§ Mr. Martin McLaren (Bristol, North-West)
I beg to move, in page 2, line 35, to leave out "establishing or."
My hon. Friend the Member for Plymouth, Devonport (Miss Vickers), who has put her name to the Amendment, asks me to apologise for the fact that she has not been able to stay in the Committee. The Clause amends the Anatomy Act, 1832, which deals with post-mortem examinations, its general tenor being that they are unlawful save as specified. The phrasepost-mortem examinations directed to be made by a competent legal authorityrefers to post-mortem examinations ordered by a coroner, which have always been legal; there is an express saving provision for them in the Act of 1832. This Clause extends lawful post-mortem examinations to those carried out by registered medical practitioners 847for the purpose of establishing or confirming the causes of death.The Amendment proposes to leave out the words "establishing or" so that the passage would read:for the purpose of confirming the causes of death.The reason for the Amendment is that it is feared that the words proposed to be left out, if they stood part of the Clause, might hamper and interfere with the jurisdiction of coroners. I am interested in this point, because at one time I acted as an assistant deputy coroner; although I am no longer in that position, I am authorised to say that the Amendment is supported and requested by the Coroners' Society of England and Wales.
On Second Reading, my right hon. Friend the Minister said that the Coroners' Society had been consulted informally about the safeguards in the Bill where a post-mortem examination might be required, and he was clearly then referring to Clause 1 (5). He was as accurate as he always is, and it is true that the Society saw the draft of Clause 1 and expressed its agreement with it, but my information is that the Society never saw Clause 2, which is the Clause with which we are dealing, before it was published, and, therefore, the Society did not express its concurrence with the whole Bill.
Deaths fall into two classes. First, there are those in which a doctor is in a position to give a medical certificate, and, secondly, there are those in which no doctor can do so. Broadly speaking, if a doctor knows the cause of a person's death and has attended him during his last illness, he may issue a certificate. That appears from Section 22 of the Births and Deaths Registration Act, 1953.
The second class, where no doctor can issue a certificate, arises because the doctor is not able to state the cause of death, not knowing it, or more commonly because he has not attended the person during his last illness. This frequently happens where someone has had no last illness in the ordinary sense, or been under any doctor, as where he may suddenly collapse and die in the street. In passing, it is worth noting that a pathologist who examines a dead body can never issue a certificate because he will 848 not have attended the deceased during his last illness.
The invariable practice in the case of deaths in the second class, where no doctor is able to issue a certificate, is that the death is reported to the coroner, who has the statutory duty under Section 3 of the Coroners Act, 1887, to make inquiry wheresuch person has died either a violent or an unnatural death, or has died a sudden death of which the cause is unknown".The coroner will usually order a postmortem examination. It will very often be found that dearth is due to natural causes and that no inquest will be necessary, but the death will have been properly investigated.
If doctors are allowed to carry out post mortems without reference to a coroner to establish causes of death, the danger is that they will do it when they do not know the cause and want to find it out. We are here in the realm of semantics, the meaning of words. We are concerned particularly with the meaning of "establish". I took refuge in Murray's dictionary. I there found "establish" defined as follows:confirm; settle (what is weak or wavering); to settle (doubts)".My hon. Friends and I say that post mortems ought not to be conducted otherwise than under the direction of a coroner to confirm or settle what is weak or wavering, or to settle doubts.
The danger is that medical practitioners will feel no need to report cases to the coroner until after the post mortem which they have conducted has shown death to have been unnatural. The post mortem might be carried out by a pathologist who does not fulfil the requirements laid down in the Coroners' Rules. Rule 3 (a) provides that such a person must have suitable qualifications and experience and that access to laboratory facilities is necessary. Any subsequent post mortem by a coroner's pathologist might well be hampered because the evidence will have been destroyed and the tissues irretrievably damaged. After all, the medico-legal autopsy is a highly specialised procedure, requiring specialised experience. A general pathologist may not have the necessary experience. The second danger is that a doctor might give a certificate after holding what I will describe as a private post mortem and even 849 though his attendance on the deceased before death had been of the scantiest.
My hon. Friend may say that she will issue a circular to hospitals making plain the difference in relation to coroners. But we are saying that it would be far better that the safeguards should be inserted in the Bill rather than in a circular. She may also say that the safeguards in Clause 1 (5) are sufficient. I am not so sure about that. In some respects they seem to me to be rather flimsy. The subsection begins:Where a person has reason to believe …We find that the test is completely subjective and the safeguards will not operate on a doctor who may say that he is a simple physician and that he knew little of the law on inquests, and that it never occurred to him that an inquest might be required to be held.
We take the view that the word "confirm" in the Clause is quite sufficient and should stand alone. That word would cover the case where a doctor knew the general causes of death, but wanted to confirm them with greater precision. If we include the word "establish" we help the doctor to venture one step further and perhaps cross the line to undertake a post mortem when he does not really know the causes. For the reasons which I have tried to give I suggest that that would not be in the public interest. We therefore think that the Bill would be improved if these words were omitted, and I hope that the Committee will accept the Amendment.
§ Miss Pitt
Despite this Amendment, and the speech in defence of it made by my hon. Friend the Member for Bristol, North-West (Mr. McLaren), I can assure the Committee that nothing in the provisions of the Bill can alter or diminish the powers of the coroner. His position is completely safeguarded. My hon. Friend anticipated that I might say that Clause 1 (5) answered him and, indeed, I do say so. It required a doctor who proposes to conduct a post mortem to obtain the consent of the coroner if he has reason to believe that an inquest might be required or that a post mortem might be required by the coroner.
The purpose of the word "establish" relates to cases where the general cause of death is known, but it is wished to 850 establish that with a little more precision. The Coroners' Society has been told that in respect of the representations which it made to my right hon. Friend. It was advised that there was no intention in the Bill of altering the present scope of post-mortem examination by doctors and that such examinations are properly carried out in cases where no report to the coroner is necessary, but where something more is being done than confirming.
The Society has also been told that the present situation whereby the doctors, knowing the interests of the coroners have to decide whether there is reason to believe that the coroner is concerned, will be unaffected by the Bill. When it becomes law my right hon. Friend will take steps to emphasise to doctors that it does not affect the position of the coroner. This we intend to do in respect of hospital doctors and general practitioners.
My hon. Friend's powerful speech prompts me to tell him something which I had not intended to tell him, that we have had representations in entirely the opposite direction. Representations have been made to the effect that the word "establishing" is too narrow and that it should be replaced by the word "ascertaining". But we think that "ascertaining" would cover cases where the cause of death was not known and might give rise to the impression in such cases that it was less necessary than at present to report to or to consult a coroner.
I think that such examinations as we have in mind in the Bill can properly be carried out where we need something more to be done than confirm, but the word "confirm" is not sufficient in itself for the type of examination where the broad cause is known, but where it is desired to explore the detailed processes of the disease to the final stage.
To accept the Amendment would restrict the proper activities of doctors in carrying out post-mortem examinations and I must, therefore, advise the Committee not to accept the Amendment.
§ Mr. McLaren
As usual, I have listened to my hon. Friend with pleasure but not, on this occasion, with complete conviction. In view of what has been said, I hope that this point may be reconsidered when the Bill reaches another place, but I will, however, beg to ask leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.851
§ Amendment agreed to.
§ Clause, as amended, ordered to stand part of the Bill.
§ Clauses 3 and 4 ordered to stand part of the Bill.
§ Bill reported, with an Amendment; as amended, considered; read the Third time and passed.