which came to the attention of the House that a mortuary keeper was also aperson lawfully in possession of the body".In that case I should have thought he was most certainly acting as the agent for some authority or group of persons. I feel that we need some clarity here. I should have thought that this Bill should have been the occasion for defining a little more precisely who isthe person lawfully in possession of the body".I hope the Minister will deal with these points when he winds up the debate. Apart from these very minor reservations, we on this side of the House warmly welcome the Bill.
§ 11.16 p.m.
§ Miss Joan Vickers (Plymouth, Devonport)
I also welcome this Bill. In doing so, I would say with the hon. Member for St. Pancras, North (Mr. K. Robinson) that I think the title a little unfortunate. I wonder whether the Minister could consider another title. I would like to suggest something like the "Human Aid to Medical Science Bill." The actual effect of the present title might be to put some people off. I hope that in Committee we might consider that point.
I was glad that the hon. Member referred to the Corneal Grafting Act, 1952. When I made my will in 1957 I definitely willed my eyes under that Act to an eye bank, and when this Bill becomes an Act I shall add a codicil to my will so that my body may become useful after death. All of us in this House and those who read HANSARD will, I am sure, do their best to make their bodies and minds as helpful in the world as they can. Therefore, I welcome the idea that one might carry on some use for one's body after one is dead, and particularly welcome the Bill for that.
I think it will be helpful to medical students. I am not a doctor, but we have a doctor in the House tonight. 1239 Practical work on a body can be useful to students. They can get used to manipulating the body with their fingers, which is better than watching someone else doing it or a film. The Bill can aid the advance of medical education. It should also be welcomed by animal lovers, because I presume that further use of bodies and experiments by students with bodies may mean that we shall have fewer experiments on animals. That should commend itself to those who are always worried about that aspect of the matter.
I think that we shall learn by the Bill a great deal which will be of help in curing various diseases about which we know very little at present. I presume it will mean that not only various parts of the body can be used for curing people who are ill but that they can be used for research work. That is something I welcome very much, because research with an actual human body can be very beneficial. Perhaps we may even learn how the brains of Parliamentary draftsmen work.
I wish to ask my right hon. Friend a few questions. Does the age of a body make any difference to its usefulness to science?
§ Dr. Horace King (Southampton, Itchen)
Age makes no difference to the usefulness of eyes provided there is sight there when the person dies.
§ Miss Vickers
Eyes obviously are useful when there is sight, but the body becomes feeble and perhaps parts wear out. I wanted to know whether age made any difference to the usefulness of the body.
I should also like to ask whether there is any limit to the number of bodies which may be required. Can my right hon. Friend announce that so many bodies are needed at a given time so that people who would give their bodies may know the need and they may then consider giving them and making preparations? If a body is not in a hospital or nursing home or other institution and a person wishes his body to be used in this way, who is to be responsible for taking the body away, and who will pay for the cost of removal of the body? Is it borne by the executors of the person who is dead, or by the people 1240 lawfully responsible for the body, or is the cost to be borne by the National Health Service? I should also like to know what time is to elapse before the removal of the body. Must it be removed at once—quickly? I think it is important people should know these details if they are to act on them when a person dies.
I welcome the Bill with these few words, as I think it will be a great help in the study of disease, and I hope it will be of benefit to humanity, not only in this country but, through research, a benefit to people in other countries of the world.
§ 11.21 p.m.
§ Dr. Horace King (Southampton, Itchen)
One of my happiest political memories is of having collaborated with a Conservative colleague, Mr. Gerald Williams, once Member for Tonbridge, in conducting a campaign in 1951 and early 1952, both in the country and in the House of Commons, which led to the passing of the Corneal Grafting Act, 1952. I should like to place on the record tonight long overdue appreciation of the services in that campaign of the Kent and Sussex Courier and the Daily Mirror and of leaders of the medical profession in the attempts which we were making to win public support for what now reaches its real fruition in tonight's new Measure.
The Corneal Grafting Act, which is to be repealed if the Bill is carried, was a Private Member's Bill which was introduced, as my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) said, under the Ten Minutes' Rule by Mr. Gerald Williams, and thanks to the generous co-operation of all Members of the House whom we had endeavoured to educate in the significance of the Measure it got through all its remaining stages in a few seconds on one evening—on the nod, to use a Parliamentary term. I always remember that while my colleague was doing the formal work in the House I was still at the last minute trying to convince one or two last minute objectors not to deprive us of the privilege of getting the Bill unopposed through the House. I can remember, incidentally, how distressed Lord Morrison was, as an old Parliamentarian, that legislating without debate should happen at 1241 all, even though the Measure was a good one, as this was. In May, 1952, the Ministry, which I had found so unsympathetic, as the Parliamentary records show, in May, 1951, was helpful and co-operative and helped us to get our Bill through.
But even before we had begun my hon. Friend himself, the Member for St. Pancras, North had been at work along the same lines. I am quite certain that he is as delighted as I am, and as Mr. Gerald Williams must be, at the enlargement of that first Measure by this Bill. This Bill proposes to repeal among other things the Corneal Grafting Act. I am delighted. In the Corneal Grafting Act we went as far as we thought we could take the House and public opinion with us at that time. The case was, as I shall hope to show, quite precise, quite narrow, and quite clear, but in our speeches up and down the country some of us visualised the day when the Measure which we were introducing would be supplanted by a much broader one. It is that broader Bill which is before the House tonight, and I want most sincerely to congratulate the Minister for introducing it.
I think it may help the House if I show it some of the beneficial effects of the Corneal Grafting Act. Among all the blind there are some who are blind not because the eye is defective but because the cornea itself is damaged or diseased. The cornea is a kind of covering of the eye, a kind of window through which the real eye looks.
If the cornea is defective—if it is opaque, blurred or cracked—even if the eye behind is a good one, it will not be able to see properly. Skilful surgeons in this century have discovered that by one of the superb operations which are the mark of modern surgery it is possible to remove a diseased or damaged cornea and replace it with a new one. In this way, always provided that the eye underneath is a good one, sight can be restored to the blind.
I wish I could convey to the House the wonderful joy I have experienced in watching these marvellous operations and in meeting and talking with in rooms down below and bringing to the public on television, with my colleague and with Mr. Rycroft, the great eye surgeon, men and women who were once blind or were going blind but who are now 1242 able to see, thanks to surgeons like Rycroft of East Grinstead and Zorab of Southampton, to mention only two. Some of them again see clearly enough to read. Some of them see enough to be at any rate aware of light and of objects around them.
The cornea from a dead person's eye is grafted on to a living eye. Nature's gift to this miracle of surgery is that it is possible to graft this portion from one human being on to another. Unfortunately, surgery has not yet made possible the practice of universal grafting of all kinds of tissue.
I was glad that the Parliamentary Secretary said that year by year we are discovering more and more ways of overcoming the difficulty that part of the body of one human being somehow will not marry with the body of another, but usually dies when transferred. When we have discovered how to do that, the possibilities of exchanging some of the organs of dead people and using them to prolong the life or health of living people will be immeasurably extended. I am sure that every hon. Member was touched deeply this week by the noble story of the father who gave one of his kidneys to save his son's life, but gave it in vain.
One of the difficulties that surgeons experienced before the passing of the Corneal Grafting Act was to get human eyes for grafting. I will not go into all the difficulties, but the chief obstacle was the Anatomy Act, 1832. This was an excellent Act of Parliament. I only wish the debates on the Act in the five of six years it took to get it through the House had been conducted in the spirit in which tonight's debate is being conducted.
Those debates were conducted under the shadow of body-snatching, the desecrating of graves by the so-called "resurrection men," and of criminals like Burke and Hare, who sold dead bodies to anatomical surgeons in anatomical schools for dissection. If Burke and Hare could not get the bodies by what became the more difficult and dangerous process of digging them up from graves, they murdered people so that they would have a supply of bodies for sale.
When the Bill came before the House so bitter and superstitious was the atmosphere that one of its opponents 1243 called it an Act to encourage "Burking", although it was designed to prevent the crimes which Burke and men like him had committed.
In the Second Reading debate on 22nd January, 1832, the radical and rather charlatan Mr. Hunt said that a surgeon had threatened to dissect him for daring to oppose the Bill. The hon. Member, striking an attitude, said:Let him take care at least that he did not Burke him first.The hon. Member himself proposed that everyone who supported the Bill should be dissected.
The young Macaulay supported the Bill in one of his early eloquent speeches in the House, but the bitter and superstitious opposition of the time and the fears expressed in the debate were responsible for all kinds of delays and ambiguities put into that Anatomy Act at the Committee stage. One of the most important delays from the surgeon's point of view was the one that required 48 hours to elapse before any medical man could tamper in any way with the body. With the growth of medical science the clash with the restrictions and ambiguities of the Anatomy Act became each day more apparent and more and more an obstacle to sight-saving. The Corneal Grafting Act of 1952 has made it possible for surgeons to obtain eyes without the delays imposed upon them by the Anatomy Act. The provisos in that Act were simple. They were that a dead person had written or said that he wanted his eyes to be used for such purpose or had never expressed objection to his eyes being used for such a beneficent purpose, always provided in the latter case that the dear ones of a dead man or woman had no objection to their being so used. The proviso that we drew up in the Corneal Grafting Act are repeated word for word in this Bill.
The ending of delay was vital. The cornea has to be taken within a few hours after the death of the person otherwise it deteriorates. If it is taken soon enough it can be kept in a refrigerator and preserved. Most of the great eye hospitals today have an eye bank, and the Bill will help most of the great surgical hospitals to have a tissue bank 1244 to which human tissue can be taken and preserved provided that it is taken from a body soon enough.
The inaugural meeting of the Corneal Bill campaign was held at the Victoria Hospital, East Grinstead, famous for the magnificient work of the late Sir Archibald Macindoe in skin grafting and of Mr. Benjamin Rycroft in eye surgery, and both of them only typical of a number of eminent surgeons working in these fields whose achievements I regard as almost miraculous. I said at that meeting that I could hardly imagine a greater joy than to think that one's eyes, having served one life, should after one's death be instrumental in restoring somebody's sight. If it is true of corneal grafting it is equally true of any other human tissue that may be used to help the living after serving the dead.
I commend the Bill to the House and suggest to the Minister that some day he and his Government might raise this matter at United Nations level. Whilst most blindness may not be curable, that due to defective corneas can be cured. There are hundreds of thousands of blind persons in the depressed areas of the world who suffer from corneal blindness. If we could build up as part of world civilisation a great tissue bank whereby the dead would be helping the living it would be a wonderful thing.
The Bill is drafted much more broadly, more generously and more scientifically than the earlier Act which it repeals but which at the same time it includes in a wider Measure. The Bill is wider in scope and therefore more beneficial in the good that it can do. It helps the dead to help the living. I welcome it enthusiastically. I congratulate the Minister and I hope that the House will give it a Second Reading.
§ 11.35 p.m.
§ Lord Balniel (Hertford)
I welcome the Bill and, without being presumptuous, I should like to welcome the way in which it was introduced by my hon. Friend the Parliamentary Secretary to the Ministry of Health. The Bill, though not controversial and not one which, as far as I know has attracted any public attention, is a fairly important Measure. I welcome the serious manner in which my hon. Friend introduced it, matching its serious content.
1245 This is an important Bill because it touches on some of the most deeply-felt instincts of man; instincts that say that the human body, once life has been extinguished from it, should be treated with the utmost dignity and respect, and that, pending interment or cremation, it should be left in peace. These instincts are felt by most persons, whatever religious—or, indeed, irreligious—beliefs they may have.
I confess that I shared those instincts when I first read the Bill. Knowing some of the consequences that will flow from it, I read it with a certain amount of emotional disquiet. On the other hand, if one tries to throw away untenable prejudices and to look at the matter objectively, there is something infinitely wonderful in the thought that the advance of medical science now enables men to use the tissues and organs from a dead body in order to bring health and happiness to the living and, in particular, to those who, because of misfortune or disease, are deprived of the good health that most of us enjoy.
To my mind, there is something infinitely wonderful in the thought that this advance that we are now legalising enables medical science to create something approaching the immortality of the living cell, because the living cell will now be transferred, and can be transferred from generation to generation, bringing with it new health.
Indeed, if one looks at the subject in a slightly wider context, it is even more wonderful, because although at the moment we know of operations whereby the living cell tissue is grafted from the living to the living, and that, under this Bill it will be legal to graft the living cells from the dead to the living, we realise, even in passing this Bill, that this is a terribly transitory phase, and that almost certainly within the lifetime of the younger generation it will be possible for medical science to create artificial living tissue which will bring health to those now suffering ill-health and misfortune.
The hon. Member for Southampton, Itchen (Dr. King) has referred to one of these operations that we read about in the Press by means of which living tissue is transferred, often at great cost to the individuals who have submitted themselves 1246 to mutilation to bring health to others, and particularly to their children. Even since the publication of the Bill—only a short time ago—an article appeared in the Sunday Express which, with the permission of the House, I will quote.
The article was headed "Inspiring", and read:This was the choice that faced Mrs. Edna Frost, of Salford. In order that her 15-year-old son Kevin, a polio victim, should walk, she had to consent to giving up bone from her shins.Now Kevin runs and plays football. Mrs. Frost is hobbling, having spent months in a wheelchair.There are many types of courage. But surely none ranks higher than that which—coolly facing pain and mutilation—still stands the test.I must say that for human beings to be willing to undergo operations like that—deliberately to undergo the mutilation of their bodies to bring health to children or others, ranks for cool courage with the courage of a soldier in the heat of battle who is prepared to lay down his life for a friend.
We look forward, under this Bill, to the time when that kind of operation will be totally superseded; when the tissue will be taken, not from the living at the cost of the living, but from the dead. We look forward to that time, and therefore welcome this Bill.
Like the hon. Member for Itchen, I feel a temptation to look back to the antecedents of the Bill. Time is short and I shall not do so, except to refer to one aspect of the matter. The hon. Member for St. Pancras, North (Mr. K. Robinson) said that the Anatomy Act, 1832, had overcome the difficulties of the anatomy schools and put an end to body snatching. This was not entirely so. If the House will permit a slightly macabre story, it was as late as 1880 that the body of my great-great-grandfather was stolen from its tomb. I confess that I do not think that the thief imagined that the anatomy of the premier earl of Scotland was superior to the anatomy of any commoner; I think he imagined that the purse of the family was slightly longer than the purse of most. In this he made a great mistake. The long ancestry of the premier earl of Scotland had inculcated into the family 1247 a sense of thrift which he had not bargained for, and he was left with the body on his hands for almost a year.
The problems of the anatomy schools have been solved by the 1832 Act, but other problems have arisen nevertheless, and there is no doubt that there is confusion in the law at the moment. This confusion has been aggravated by the passing of the Corneal Grafting Act, 1952, which, by legalising specifically corneal grafting, has cast doubt on the legality of post-mortem operations of the kind we are discussing.
While I welcome the Bill, I have one question to ask. I have no great technical knowledge and I do not claim to have detailed information on the subject, but, like other laymen, I have heard of the world-famous Bethesda Hospital, the naval medical research centre at Maryland in the United States of America. I thought it of interest to look up something of the work undertaken at that hospital in order to see what relevance it had for us in this country and, in particular, in relation to this Bill. I am not in any way squeamish, I think. Unlike the right hon. Lady the Member for Warrington (Dr. Summerskill), I can sit through a boxing match without too much worry. After being educated at a British public school and going through normal Army life, one ceases to have an excess of sensitivity. I cannot deny, however, that, when reading the description of the work undertaken at the Bethesda Hospital, I felt myself going slightly white around the gills.
I had not realised how immensely complicated is the post-mortem operation which has to be undertaken, and which we propose shall be legalised under the Bill. I understand that the average post-mortem operation at this hospital lasts between 12 and 14 hours. It is not a desultory operation; it is, in fact, continuous and intense. I am told by a friend who is well acquainted with the work of the hospital that the operation has to be undertaken by not one but by a series of surgeons, and, as a result of the intensity of the work, they are incapable of undertaking any other work for a considerable time afterwards.
I had not realised that, for instance, the aseptic regulations are considerably stricter than the aseptic regulations in 1248 any normal operation. Throughout the operation, although all are wearing double masks, no talking is allowed for fear of aerial borne bacteria contaminating the tissue which is to be grafted on to living persons. During the operation, anything up to 130 grafts, any one of which can give health and, indeed, possibly life to others are obtained.
The complexity of the operation, combined with what the hon. Member referred to as the speed at which the operation has to be undertaken after death, seems to me to lay the matter open to certain difficulties. The speed with which the operation has to be undertaken after death is very great. Although in theory the consent of relatives has to be obtained, I understand that in Bethseda Hospital the consent of relatives is obtained while the patient is still living and the operation is undertaken instantly upon decease.
It seems to me that the complexity of the operation combined with the speed does enhance the possibilities of foul play—through the elimination of evidence. I have read the safeguards which my right hon. Friend the Minister of Health has included in the Bill under Clause 1 (5), but the onus of securing the safeguards rests with the person having reason to believe an inquiry may be required. I would ask my right hon. Friend to consider these safeguards during the course of the Bill to make sure they are adequate. They are not, for instance, as strong safeguards as are required in the event of cremation being undertaken, and I would have thought they should have been as firmly written into the Bill as in the event of cremation.
Permission under the Bill has to be obtained from any surviving relative. My right hon. Friend shakes his head, but I think I am right—that permission has to be obtained from the spouse or any surviving relative. What does "any surviving relative" mean? Most of the Front Bench are related to one another nowadays. My right hon. Friend is a notable exception. But we are all to some extent related. Would it not be desirable in the interests of accurate drafting rather than this rather slipshod drafting, to lay down the limit of consanguinity from whom permission should be obtained?
1249 Subject to these questions, which I hope the Minister might bear in mind, I welcome the Bill with great pleasure.
§ 11.47 p.m.
§ Dr. Dickson Mahon (Greenock)
We all appreciate the contribution which the noble Lord the Member for Hertford (Lord Balniel) has just made, particularly his last point. No doubt the Minister is grateful for being exempted from the consanguinity that seems to flow through the Government Front Bench.
I think there is a point here. I like to think that in a sense this Bill almost has the spirit of Dr. Knox hanging over it. He was the man who was not hanged as the result of the Burke and Hare episode but was alleged to be the clever, if somewhat sinister, character who more or less pressed on them the need for supplying him with many bodies for his Anatomy rooms.
The Anatomy Act of 1832 is responsible for letting myself and many hundreds of thousands of young men and women over the years dissect dead bodies in this country, and we have learned a great deal from that. Despite the levity for which medical students are renowned, there is no such levity attached to the dissecting rooms. These bodies are treated with the natural care with which one would treat a patient, and while the limbs and trunk are detached so that a more close examination can be followed by one, two, or three students, regard for the person as a person is observed and arrangements at the end of the term involving that body are made to ensure that it has proper disposal in accordance with the religious persuasion and desires of the person concerned.
It is a fact, nevertheless, that the medical schools would be in a sad position if it were not for the poor and the friendless upon their deaths. It is not a large section of the population who will their bodies but a very small section, and of the poor and friendless it is the many who do not take the positive act of willing their bodies who enter the dissecting room. That might well be why some of their Lordships, who debated the original Act, made so many criticisms of it. For example, Lord Wynford in 1831 said that the 1832 Act "would reflect the highest disgrace on the British 1250 Legislature without any benefit to science." He was wrong, because it affected science to a large extent. Certainly Dr. Knox would regard that as a silly argument. I like to think that being a descendant of John Knox and having a German mother, he was a scientist par excellence but regrettably more devoted to science than to humanity.
In discussing this Bill we might think of one fundamental principle. I do not know which side Dr. Knox would fall on in this, but the Minister seems to have made up his mind about the point raised in the closing remarks of the noble Lord the Member for Hertford, and by my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson)—the rôle of the next of kin.
I have a letter from a person who is on the blind register—strictly speaking he is not blind but fulfils the qualifications of the register—and in making various points about getting corneal grafting for his eyes he says:My third suggestion to the Members of Parliament who might have some influence in this matter is that, though some donor may give his eyes to a hospital, his next of kin can refuse to let those eyes be so taken. This should be done away with.That is an interesting point, and the Minister must justify either at this stage or later, his acceptance of the principle that the next of kin should have an absolute right of veto. Many people are in the queue for these corneal grafting operations. It is alleged—and my hon. Friend the Member for St. Pancras, North has given an example—that there are 100 at Mootfields. I know a hospital in Glasgow with several dozens such persons, and it has been assessed unofficially in Scotland that there are 130 people awaiting such grafts today. This is a matter which many of us have been concerned about, and I have written to the Scottish Office to elicit the Scottish position.
The Minister must explain further the working of the Corneal Grafting Act for which we are indebted to my hon. Friend the Member for Southampton, Itchen (Dr. King) and to a former hon. Member of this House for their contributions. He must state and justify his statement whether or not the circumstances which should operate under this Bill will provide the numbers necessary to meet the need.
1251 The semi-blind person I have quoted alleges that it is not that people are unwilling to donate their eyes in sufficient numbers but that there are too few people willing to accede to the donor's wish. One can understand this. It is natural that a widow, grieved by the death of her husband, should, even if he has donated his eyes, decide not to allow it to proceed in the moment of grief. I do not know the figures, but if it is true it is an important factor. The House, in consolidating its legislation on this matter—legislation going back 128 years—might think about this principle.
I know that many medical men disagree with the idea of interfering at all with the right of the next of kin to exercise an absolute veto over any decision related to a body or of the right of the person who is the executor or is in possession of the body. Their argument is that we should popularise the donation of human tissue on death and make people so aware of how vital a contribution they can make that it will overcome even the sentimental or emotional or religious objections of persons who are actually in charge of a body. Various factors can decide this.
While I accept that the Minister must take every Parliamentary opportunity that he can to bring in Bills like this—and there is a long queue awaiting legislation—nevertheless it is important for all Members, and certainly for the Committee later, to be given the facts so that they will be in a position to exercise judgment on how properly to amend this Bill, if it is in need of amendment. I will not recite the list of questions, but, as I have said, in the letter which I wrote to the Scottish Office I asked a number of specific questions, and I hope that the answers which will be given in relation to Scotland might, perhaps, also be given in relation to England and Wales.
The spirit of Dr. Knox might prevail and it might be said that the wishes of the donors should be sacrosanct and that the next of kin ought not to have such an important part to play. I do not necessarily associate the Opposition or any of my hon. Friends with that point of view. I merely put it forward as a principle of objection put up by some of those most intimately concerned.
1252 I have no doubt that the hon. Lady the Member for Plymouth, Devonport (Miss Vickers) has a very good point in her objection to the name of the Bill. One has only to recall the comments of hon. Members outside the Chamber tonight to realise this. It may be a point of misplaced humour, but, nevertheless, it is a point which will not help in making the Bill as well and favourably known as it should be. I believe that we should think of a different title for it. Of course, there are several titles which could be suggested that would be more disastrous than "Human Tissues", but this is a point on which I should like to join with the hon. Lady in commending to the Minister.
I do not wish to embark on looking into the future with regard to advances in medicine, but I am glad that the general terms of the Bill are such that we shall be able to meet almost any forseeable developments in medical science which the law might not find harmonious to its own provisions.
I am surprised that in introducing the Bill, which, if I may say so, she did extremely well, the hon. Lady mentioned that the Anatomy Act and subsequent provisions might be acting as deterrents. I should like to know on what information she bases that opinion. How is it so? How, in fact, is this related—I presume she was speaking in the context of providing subjects for dissection—to corneal grafting? This is something about which the Minister might tell us, and I will make way for him to do so.
§ 11.58 p.m.
§ The Minister of Health (Mr. J. Enoch Powell)
I am grateful to the whole House for the reception which has been given to the Bill. As the hon. Member for St. Pancras, North (Mr. K. Robinson) recognises, the Bill deliberately brings into the open the whole of this question and is an attempt to lay clearly upon the Statute Book the lawfulness of those matters concerning dead bodies which are required for medical purposes, subject to equally clearly stated stipulations and conditions. I agree with the hon. Gentleman that legislation of this importance—and it is important—should be introduced officially on behalf of the Government.
A number of very pertinent questions have been asked from both sides of the 1253 House during the debate tonight, and I should like to attempt to reply to them. The hon. Member for St. Pancras, North asked about the supply of corneas and the present position. I might, perhaps, link this question with that of my hon. Friend the Member for Plymouth, Devonport (Miss Vickers) who asked whether there was any question of placing a limitation upon the donation of bodies or parts of bodies for the purposes envisaged in the Bill.
I must say that I cannot foresee the happy time when it will be necessary to cry, "Hold, enough." On the contrary, the present position cannot be regarded as fully satisfactory in regard to the cornea which has, of course, a longer history than the removal of most other parts of the body for therapeutic purposes.
The solution to this matter lies in wider public understanding of what is involved—and I hope that this debate will make its own small contribution to that—and in close relationships between the corneal grafting centres and the hospitals in the area to which persons may be brought who have made dispositions of their eyes or which may be in a position to approach, during their last illness, the persons who will die in those hospitals or their relatives.
Propaganda is undoubtedly of importance in this matter, and the House may be interested to know that the Royal National Institute for the Blind is planning a publicity drive, in which it is my intention, as far as I can, to co-operate, to bring to the attention of the public the opportunities and the benefits which donation, of eyes in particular, can give.
The hon. Gentleman and his hon. Friend the Member for Greenock (Dr. Dickson Mabon) asked me to explain a little more exactly how it was that the Anatomy Act, 1832, had cast that doubt which Clause 2, not Clause 1, of the Bill seeks, if it exists, to remove. It happens in this way. Parliament in passing that Act thought it necessary to make a saving for post mortem examinations. However, it only made a saving for post mortem examinations:required or directed to be made by any competent legal authority.If it be that an autopsy carried out in a hospital is a post mortem examination 1254 within the meaning of the Anatomy Act, and if it be that the Anatomy Act related to matters which include bodies lying in hospitals and subjected to autopsies, then the doubt can arise whether, not beingrequired or directed to be made by any competent legal authoritythose autopsies fall under any disability which the 1832 Act was designed to remove. It was, as so often, an attempt to remove doubt in the 1832 Act which created the doubt which we seek finally to lay in Clause 2.
The hon. Gentleman asked about the expression in the Bill:the person lawfully in possession of the body.He is right in saying that this is a difficult matter. The difficulty arises from the fact that in law there is no property in a dead body. However, I am advised that the expressionthe person lawfully in possession of the bodywhich, as he says, is an expression deliberately carried on from the Anatomy Act, would include a hospital authority in respect of a body lying in a hospital, but that it would not be deemed to include the mortuary attendant of the hospital, nor any person other than a person duly authorised under Clause 1 (7).
§ Mr. K. Robinson
Before the Minister leaves that point, can he say how the executor comes into this? I gather that an executor is included. What about the relative property rights of the executor and the hospital management committee in the case of somebody who dies in hospital?
§ Mr. Powell
The difficulty, as the hon. Gentleman recognises, is that property rights is a term which is not here applicable, but I think that the question of a concurrent right over the body arises in regard to a matter to which I want to come later in answer to a point raised by the hon. Member for Greenock, where one might have a clash of intention, and perhaps I might deal with that point in that context.
My hon. Friend the Member for Devonport complained, and she is not the first to do so, that this was probably not the best title which could have been found for the Bill. I do not 1255 disagree. I have been doing my best, and a lot of people have been doing their best for some months, but if my hon. Friend or any other hon. Member can produce something better which will stand up to scrutiny I will certainly see what can be done. I can only say that it was the best that we could manage.
In one of the few flippant sentences which have been uttered during the debate, my hon. Friend referred to the possibility of having available the cranium, or the contents of the cranium, of a Parliamentary draftsman, and indeed it is a charming thought to think of some Hunterian collection of the future containing that trophy. She asked about the optimum age of persons from whose bodies parts may be obtained for therapeutic purposes. I am told that in this respect the cornea is unique in that it is better to get it from an elderly person, but otherwise it is the younger bodies from which, at present at any rate, the more useful tissues for therapeutic purposes might be expected to come.
The answer to her question about the cost of removing a body for the purposes of the Bill where the body is at home is undoubtedly that the cost would be borne and all incidental trouble taken by the hospital which was to benefit by the removal of the parts. She also asked about the maximum time which ought to elapse between death and the removal of the parts. In the case of a cornea it is generally considered that the eye should be removed within four hours unless there has been refrigeration, but, for reasons which I am sure the House will understand, I think I would be doing no service in attempting to give detailed information here because, as scientific procedures are elaborated, one hopes that some of the difficulties may be eased, if not removed, and secondly, because one would wish to do nothing to lessen the sense of urgency on the part of those concerned where use is to be made of a body.
I feel that if there were this sense of urgency, somehow, paradoxially, the natural instincts against this use of a dead body might be counteracted by the anxiety of the relatives, even in the moment of bereavement and distress, to be sure that the wishes of the deceased for the beneficial use of the body should 1256 not be frustrated. So I think the best thing I can say is that there is undoubtedly urgency and that urgency should be understood by all who may be concerned with carrying out these intentions.
Closely allied to this point was the point raised by my noble Friend the Member for Hertford (Lord Balniel), who referred to the safeguards where a post mortem might be required. He may have noticed that the safeguard in the Bill has been strengthened as compared with the Corneal Grafting Act, 1952, for this Bill places the onus, not only upon the authority which authorises the removal, but also upon the doctor who carries out the removal. The Coroners' Society has been informally consulted in regard to this safeguard and has intimated that it regards the safeguards embodied in the Bill as satisfactory.
My noble Friend also drew attention to the phrase, "any surviving relative" and asked its meaning and why it was not further defined. I must point out to him that the expression "permission of a surviving relative", which he used is not strictly accurate. If he looks at the context he will see that the reference is to having "no reason" after "reasonable enquiry" "to believe" that "any surviving relative" objects. In that context I have deliberately left the term "any surviving relative" undefined so that if a relative makes it known, or if there is reason to believe, that there is objection, it shall not be necessary nicely to inquire into the degree of consanguinity; because I am convinced that far more harm can be done to the cause which the House has at heart tonight by a single case in which a strongly held scruple is overriden than perhaps a temporary loss of opportunity due to the width in which this Clause has been drawn. So I say it is quite deliberately left at large, that anyone who can claim to be a relative may be able to express an objection under Clause 1 (2).
That finally brings me to the difficulty which was felt by the hon. Member for Greenock, and which, I hope, I can remove. There are two separate cases covered by subsections (1) and (2) of Clause 1. Subsection (1) deals with the case where the deceased person himself has desired that his body shall be so 1257 used. In that case there is no question of that desire being overridden by anybody. For example, if the body is lying in a hospital, and there is evidence of his wish, there is no question of a surviving relative having a veto over it. The surviving relative only comes in where there is no specific desire known on the part of the deceased person, and where, therefore, it is right to be sure both that the deceased did not object himself to this being done, and that this being done will not outrage the surviving spouse or any—I repeat, any—relative.
§ Dr. Dickson Mabon
The point I want to make to the Minister is this. I am sorry if he is not able to give us the fact as to the number of people who have, in a sense—I use this term loosely, perhaps wrongly—frustrated the wish of the donors. It is rather important to know exactly what the facts have been. I put this to the Minister. Clause 1 (1) says:If any person … has expressed a request that his body … be used after his death … the person lawfully in possession of his body after his death may..Of course, he may not. That is the point. Surely he can frustrate the wishes of the donor?
§ Mr. Powell
Where that person is, as in the majority of relevant cases that person will be, a hospital, the question of frustrating the wishes of the donor does not arise. I quite agree that in the case of a person dying at home it is conceivable that the known wish may not be carried out by failure, deliberate or otherwise, on the part of the relatives, but I hardly think that in the nature of the case statistics of these instances can be known. So I would not have thought it possible statistically to answer the hon. Member. But the fact is that there is here, as there was in the Corneal Grafting Act, no veto; that so far as humanly possible, while there is no property in a dead body and therefore no formal bequest can be made, we are giving overriding right to the person deceased to ensure the use which he desires of his body after death.
I would agree that we are here not at the end of the road, but we are looking forward. The hon. Member for St. Pancras, North referred to a change of climate over the last ten years, but we all hope that the climate will change 1258 further still, and that the public mind will open more and more both to the benefits and to the utter propriety of the processes which this Bill makes lawful, and in that hope I think we can all feel that the House tonight, on this matter which touches many solemn and even irrational emotions, is doing good work in giving a Second Reading, as I hope it will, to the Bill.
§ Question put and agreed to.
§ Bill accordingly read a Second time.
§ Bill committed to a Committee of the whole House.—[Colonel J. H. Harrison.]
§ Committee this day.