§ The Minister of Health in respect of England and Wales, and the Secretary of State in respect of Scotland, shall by statutory instrument make regulations to provide for requiring a panel of medical practitioners to be appointed including physicians, surgeons and psychiatrists to undertake compliance with the requirements of section l(a)(i) of this Act.—[Mr. Rees-Davies.]
§ Brought up, and read the First time.
§ Mr. W. R. Rees-Davies (Isle of Thanet)
I beg to move, That the Clause be read a Second time.
It is quite clear that such a large and well attended House this morning reflects faithfully the deep-seated interest which there is in this Bill throughout the country, and it would only be right to show that the House bears testimony of it by the large number of hon. Members present.
I am one of those who have Amendments on the Order Paper to try to ensure that we succeed in having an Act of Parliament which amends the present law and makes provision for more cases in which abortion may be permitted to take place. I am a supporter of the Bill, and I mention that as there are those against who are moving other Amendments of a different nature.
451 The whole essence of the successful operation of this Act of Parliament, if it becomes an Act, will depend upon administration. It seemed to me quite early on that the method by which the administration was set up for the medical profession was one of the most crucial aspects because, after all, it is the medical profession who will be responsible for the whole operation of this Act and, without its assistance and guidance, we cannot succeed.
I am sure that we all agree that if abortion is to be permitted, whatever the circumstances may be, it should take place as early as possible. Generally speaking, therefore, the great majority of abortions will take place at somewhere between ten and 11 weeks. If one is to provide a very narrow range or panel of doctors able to deal with the handling of abortions, the administration of the whole scheme will fail.
May I say at once that I am not in any way wedded to the Clause as I have drafted it. There are a number of alternatives which can be considered. However, I want to point out exactly what the wording is so as to draw attention to the principle which I wish to sustain. It reads:The Minister of Health in respect of England and Wales, and the Secretary of State in respect of Scotland, shall by statutory instrument make regulations to provide for requiring a panel of medical practitioners"—?I do not refer anywhere there to the nature, the registration or the effect; the discretion is vested entirely in the Minister—to be appointed including physicians, surgeons and psychiatrists to undertake compliance with the requirements of section 1(a)(i) of this Act.The reason for moving this Clause and setting it down in this way is that I hope the Minister who is to reply for the Government will say which of these alternatives is most acceptable from a Governmental point of view. I recognise that the Government do not want to intervene in this debate on a Private Members' Bill other than to offer Departmental advice.
I have drawn the Clause in this way because I want to ensure that the Minister has a wide discretion in appointing this panel of medical practitioners and in 452 approving them in different areas of the country so that no great delay will be involved in dealing with cases, and also so that we can have as wide a choice as possible of medical practitioners so that the National Health Service shall not be affected by a large number of cases in any one area.
I think that the main difficulty with regard to the practice overseas is to be seen best in Sweden. There they have medical boards, and the principal criticism of their service is that there is considerable delay by the panels which have been appointed. The effect of this has been extremely undesirable. In many cases abortions take place at about 18 to 20 weeks, whereas in ordinary circumstances they would have taken place at 10 or 12 weeks. There is frequently a two months' delay between the notification by the patient and the carrying-out of the operation.
If one were to have an Amendment which said that a consultant gynaecologist only shall be permitted to be one of the two registered medical practitioners on the panel, this would be a wrecking Amendment. It might not be meant to be such, but there can be no doubt that that would be the effect of it. Indeed, I go further and say that if we were to limit this purely to physicians and surgeons it would make the scheme impracticable, quite apart from the fact that in almost all cases the ordinary general practitioner is well able not only to recommend whether the case is appropriate, but to carry out the requisite operation.
There is on the Order Paper a very good Amendment, No. 28, in the name of my right hon. and learned friend the Member for Warwick and Leamington (Sir J. Hobson). My right hon. and learned Friend and his supporters have carefully delineated the whole scope of what they want. There is another Amendment, No. 1, in the name of my hon. Friend the Member for Essex, South-East (Mr. Braine) and myself. These Amendments are alternative and with all humility in the matter I wish to hear from the Government which one they recommend as being most suitable.
I make my plea on the principle that we in this House should try to secure the widest discretion for the Minister so that he will be able to get the widest possible panel of medical practitioners to ensure 453 that the administration of the Bill is capable of really speedy execution. It is the necessity to be able to deal with these medical matters promptly, which is, after all, the humane consideration. It is not only a question of realising that if there is a delay of 16 to 20 weeks and more there is a danger to health; One must remember that if there is delay the mental anguish of the person concerned is prolonged. It is almost like someone waiting for trial for many weeks before it is ultimately carried out. I think we all agree that if the Bill becomes an Act its administration will be particularly important. It is therefore essential that the doctors should be drawn from the widest possible scope, and I hope that the widest possible discretion will be given to the Minister.
I have read the debates, and I know that there have been difficulties and different views expressed by the Home Office and by the Minister of Health who is faced with the obvious difficulty of ensuring that the National Health Service continues to be well-administered while at the same time ensuring that the provisions of this Measure can be carried into effect. I think we all agree that the right hon. Gentleman will need to appoint an enormous number of homes. Much of this will not take place in hospitals. If he appoints specific homes for this purpose, it is clear that he will need to have a wide range of consultants of the psychiatric type, and it is for this reason that I have drawn the Clause as widely as I have.
I know that many hon. Members wish to speak and to deal with other aspects of the Bill. I end by saying that when it comes to a Division, as I understand it will, I would like to know the Government's view about which proposal they prefer so that, bearing in mind that guidance, and the intentions of the Bill, one is able to decide which is the most suitable of these alternatives.
§ Mr. Charles Doughty (Surrey, East)
I rise to speak as an opponent of the Bill. I hope that it will not receive the approval of the House, but on the assumption that it may go through I want to deal with this Clause and these Amendments on their merits.
454 The Clause proposes that this panel should be appointed, and what the panel will have to decide will be in compliancewith the requirements of section 1(a)(i) of this Act.One therefore has to look at the Clause to see what the panel, however it is constituted, will have to decide, and that sub-paragraph says:that the continuance of the pregnancy would involve risk to the life or of injury to the physical or mental health of the pregnant woman or the future well-being of herself and or the child or her other children.Whatever the medical qualifications of those who will be on this panel—and the qualifications are dealt with in the various Amendments—those are not medical questions. The phrase "risk to the life" is much too wide. We all run a risk when we leave this House and cross Parliament Square. There is a considerable risk to life from traffic. The words should be, "serious risk to life".
§ Mr. Speaker
Order. With respect to the hon. and learned Member, he must not on this group of Amendments traverse the whole Bill.
§ Mr. Doughty
I am not doing that, Mr. Speaker, I am considering what the panel will have to decide, and that is set out in subsection (1,a,i), which saysthat the continuance of the pregnancy would involve risk to the life or of injury to the physical or mental health of the pregnant woman or the future well-being of herself and or the child or her other children.That opens up the whole of her life position, that of her husband, that of her other children, that of employment, and permanence of employment, of her husband, if she has one, of her housing conditions, whether she has a permanent occupation of the house, or whether she is under notice to quit, and so on. There is a whole host of matters which have nothing to do with doctors at all. They are matters of interest to doctors but not matters on which doctors are trained, or in respect of which they are called upon or asked to decide.
But doctors are trained to accept their patients' word about their complaints and troubles. If a person goes to his doctor and says, "I have a pain in my left leg," the doctor does not proceed to cross-examine him in order to make sure that he has not got the pain in his right leg. Those who inquire into social conditions 455 and into criminal activities, however, are trained to ask questions of that sort.
§ Mr. Speaker
I must ask the hon. and learned Member to address himself to one or all of the questions before us at the moment and not to the general question whether medical men should be permitted or are qualified to carry out abortions.
§ Mr. Doughty
Subject to what I have said, if we are going to have the new Clause, Amendment No. 28 should be inserted, because it will be necesary to have proper and full medical tribunals and not newly-qualified medical practitioners who will carry out this work.
I therefore draw particular attention to Amendment No. 28, which sets out the kind of qualifications that a person called upon to make this decision should have. If the House accepts the new Clause I hope that it will also accept Amendment No. 28.
§ Mr. Bernard Braine (Essex, South-East)
I begin by stating my personal position. I believe that common sense and compassion combine to argue for clarification and amendment of the law. On the strength of that belief, I voted for the Second Reading of the Bill and sought, with others, to amend it in Committee. Like many other hon. Members, and many leading members of the medical profession, I had and still have very grave reservations about some of the Bill's provisions.
I believe that much of the controversy over the Bill might have been avoided if greater attention had been paid at the outset to the advice of leading members of the medical profession whose views were set out in clear and compelling fashion in the two reports of the B.M.A. and the Royal College of Obstetricians and Gynaecologists, published last year. These reports attach the highest importance to two questions—the question by whom and under whose direction the termination of a pregnancy will be performed, and the question of effective control over the place in which an abortion is carried out.
Many eminent specialists have told me that if those conditions had been guaranteed from the outset there would have been no need to spell out in detail the 456 grounds on which a termination could be carried out. It was agreed in Committee that effective control should be exercised over the places where terminations could take place. But the Committee rejected an Amendment which sought to ensure that one of the two registered medical practitioners who must agree on the carrying out of a termination should be a consultant or someone acting under his authority.
One may argue about the precise form of such an Amendment, as we shall do in respect of those now under discussion, but essentially what is at stake is the question whether so grave a matter as many an abortion may be should be left to any two doctors, irrespective of their qualifications and experience.
Let the House consider what the Bill leaves out. It does not require that either of the two registered medical practitioners should have had a minimum period of qualification. It does not require one of them to be a consultant in obstetrics, gynaecology, pediatrics or psychiatry. It would not prevent two newly qualified doctors from rushing in to abort a woman where more experienced men might hesitate—provided that those two doctors did so in good faith and on premises which were properly equipped and approved by the Minister.
Since the Bill does not stop the payment of fees it is, as it stands—and I am weighing my words very carefully—an open invitation to certain practitioners to move into the abortion factory industry which we know exists. This is the fear of many sincere and eminent doctors. Some of them do not mince their words. The Society for the Protection of Unborn Children—which, whether one agrees with its views or not, includes some of the most eminent gynaecologists in the country—recently issued a statement saying:With the Bill in its present form, safeguards against proliferation of the racket in abortions done for large fees but dubious indications are virtually non-existent. The suggestion that the provision that two registered medical practitioners must form the opinion 'in good faith' that abortion is indicated would be in any way an adequate safeguard is manifestly ridiculous. Such an arrangement has led to the present prolific racket whereby unscrupulous practitioners working in collusion find that abortion is indicated provided the fee is large enough.Not everybody in the House will accept that; some may take the view that it is 457 exaggerated. But there is clearly a need for some safeguards, and therefore I want to draw the attention of the House to a letter which appeared in The Times on Monday, signed by Sir John Peel, President of the Royal College of Obstetricians and Gynaecologists, Dr. Ronald Gibson, Chairman of the B.M.A., Dr. E. A. Gerrard, Chairman of the B.M.A. Committee on Therapeutic Abortion and others. Briefly, they said that they wished to make their position absolutely clear and to avoid any possibility of misrepresentation. These men, speaking on behalf of the governing bodies of two of the most representative organisations in the medical profession, said:We would, therefore, be prepared to give support to a Third Reading of the Bill only if further Amendments are made in Clause 1. ….One Amendment that they suggest is that which stands in my name.
My hon. Friend did not touch on the reasons in detail, and it is important to give the House the reasons why these eminent men take this view. First, they say that while in many cases the medical decision whether a termination should take place is relatively easy, in some cases it is not. The decision turns on the weighing of a number of interrelated factors, such as the duration of the pregnancy, the woman's obstetric history, her age, her present physical and mental state of mind, and her family circumstances.
In many cases the family doctor is in the best position to make a balanced judgment on these factors—certainly in respect of the family circumstances, but this does not always apply. The woman concerned may have no family doctor. She may have left home because of her pregnancy, and her state of mind and social circumstances may be such that her family doctor is the last person she wants to consult. But whoever she consults about what must be the most agonising decision in her life, she is entitled to ask—and to do so through the medium of the Bill—for the best possible advice, and, medically speaking, there can be no argument that this is likely to come from someone who has had long practical experience in obstretrics and gynaecology and who is experienced, in a practical sense, through a large number of abortions.
458 Of course, the family doctor is important. Ideally he should be one of the two doctors concerned, and under my Amendment he could be one. Of course, the consultant psychiatrist is essential wherever mental stress is a factor. Under the Amendment, he could be one of the two doctors.
Essentially, however, what we are concerned with here is two crucial decisions—first, whether a pregnancy should be terminated for the sake of the woman herself, with all that that means for her future child-bearing capacity and marital happiness; and, secondly whether a potential life should be ended. In both respects it is essential, in those circumstances, that she should have the best possible advice.
The second reason for the attitude of the leaders of the profession, as revealed in the letter in The Times on Monday, is that while the actual operation may be simple—if taken early in a healthy woman, I understand that it is—this is not always the case and severe complications may ensue, such as shock, haemorrhage, thrombosis and infection which, even if these do not have fatal results, can often lead to lasting ill-health, affecting future child bearing, and sterility.
A number of other related factors are involved. The longer the pregnancy, the more hazardous the operation. I am advised that the people whom we are seeking most to help—the very young woman and the woman who has already had four or five children, the hazards may be considerable. Thus, once a decision to terminate has been taken, a woman is entitled to an assurance that the operation will be carried out in the most skilful fashion.
There are two possible sets of objections, first, that, if this Amendment or any of the others were carried, we should be discriminating against the general medical practitioner and insisting by Statute that one of the two doctors concerned must be a specialist or someone specially appointed by the Minister for his qualifications and experience. Some have argued that this is a new principle and that it is wrong for Parliament to lay down that there shall be two kinds of doctors.
459 But it is not a new principle. It is laid down in law that one of the two doctors who sign a cremation certificate should have a minimum period of registration. We insist on medical officers of health in larger cities having the Diploma of Public Health. We lay down in Section 28 of the Mental Health Act, 1959, that, for compulsory admission to hospital, a recommendation must be made by a doctor with special experience in the diagnosis and treatment of mental disorder. In practice many of these are consultant psychiatrists.
We are told that in other operations which are far more dangerous no discrimination is made—such as heart operations and brain operations—and we do not lay down specifically the presence of consultants with special qualifications. There are two pertinent answers to this. First, this operation differs from all others. It is the only one I know involving two lives, one of which must of necessity, be terminated. For that reason, the woman and the doctor are facing perhaps the hardest decision of all. Even if it goes right, it means the ending of a potential life, and, if it goes wrong, it may adversely affect the woman's future reproductive life and hopes of marital happiness.
Second, it is an operation which offers a lucrative income to any two doctors who choose to practice solely in this field in the private sector. Hitherto, the Government have taken the view that specialist qualifications are necessary. When the noble Lord, Lord Silkin, introduced his Bill in the House of Lords, he took the view at first that any one doctor could be permitted to abort. He changed that view during the Bill's passage. There had to be a concurring second opinion and he finally agreed that the treatment must be carried out by a practitioner with… an appointment as registrar or in a superior capacity under a hospital board, being an appointment involving the practice of gynaecology.When his second Bill emerged from Committee, there was a specific provision that the treatment must be carried out by or under the supervision of… a consultant holding an appointment under a hospital board, being an appointment involving the practice of gynaecology.460 That provision was approved on the Government's behalf by the noble Lord, Lord Stonham.
It is relevant here, in view of what may be said from the Government side later, to quote his words on 23rd May, 1966:The view of the Royal College of Obstetricians, which has the support of the Minister of Health, is that the Bill should provide for placing responsibility for an operation at a higher level than a registrar. We think the answer might be to frame a provision which would require an operation to be performed by a consultant holding a post which involves the practice of gynaecology, or a practitioner authorised by such a consultant to act on his behalf. If that concept meets the view of my noble friend, we shall be pleased to assist him to draft a suitable Amendment."—[OFFICIAL REPORT, House of Lords; 23rd May, 1966, Vol. 274, c. 1224.]I hope that the Minister will accept this or a similar Amendment, and I want to know whether he offered the same advice to this Bill's sponsor. If he has changed his mind, the House is entitled to know why.
One other possible objection is that the Amendment might restrict the number of doctors who could lawfully carry out a termination. There is, after all, only a limited number of gynaecologists and surgeons and other consultants. In some areas, with the best will in the world, it would be difficult to find a consultant gynaecologist. This is why my Amendment and the others would give the Minister power—he would, of course, consult the profession—to appoint doctors where local circumstances suggest that this should be done. I have not suggested the precise machinery which should be used, but I am told by the B.M.A. and the Royal College that they see no practical difficulty if the Minister has the will to take this step.
If we are to reform the law in the true interests of the women whom we seek to help, and their families, and if we are to carry the support of the medical profession, without whom it would be impossible to work the Bill, we have a duty to ensure that the changes which we make are both reasonable and practicable. The Amendment injects a sense of responsibility into the Bill. It has the support of the governing bodies of the B.M.A. and the Royal College, and I trust that, for the reasons which I have given, the House will accept it or something on similar lines.
§ Mr. James Tinn (Cleveland)
Before the hon. Gentleman sits down, would he clear up a difficulty of mine? It would appear that one word in his Amendment on page 8410, the word "or", is superfluous and would make nonsense of the Clause. Perhaps it is a typographical error.
§ Mr. Braine
I should not have thought so, but I am not sticking on this Amendment. It would be presumptuous of a back bencher to suggest how the Bill should be amended precisely. I have been arguing the principle, which would ensure that, in circumstances where a consultant gynaecologist, surgeon or any other consultant was not available, the Minister should satisfy himself, after consultation with the profession, that persons of adequate experience would be available. The formula here is design to meet that.
§ Mr. Tinn rose—
§ Mr. Speaker
The hon. Member for Cleveland (Mr. Tinn) must be careful not to exhaust his right to speak. His intervention was suspiciously like a speech. He cannot carry on a dialogue.
§ Mr. Speaker
I understood the purpose of the first intervention by the hon. Member for Cleveland. I think that the hon. Member for Essex, South-East (Mr. Braine) understood the question put to him and answered it.
§ Mr. Steel
It would, perhaps, be helpful if I indicated the views of the sponsors of the Bill on this series of Amendments and new Clauses. I welcome the constructive manner in which the hon. Member for the Isle of Thanet (Mr. Rees-Davies) moved his new Clause. I understand what he is seeking to do. But, in the course of pointing out all the difficulties about this matter, he advanced the case against his own new Clause better than I could have done.
In this matter we have a great deal of information from other countries. It has been one of the arguments of the 462 opponents of the Bill—and the hon. and learned Member for Surrey, East (Mr. Doughty) declared himself to be one—that we do not have enough information to proceed with legislation. It seems odd that when we do have information, as we have in this case, from the legislation of other countries, that information should be ignored by the opponents of the Bill.
One of the pieces of information that we have is that in both Sweden, which the hon. Member mentioned, and also in Denmark, where they legislated a Bill similar to this and inserted a provision similar to that which the hon. Member moved in his new Clause, the result has been that, while the legislation has operated smoothly and correctly, there have been two undesirable side effects.
One is that there is delay in carrying out the operations. Indeed, the hon. Member mentioned this. In both Denmark and Sweden legal abortions are rarely carried out at under 12 weeks. This is most undesirable from the medical point of view. If a termination has to be carried out, then, medically, it is better that it should be carried out at the earliest possible opportunity. I submit—and I give this as a personal opinion—that it is also preferable ethically that if it has to be carried out it should be at the earliest possible opportunity after conception. Therefore, if in the experience of these countries provisions involving an excessive amount of red tape result in delay, then, medically and ethically, we should be wise to take note of that and we should decide to reject the suggestion.
Research has also shown that in Sweden the existence of such a cumbersome procedure has meant that the success of the legislation in reducing the number of illegal abortions has not been as great as those who promoted the legislation would wish, because the procedure is so complicated that the back-street abortionist can still flourish with relative ease.
That is the first observation that I would make with particular reference to the new Clause, although my general comments about the excess of red tape apply to most of these Amendments.
The second argument which was clearly made by the hon. Member for Essex, South-East was that the leaders of the Royal College of Obstetricians and the British Medical Association have 463 indicated support for his Amendment. That is true. It is equally true that other bodies have expressed opposition. The Royal Medico-Psychological Association, in a letter to The Times and in a meeting which they had with some of the sponsors of the Bill, stated that it was strongly opposed to bringing in legislation of this kind. I have had over 200 letters from individual general practitioners throughout the country with specific reference to any suggestion of legislating as to who may or may not perform such an operation, protesting about any suggestion that I might accept such a provision.
It was the unanimous view of the doctors who served on the Committee charged with reviewing the Bill that they would be opposed to any such provision, because it would be a new principle in our law for Parliament to dictate to the medical profession who may or may not carry out a certain operation.
The hon. Member for Essex, South-East tried to answer that objection. He said that the reason for making an exception in this case was that we were dealing with an operation which would extinguish potential life and which carried possible risks to the life of the mother. He said that it was an exceptional case. I cannot accept that argument. We have heard from doctors that the operation involving the application of forceps at the delivery of a child is a dangerous operation. A caesarean operation involves the life of both the child and the mother and is highly dangerous, but there is no Act of Parliament which states that only certain doctors may perform such an operation. The medical profession use their common sense in these matters, and any practitioner who undertook an operation for which he was not qualified and experienced would be guilty of negligence.
I do not think that we should bring the law into this subject at all. There is no dispute that this is a serious operation and there is no dispute that in some instances, such as those given by the hon. Member, it may be more serious than in others. However, I think that we can leave it to medical practitioners to decide when they are or are not qualified to carry out this operation and to advise whether the operation should be carried out.
464 The hon. Member tried to meet the objection raised in the Committee to his original Amendments, which limited those who could carry out the operation to consultant gynaecologists. He has extended it in that the Amendment in his name today refers simply to "a consultant". He therefore admits that the operation could be carried out by people other than consultant gynaecologists. He has in mind consultant surgeons. In trying to meet this objection which was raised in Committee—I recognise that he has done this very fairly—he has opened up what seems to be a complete nonsene.
If we were to accept his Amendment, it would be possible for an eye consultant or an ear, nose and throat consultant to perform this operation. He would answer that that is ridiculous and that it would not happen in common sense, but that is precisely my argument against accepting any of these Amendments. The medical profession has its own ethical and medical standards and there is no need for us to intervene with legislation of this kind.
The hon. Member referred to the "abortion factory racket". The evidence that we have suggests that this racket is carried out by people with the highest qualifications.
Finally, I submit that it is necessary, in a Bill of this kind, to introduce certain safeguards, and that we have done. For the first time there is a legal requirement of a second opinion; no one doctor can act on his own. Secondly, there is the requirement for notification of the operation to the chief medical officer of health. Thirdly, and importantly, the Committee inserted a further safeguard which was not present when the House gave its approval to the Bill on Second Reading in that there is now in the Bill—it was not there when the House last discussed it—a provision for control over the place where the operation may be carried out. These are three essential and new safeguards which do not exist in the present law.
I submit in all sincerity that to tie up the Bill with any more red tape will seriously undermine the effect of the reform that we are seeking. On behalf of the sponsors of the Bill, I advise the House not to accept any of the Amendments.
§ The Minister of Health (Mr. Kenneth Robinson)
The new Clause and the Amendments under discussion have two factors in common. They require, first, some limitation on the class or category of doctors who shall be legally authorised under the Bill to terminate a pregnancy, and in all cases Health Ministers are required to assume responsibility for that selection by one means or another. It might, therefore, be helpful if I were to intervene at this point. I should like to deal mainly with these two broad issues which, as I say, are common to all the Amendments.
The hon. Member for Essex, South-East (Mr. Braine) and other hon. Members said that it is desirable that the Bill should broadly have the support of the medical profession. We all accept that. The medical profession will have to work within the framework of the Bill as it emerges from Parliament. It is a fact that the profession, or the leading elements of it, have expressed the wish to have some restriction of the category of practitioner who is to be empowered to perform this operation. It was largely in deference to the views expressed by the leaders of the profession that my hon. Friend the Parliamentary Secretary commended to the Standing Committee an Amendment which was designed to secure such a restriction.
I emphasise at this point that what we are really talking about is that limited category of terminations which will take place outside Health Service hospitals. I think that all the supporters of the Bill hope that, as a result of this Measure, if it is passed, the majority will take place in Health Service hospitals and that, therefore, automatically women who go into Health Service hospitals will be under the care of consultant gynaecologists for this operation. We are, therefore, concerned only with those places which are to be approved by the Minister which are not Health Service Hospitals.
§ Mr. Doughty
Further to the right hon. Gentleman's remarks about these operations taking place in National Health Service hospitals, can he say whether those hospitals have the beds and facilities available to do these operations? Is he aware that for a considerable time I and many hon. Members have been writing to him about trifling operations such as tonsilitis not being able to be carried 466 out because of the lack of beds and facilities?
§ Mr. Robinson
A very large number of gynaecological beds are at present occupied by patients who have had illegal and unskilled abortions which have gone wrong. At least, we would hope that that pressure on gynaecological departments would be reduced as a result of this Measure. The issue was thoroughly debated in Committee.
§ Mr. James Dempsey (Coatbridge and Airdrie) rose—
§ Mr. Robinson
I hope that my hon. Friend will forgive me if I do not give way. I do not want to take too long in giving this explanation.
Despite the support of my hon. Friend the Parliamentary Secretary in Committee, the Amendment was defeated. There were probably several strains of opposition to the Amendment which coalesced into that vote. There were, for example, those who thought that it would be too restrictive, those who feared that, in some parts of the country, there were consultant gynaecologists who disapproved of the whole practice and that, therefore, women would be deprived of the opportunity of having perfectly legal abortions under the Measure, and those who erroneously saw the Amendment as no more than an example of a professional restrictive practice. However, the Amendment was defeated.
This Amendment and the new Clause seek, as I see it, the same end product, but by a different means. The methods proposed to reach this objective are such that I very much hope that the House will not support them because these proposals would place a new responsibility on the Health Ministers—certainly, a responsibility which I would not wish to assume. That is the difference between this Amendment and the one which was discussed in Standing Committee.
§ Mr. Braine rose—
§ Mr. Robinson
I do not want to delay the House. I trust that the hon. Gentleman will allow me to proceed.
This would be the responsibility of making invidious comparisons between doctors and of approving, in my capacity of Minister of Health, or the Secretary 467 of State's capacity as Secretary of State for Scotland, those who, in our view, were competent to perform a termination of pregnancy. This is something which no Minister has to do for any medical procedure at present. It is no analogy for the hon. Member for Essex, South-East (Mr. Braine) to talk about what happens to medical officers of health or to refer to the Medical Health Act in respect of cases involving psychiatrists.
These are objective criteria. If this Amendment, or one of this series of proposals, was accepted it would be impossible to exclude subjective criteria and it is clear, from the speeches that have been made, that the intention would be that subjective criteria would be imported into this distinction.
§ Mr. Braine
The right hon Gentleman now rejects the principle enshrined in these Amendments. Will he explain why the principle of placing responsibility on gynaecologists was accepted by Lord Stonham during the debates on Lord Silkin's Bill last year and why the principle was accepted by the Parliamentary Secretary in Committee on this Measure?
§ Mr. Robinson
If the hon. Gentleman were listening to what I am saying he would not need to intervene so much. I have said that that is not before us now. What is before us is a series of Amendments, all of which would require the Minister to approve practitioners for certain procedures.
§ Sir John Hobson (Warwick and Leamington)
The right hon. Gentleman has said several times that that would be the effect of each of these Amendments. Is he aware that my Amendment, No. 28, does not place any responsibility on the Minister, but places it in the same place as the Mental Health Act places it, namely, on local health authorities?
§ Mr. Robinson
The right hon. and learned Gentleman's Amendment refers to… a registered medical practitioner who is currently approved for the purposes of this section … by a local health authority which is satisfied."….The same principle is, therefore, imported into his Amendment and—
§ Mr. St. John-Stevas rose—468
§ Mr. St. John-Stevas rose—
§ Mr. Robinson
I want to be as brief as I can and explain, as I have been trying to do, why I find this series of Amendments unacceptable. There are, I am advised, defects of drafting in them and particular difficulties in all of them; but I do not think that the House will want me to go into those matters now. I would rather deal with the main objections from my point of view.
Before resuming my seat, I wish to comment on the attitude of the profession. The Amendment standing in the name of the hon. Member for Essex, South-East was mentioned in a letter to The Times, which was signed by a number of leaders of the medical profession. It was, I believe, one of four changes which the signatories to the letter said they would like to see made in the Bill on Report. Since the letter was written, my right hon. Friend the Home Secretary and I have seen most of those who signed the letter. We have seen the President of the Royal College of Obstetricians and Gynaecologists and other signatories and we have discussed the position with them in the light of Amendments tabled by the sponsors of the Bill.
I do not want to anticipate the discussion of subsequent Amendments, but it was perfectly clear that the main objection which the leaders of the medical profession had to the Bill as it emerged from Committee was the concept of well-being in the Clause defining the grounds for termination of pregnancy. While I do not for a moment suggest that those who signed the letter to The Times would not still prefer some limitation on the category of practitioner, in the context of a Bill which does not include well-being, I believe, and I have reason to hold this view, that their desire for this limitation would be substantially less strong.
§ Mr. Braine rose—
§ Mr. Robinson
No. I will not give way.
I am making it perfectly clear that I accept that at any rate the Royal College of Obstetricians and Gynaecologists 469 would like a limitation of this kind. The British Medical Association, however, is not quite so unanimous on the subject. Indeed, it would be most unusual if the medical profession, on a matter of this kind, was able to speak with one voice. I am sure that the hon. Member for Essex, South-East has seen a Gallup Poll which gives the views of a scientific sample of general practitioners on the Bill as it emerged from Committee, which takes a somewhat different view.
§ Mr. Braine rose—
§ Mr. Robinson
I have told the hon. Gentleman that I wish to be brief. I have given way to him.
In all these circumstances, I hope that the House will not seek to place a duty on Health Ministers which no Minister has been asked to shoulder before—the responsibility of making invidious distinctions between doctors; a responsibility which I would find quite unacceptable.
§ 12.30 p.m.
§ Mr. Quintin Hogg (St. Marylebone)
I am a little troubled by what the Minister has just said. I do not want to say more than a few sentences, but I must tell the House that what has principally troubled me about the Bill from the start has been the danger of a racket developing. That is something which I am perfectly certain both the sponsors and the opponents of the Bill wish to avoid if they can.
This is not a purely imaginary danger, because all of us who have taken an interest in social affairs over the years know that such a racket exists now. There is no question about it. I mean, by a racket, not the back street abortionist, but the professionally qualified abortionist who evades the law. This is a reality and a real danger, and if the Bill is to have a respectable future and not do a great deal of damage, the racket must be prevented if it is possible to do so.
To my mind, the principal effect of the Bill without the Amendment—and it will, indeed, be an effect of the Bill with the Amendment—will be to take out of the jurisdiction of the courts and put on the conscience of any two medical practitioners conscientiously applying the criteria prescribed by the Bill—whatever emerges from this Report stage—the question whether an act of termination 470 is or is not a criminal offence. Whatever else may be said about the Bill, if we can prevent a racket this is probably an advance, because leaving to the ultimate decision of a jury what is or is not legal is not one that I personally accept with any degree of comfort.
Therefore, in any view of the Bill, that provision certainly demands serious consideration, and very well may command a good deal of acceptance if the criteria are right criteria. But in so far as it takes away from the courts—a jury and a judge—the right to determine legality or illegality, and puts it only on the conscientious view held in good faith by any two medical practitioners, this is in itself a departure from procedure which is unprecedented, I think, in the law in this or any other country.
Whether a man doing an act of termination will or will not be committing a criminal offence will in future depend on the honesty with which he approaches his problem. From the juristic point of view—and we are, after all, professional legislators—this is something that has not been attempted before.
The Minister has said, and I quite see that what he said has considerable force, that he does not wish his conscience to be saddled with subjective criteria in deciding between doctor A and doctor B. There was force, also, in what my right hon. and learned Friend the Member for Warwick and Leamington (Sir J. Hobson) pointed out—that his Amendment No. 28, at any rate, leaves that matter to the local authority, which is a collective body, and does not saddle the unfortunate conscience of the Minister with it. I can see objections to both attitudes, but my whole attitude to the Bill will very largely be coloured by whether it contains adequate safeguards against a racket. I do not believe that at the moment it does.
Although I see great force in the argument that no one wants to put in the Bill any administrative machinery that would cause terminations to take place at a later period of pregnancy—because that is medically most undesirable—as a Member of Parliament I want to see something workmanlike come out of our discussions. At the moment, I think that the Bill is defective, and will create an organised qualified racket precisely of the kind that I am sure that the House as a whole would wish to avoid.
§ Mr. Rees-Davies
Before my right hon. and learned Friend sits down, would he not agree, from his long experience in office, that there are other cases in which a Minister is required to draw up a panel of practitioners of a particular kind—
§ Mr. Rees-Davies
I say "Minister". Not necessarily in medicine but in other professions a Minister is required to draw up a panel of practitioners from whom the various committees will be formed, but although this may to some degree involve a question of conscience—
§ Mr. Speaker
Order. We are now on the Report stage, and the hon. Member has spoken. Interventions must be brief.
§ Mr. Hogg
I certainly do not want to review the whole spectrum of legislation. It is probably true that there is no exact analogy with the medical side, and for the reason I give—that we are breaking ground legislatively—I do not think that it is a conclusive objection. But there are numerous cases of all types of appointments for one purpose or another outside this sphere where panels are chosen by Ministers who, I am quite sure, are affected in their choice by both objective and subjective criteria.
§ Sir J. Hobson
We have now reached a very narrow point. As I understood him, the Minister did not depart from the view expressed by the Parliamentary Secretary in this House, and expressed on a previous Bill in another place, that it is desirable that there should be some limitation on those who either advise on or perform an operation which, while on occasion it may be simple, still involves very great issues and very considerable risks.
The right hon. Gentleman has told us that it would be very invidious for him to make that selection, but if it is right that there should be a limitation on the doctors who are to advise on or perform this operation, it should not be beyond the wit of the Ministry and of the House to find a sufficiently wide scope of 472 doctors who will have the knowledge, experience and skill to see that the women involved get the best possible service. To this extent, those who take the view that there should be some such restriction should vote for new Clause I, always bearing in mind that it will have to be materially improved in another place.
If the Minister considers that it is invidious for him to make a selection, there are many other ways in which the selection can be made. My proposal is that the local health authority should do it. The Minister shakes his head, and I appreciate that there may be disadvantages, but local health authorities already undertake the duty in relation to mental health under the Mental Health Act, which provides that no person can be compulsorily admitted into a mental hospital except on the advice of one of the concurring doctors, being a doctor approved by the local health authority. That is a very good example of the way in which serious decisions can be limited to a group of the medical profession.
I do not suggest that it should be very narrowly limited. The matter is eased when one realises that my proposal is that one should have a fairly wide selection, that it should not be too narrowly confined, and certainly not be so narrowly confined as to create—as would have been the result of what was drafted by the Ministry and proposed by the hon. Member for Pontypool (Mr. Abse) in Committee—very great difficulty of shortage of supply.
The Minister is right in saying that we are concerned here with the private sector. The National Health Service will obviously see to it that this operation is done in a manner that is satisfactory, so we need not trouble about that. We are therefore concerned with the private sector, and, above all, with the danger of rackets mentioned by my right hon. and learned Friend the Member for Marylebone (Mr. Hogg).
I personally think that this question has two aspects. One is the main principle—should there be a limitation? The second, which is detail only, is: if so, how can it be brought about? I believe that the decision to terminate involves a very difficult balance of judgments.
One of the real divisions over the Bill is between those of the supporters of the 473 Bill who believe that, on the whole, abortion in general is quite good and should be available as frequently as possible—and, indeed, often when the woman concerned alone thinks that she needs it—and those who, like myself, support the Bill and are anxious to see an improvement in the law but who think that every abortion is, in a sense, a defeat for the human race, acceptable only because it avoids a worse defeat.
§ Mr. Eric Lubbock (Orpington)
Does the right hon. and learned Gentleman think, then, that local health authorities should also be able to decide who should perform a hysterectomy?
§ Sir J. Hobson
No. This confusion has already arisen—that, because there are other difficult operations where there is no distinction, it does not matter and it can be left in the air, so to speak. However, this wholly ignores the risk mentioned by my right hon. and learned Member for St. Marylebone of the racket. This is the difference. There are very large sums of money indeed to be made from women who urgently need an operation, which will be lawful if a doctor can persuade a jury that he did it in good faith, however wrong-headed he may have been. This distinguishes serious operations to heart or to mind, or hysterectomies, because they are not the sorts of operation that people want to pay large sums of money for. They do not want to have such operations unless they have to. To this extent, there is a very great distinction between the type of operation with which we are here concerned and the ordinary type of operation.
I do not necessarily say that local health authorities are the right ones. I put them in because I realise the difficulties of the Minister. It may be that it ought to be a combination of local health authorities, the medical profession, and the Minister himself, on a joint panel. I should be perfectly content to see some such organisation, which could very easily make a selection of those who shall and those who shall not perform this operation.
Further, most professional people know very well that in their professional lives there are certain activities which seem very easy to the beginner and which may often be easy but in which there are very substantial risks that the inexperienced do not know of, do not recognise, and do 474 not understand. This is an aspect which troubles me greatly about this particular form of operation, because I think that it was conceded in Committee that it is an operation which has a high risk, both of mortality and of morbidity.
I recognise that there are many occasions when it is perfectly simple, but even an operation which appears to be very simple and quite straightforward may go wrong. This was one of the reasons why in Committee the Parliamentary Secretary recommended an Amendment which would have placed a limitation upon the doctors who should perform such operations.
I know not if the figures be accurate, but Dr. Donald Robertson, Lecturer in Anatomy at Edinburgh University, has stated that the death rate for mothers is at least 1 in 2,000 and that the complication rate is 30 in 1,000, some of the complications being very serious, involving not only the physical condition of the mother, her sexual future and her reproductive capacity, but also on many occasions her morbidity and mental and nervous reactions.
Although I concede that there are many doctors who state that this is a simple operation on a great number of occasions, with very little risk attached to it, I nevertheless believe that, because there is a high risk of mortality and morbidity, it would be much better to place this operation in the hands of those who are skilled, experienced and knowledgeable—not necessarily gynaecologists. I am quite willing to see a psychiatrist introduced for the mental disorder cases.
§ 12.45 p.m.
§ Dr. John Dunwoody (Falmouth and Camborne)
Would the right hon. and learned Gentleman accept that very similar difficulties could be quoted as being the risks in the confinements which would have resulted if those terminations of pregnancy had not taken place in these women? In other words, the risk in this operation is probably of the same magnitude as that which always arises when a confinement takes place.
§ Sir J. Hobson
I certainly do not accept that this operation is the equivalent to the ordinary confinement risk, in either mortality or morbidity. If it is limited only to the women who raise these problems, that may well be so. 475 However, that does not relieve us of the necessity, both in cases of confinement and in cases of legal abortion, of providing the very best possible treatment.
The best way to do this is by limiting those members of the profession who shall undertake this operation, though the limitation I would put on would be very broad and certainly would be sufficiently wide to ensure that in every area, including remote country districts, facilities would be easily available. I cannot believe that, if the principle is accepted, there will be any difficulty in arriving at a result which will allow selection between members of the profession to be made.
I should have much preferred to see those who take the view on the main principle vote in favour of the Clause, in the realisation that it may well be that improvements can be made in the House of Lords as to the manner in which selection is to be made.
The Minister seemed to indicate that the medical profession as a whole was not wholly in support of this idea of distinction. I remind him that at any rate the official Councils of the two main bodies—the British Medical Association and the Royal College of Obstetricians and Gynaecologists—in their letter of 1st June—yesterday—say this on this issue:The changes which the two Councils wish to see in the Bill are in their view essential if its operation as an Act is to have the support of the large majority of the medical profession.We shall ignore that majority and official view at our risk and peril.
§ Mrs. Renée Short (Wolverhampton, North-East)
Is the right hon. and learned Gentleman aware that those who purport to speak for the gynaecologists represent only a small minority of the 500 gynaecologists in this country, and that on no occasion has there been a poll of the gynaecologists to discover precisely what they think about the Bill? Therefore, those who purport to speak for the gynaecologists do not represent the whole profession.
§ 12.45 p.m.
§ Mr. Speaker
Order. The hon. Gentleman's Amendment has been selected for 476 discussion with the new Clause now under discussion. The hon. Gentleman can talk about his Amendment. He cannot move it.
§ Mr. St. John-Stevas
I rise to discuss my Amendment.
I must, first, comment upon the remarks made by the Minister of Health. I found his speech one of the most unsatisfactory and evasive, not to say dishonest, that I have ever heard in the House. The point was made by my hon. and learned Friend the Member for Surrey, East (Mr. Doughty) that, if the Bill were passed, it would put the National Health Service under intolerable pressures. This very serious point was met by the Minister with the debating point that the hospitals in the Health Service were full of people suffering from the effects of illegal abortions.
That is the sort of reply that one might expect from a partisan of the Bill like the hon. Lady the Member for Wolverhampton, North-East (Mrs. Renée Short), but not from the Minister, who is responsible for the health of the country and for the medical profession.
The objections which the Minister raised to the Clause were most unconvincing. He was faced with a task; he had to explain this extraordinary change of front which has come about since the Committee stage, because in Committee the Parliamentary Secretary to the Ministry of Health spoke and voted in favour of an Amendment in very similar terms to the Clause and to other Amendments on the Notice Paper. Why has there been this change of front?
§ Mr. Robinson
Since the hon. Member sets such store by honesty, perhaps he will modify his statement that the Amendments considered in Committee were very similar to those on the Notice Paper today. I have pointed out the complete difference between the two sets.
§ Mr. St. John-Stevas
That is the Minister's view, but I think the principles of the Amendments in Committee and those on the Notice Paper today are the same. 477 As my right hon. and learned Friend the Member for Warwick and Leamington (Sir J. Hobson) said, there is a difference in achieving the principle but the principle is the same. If the principle was approved upstairs in Committee, it is the duty of the Minister to find means by which that principle can be translated into language which is acceptable to him.
In his speech, the Minister used as an explanation of his change of front an unwillingness on his part to accept responsibility for appointments he would have to make under these Amendments, but surely the Minister must accept responsibility. If he accepts responsibility for the Bill—and although, in theory, he is neutral we know that, in practice, he is not—he should be prepared to accept responsibility for a necessary safeguard. He cannot behave like Pilate and just wash his hands of the whole thing when it comes to practical considerations. I am sorry to have had to speak so strongly to the Minister, who is a very mild man—like myself—but I felt it necessary to put that point as strongly as I could.
I consider the Amendment I have tabled, all the Amendments for that matter, most vital improvements to this badly drafted Bill. If one of these Amendments could be accepted by the sponsor it would go a very considerable way to meeting objections which I have against the Bill. I hope that he will reconsider the matter. He has reconsidered other matters in the course of the passage of the Bill. Perhaps he will reconsider this in the course of the debate after the arguments have been deployed.
The importance of this particular medical Amendment arises from the fact that there are so few limitations and safeguards in the Bill as it now stands. I know that it is proposed to limit the Bill still further at a later stage in the debate, but we cannot know now whether those Amendments will be carried or defeated. We have to consider the Bill as it now stands when we are considering the Amendment before us at the moment. It is the only major safeguard which has been proposed and which is being discussed.
While it is true that under the Bill the Minister must designate places other than National Health Service hospitals where abortions can be carried out, once that 478 designation has been made there is no control in the Ministry over who uses those places which are designated. That is a very important gap which these Amendments are intended to fill.
I agree that as regards National Health Service hospitals there is one problem, but as regards the places designated by the Minister there is a completely different problem. In those cases the position is that any doctor, however inexperienced, can carry out an abortion provided he can secure the agreement of one other doctor. This is a very grave situation indeed, because an abortion operation is not a simple, easy operation. It can in many cases be a very difficult and dangerous operation.
I am not a doctor and, therefore, I speak with a certain reserve on this subject, but there is a very strong body of medical opinion which I have studied which indicates that an abortion is not the simple operation which the hon. Member for Wolverhampton, North-East (Mrs. Renée Short) would have us believe.
I quote from the report by the Council of the Royal College of Obstetricians and Gynaecologists, published in the British Medical Journal on 2nd April:Those without specialist knowledge, and these include members of the medical profession, are influenced in adopting what they regard as a humanitarian attitude to the induction of abortion by a failure to appreciate what is involved. They tend to regard induction of abortion as a trivial operation free from risk. In fact, even to the expert working in the best conditions, the removal of an early pregnancy after dilating the cervix can be difficult, and is not infrequently accompanied by serious complications. This is particularly true in the case of the woman pregnant for the first time. Because of this, many gynaecologists consider that a safer approach is often by way of an abdominal operation. For women who have a serious medical indication for termination of pregnancy, induction of abortion is extremely hazardous and its risks need to be weighed carefully against those involved in leaving the pregnancy undisturbed. Even for the relatively healthy woman, however, the dangers are considerable.
§ Dr. M. S. Miller (Glasgow, Kelvingrove)
Would the hon. Member accept from me that, while I accept that there are occasions when this operation could be dangerous, exactly the same circumstances could apply to any operation carried out by any doctor? Any operation could be met with the conditions the hon. Member has described in this case.
§ Mr. St. John-Stevas
I would accept that, coming with the authority with which it is given, but I do not see how it affects this particular argument because this is a very special kind of operation. It is not an operation in the ordinary run of events. It is an operation which involves the lives of two people.
§ Dr. Miller
What we are discussing here is surely the medical implication of the operation. That is the only argument to which I am applying myself at the moment. The hon. Member maintains that on occasions this can be a serious operation. I am not contesting that. I am saying, however, that on occasion any operation can be a serious matter.
§ Mr. St. John-Stevas
I fully accept that and I would not dream of trying to pit my minimal medical knowledge against that of the hon. Member. What I am pitting against him is the considered view of the Royal College of Obstetricians and Gynaecologists. It is a statement which any serious responsible person must regard as a matter of the gravest importance.
There is this further consideration on this most vital Clause: unless we have a safeguard of this kind the way will be open for unscrupulous doctors to run the sort of racket which has been referred to by my right hon. and learned Friend the Member for St. Marylebone (Mr. Hogg). I am not saying that the majority of doctors will have any truck with any such thing—of course they would not. The majority of doctors, like the majority of lawyers, are honourable men, but there are individuals in both professions who are dishonest and it is extremely important that they should not be given scope for the practice of their dishonesty and the undermining of the social welfare and health of the nation.
I conclude by referring, once again, to the vital position of the Minister of Health in this matter. He referred to a poll which had taken place. He said that there had been a Gallup Poll and that in that poll the majority—I think that it was 69 per cent.—of general practitioners favoured the Bill as it is now drafted and, therefore, favoured the exclusion of the Amendments concerned. But it is very important to add to that one fact that of the 1,800 practitioners who were polled only 1,100 replied.
480 Therefore it is not a representative sample, and little reliance can be placed upon it. What we can place reliance on are the express views of the medical profession speaking through its official bodies, through the Royal College of Obstetricians and Gynaecologists and the B.M.A, and reaffirmed in The Times last week. If the Minister of Health is to be worthy of his position those are views of which he must take account.
§ 1.0 p.m.
§ Mrs. Jill Knight (Birmingham, Edgbaston)
Watching this debate are various learned doctors who will have been deeply disappointed with the speech of the Minister of Health this morning. There is a much larger number of members of the medical profession outside the House who will also be grievously worried over what he said. They may look upon it as a politician's speech, and, without wishing to denigrate any hon. Members and the calling we follow, I suggest that although the right hon. Gentleman is a politician he is at the moment primarily the Minister of Health and not a politician. Therefore, it was most disappointing that in his speech this morning he gave no indication of the responsibility he bears, or that he was ready to take on such responsibility.
I cannot understand his soothing point that because termination will take place in a hospital, and in a hospital there are consultants, women will have a consultant's help. If that point is valid, why does he oppose the Amendments? The whole aim behind them all is to give the women the best possible care that the Health Service can afford her. If that is to happen anyway, why does he so strongly object to accepting the Amendments?
It must be made absolutely clear that there is still very great opposition from the medical profession, members of which have contacted hon. Members because that particular point is not enshrined in the Bill. The Minister was less than honest when he suggested that because possibly—who knows?—"well-being" may come out at a later stage in the debate the medical profession was perfectly happy about this, or was at least more ready to receive it. But it is not happy about this point. Let no hon. Member be in any doubt about the way in which the medical profession views the importance of having people who are qualified—by 481 which I mean also qualified by experience—to suggest when terminations are necessary and to carry them out.
It has been suggested that the Royal College of Obstetricians and Gynaecologists has not spoken with any voice on this. In fact, it recently took a poll, in which 192 against 5 stated clearly that they had the gravest possible reservations about the Bill. It is utterly untrue to suggest that the obstetricians and gynaecologists have not spoken clearly and very authoritatively on this point.
I want to spend a few minutes dealing with some of the points made by the Bill's sponsor, the hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel). He suggested that he will not accept this series of Amendments because they would lead to a delay. Obviously, nobody could quarrel with the suggestion that delay is medically unsupportable in many cases. He said—
§ Mr. Speaker
Order. There are too many private conversations going on in the House and below the Gangway.
§ Mrs. Knight
The hon. Gentleman suggested that such Amendments as we are now discussing would draw out the period in which a woman could get an abortion and that we should therefore not accept them. He spoke of experience in other countries such as Sweden, and the panel system which is used there and which has been advocated here this morning. But surely if what he says were so the B.M.A. and the members of the medical profession would not have continued to urge so strongly that the safeguard we seek should be written into the Bill? The doctors are well aware—nobody better—of the danger of delaying the operation, and if this were a valid point I cannot believe that they would have gone ahead with their requests and pleas that their point of view should be taken note of and that some sort of safeguard should be built into the Bill.
The hon. Member says that we have stringent precautions here which have never been known before. For the first time ever two doctors will have to pronounce. But the validity of that point falls to the ground when one realises that we have not had any legislation before anyway. Therefore, how could there have been any other regulations beforehand? All that we have had in this 482 country is case law and not legislation. It is entirely misleading to suggest that the Bill somehow magically tightens up the situation. It does not; it opens it out. The three safeguards on which the hon. Gentleman laid so much stress and which he said do not now exist could not now exist, of course.
Many reasons have been advanced as to why the Amendments are necessary and good. Some people have said that they will help to make sure that the illegal abortionist does not flourish, and we all support that I have spoken of the wish in the medical profession for these things. But let us not delude ourselves. The overriding important reason for moving the Amendments and hoping that they will be incorporated in the Bill is to protect the health of the pregnant woman. Above all, that is the most important thing.
Not enough has been said about the importance of protection in health of the woman who seeks an abortion. The operation has been presented in some quarters as a simple little affair, no more dangerous or troublesome than at the least the removal of a splinter and at the most the evacuation of an appendix. There has been quite a lot of talk about that important point this morning. Is it a dangerous or a simple operation? Sometimes it is dangerous and sometimes it is simple. But to suggest that it is always simple and that we can therefore legislate on that assumption is very dangerous, because an abortion is always a delicate matter and quite frequently is dangerous.
The G.P. is a skilled man. Nobody would deny that. But, his skill ranging as it does of necessity over all the ailments to which the human body is subject, he would be the first to say that he does not have knowledge in depth of all the immensely complicated sphere of medicine. That is why he is called a general practitioner. He knows sufficient to recognise when a condition is arising which it would be better to refer to a consultant. If I had to have a skin-grafting operation, a sinus operation, or a piece of bone treated, I should not be altogether happy for a G.P. to do it. He might well do it in an emergency, and it has been asked why doctors, because they do abortions in an emergency, should not do them all the time.
483 I cannot accept that point of view. The G.P. is not an expert in gynaecology, and it is not a bit of use pretending that he is. If I wanted one of the operations to which I have referred, I should go to a plastic surgeon, an E.N.T. specialist or an orthopaedic surgeon. It does not make sense to say that because any of those operations might have to be carried out by a G.P. in an emergency one should therefore legislate that on any occasion they could be carried out by a G.P. What is more, I would go to those specialists almost invariably because a G.P. had sent me. The G.P.s themselves will say "Yes, you need to see a consultant".
This is an important point, because G.P.s are trained to recognise a condition which lies outside their scope and are the first people to refer their patients to specialists. Make no mistake about it: the G.P.s will not want to carry out abortions themselves. I am sure of that. The medical profession has made it crystal clear. The decision and the operation should involve a consultant. The medical profession has said this over and over again.
In Committee upstairs the Parliamentary Secretary, speaking for the Ministry of Health, urged the Committee to accept an Amendment which sought, as does the present series of Amendments, to ensure that there would be a limitation on the class of doctor performing the operation. When this point was mentioned earlier this morning, the Minister of Health violently shook his head. I have with me the OFFICIAL REPORT of the Committee proceedings. The Parliamentary Secretary made an extremely well reasoned and able speech in which he urged that a consultant should participate in the decision. The hon. Gentleman said:Sometimes I think we get a little preoccupied with the interests of the profession and tend to forget that a large part of outside opinion appears to be that women would want to go to doctors who have some gynaecological experience and practice."—[OFFICIAL REPORT, Standing Committee F, 8th March, 1967; c. 394.]I am sorry if the Minister of Health has not read what happened in Committee. I assure him that the representive of his Ministry was quite clear in his support of the principles behind these Amendments.
§ Mr. Angus Maude (Stratford-on-Avon)
My hon. Friend may have forgotten that the Parliamentary Secretary to the Ministry of Health further said that he was making those observations at the express request of the Minister.
§ Mrs. Knight
I am grateful for my hon. Friend's reminder. He is quite correct. There was no doubt about the clarity with which the Parliamentary Secretary made the point.
We thereupon had an interesting discussion, because the right hon. Lady the Member for Leeds, South-East (Miss Bacon), who is Minister of State, Home Office, would have none of it. The Committee gazed fascinated as the Ministry of Health and the Home Office were, figuratively speaking, locked in combat. The right hon. Lady won. Unfortunately, the right hon. Gentleman was defeated. The consultant was not brought in. He is not included now. I hope very much that he will be.
Whatever may be desired by the Ministries, whatever may be thought best by consultants and whatever may be the express wish of the G.P., I am concerned above all with the health of the pregnant woman. There is no doubt that she would be best served by having the benefit of specialist advice.
Occasionally, an abortion is a simple matter. I do not deny that there might well be occasions when G.P.s could carry it out with success. The Bill, however, makes the mistake of legislating with rose-coloured spectacles. Because some cases would be simply enough for a G.P. to treat, it pretends that all cases are as simple as that, that we will legislate on that basis that all abortions are simple and do not need a specialist.
Imagining that they know better than the medical men who have advised them and who have begged and pleaded that a consultant should be one of the tiny team deciding the issue, the sponsors of the Bill have gone blindly on, and are, apparently, continuing to go blindly on and are refusing to see or to listen. It is not a scrap of good of them saying comfortably that when a complicated case turns up, it can always be referred to a specialist. They must realise that it is almost impossible to be sure whether a case will be simple or difficult.
485 1.15 p.m.
This is the crux of the matter. What starts as a perfectly simple termination may in midstream, as it were, suddenly turn into the most desperately dangerous situation and an extremely troublesome matter for any doctor to deal with. What then? Does the Ministry say, "We are very sorry. We rather hoped that it would all be so simple that this would not happen"? It is bound to happen unless sufficient safeguards are written into the Bill as we would all wish.
I cannot think that because there are not a large number of consultants or gynaecologists we must, therefore, for the sake of the woman, say that she must be satisfied with a less experienced man and cannot be provided with an expert. That is not the way that this House should legislate. It should say that the woman needs a specialist. It is, therefore, the responsibility of us all to see that she gets one.
Earlier in the debate, it rather seemed as though the Minister had not bothered to read the Amendments. At the outset, my hon. Friend the Member for the Isle of Thanet (Mr. Rees-Davies) sought guidance about which of the Amendments would be acceptable and good. I am sure that if any one of them were suggested, we would all support it simply because we are all trying to do the same thing. We are all trying to protect the woman. These are not wrecking Amendments. They are put forward by people who are concerned about the woman. On that basis, I beg the Minister and the sponsor of the Bill to think again and to accept what the doctors, who have responsibility to carry these things out, and the medical profession, which has to take responsibility, wish should be done.
§ Sir Myer Galpern (Glasgow, Shettleston)
The contribution by the right hon. and learned Member for St. Marylebone (Mr. Hogg) has aroused in me support for the Amendment, and that is no mean achievement. His argument of the inbuilt dangers of a racket developing in the carrying out of abortions should be treated with great seriousness, because it is a practical possibility.
It is not inconceivable, for example, that a woman who seeks abortion approaches a medical practitioner, who listens to her case or examines her and 486 gives his conclusion that it is not a case in which he should agree to abortion. The woman, desperate to have an abortion, then turns to another doctor, who has been recommended to her as one whose conscience might be considerably eased according to the size of the fee which might be payable. That is a great danger.
If two medical practitioners decide that a woman is not a fit case for abortion, there is nothing in the Bill to prevent her from seeking out two other medical practitioners who might take an entirely different view. As soon as we permit a situation of that kind—remembering that medical practitioners are not a race apart; they are merely human beings with the weaknesses and foibles of their fellow citizens—in which other doctors might be able to decide that their consciences would in the circumstances permit them to recommend an abortion, all that we would have achieved would be that we had taken it out of the back streets and put it into the front streets and given it an air of respectability, and the money payable for the back-street abortions would then pass to professional people in the medical profession.
My right hon. Friend the Minister of Health surprised me this morning in his resistance to the Amendment. He seems to base his objection to it on the fact that he does not want to have upon his shoulders the responsibility of selecting the people who would be recommended as suitably qualified to make recommendations for abortion. I wonder, therefore, how my right hon. Friend reconciles himself to his responsibility for a scheme which, I think, is even more criticised in the medical profession, namely, the award of special merit payments to consultants, carried out by an unknown body which has to assess for reasons best known to it why A is to receive £5,000 and B is to receive only £2,500 and somebody else is to receive nothing at all. Surely in a situation of that kind, and having accepted that kind of responsibility, it ill becomes my right hon. Friend to say that he refuses to take this additional responsibility which, I can assure him, would rest much more lightly on his shoulders than the one to which I have just referred.
No one, not one of the Amendments, calls upon him to accept the responsibility. I doubt very much whether I would 487 agree with a local authority being the responsible body to make recommendations as to suitably qualified practitioners, but I see no difficulty whatsoever in machinery being devised whereby there can be a responsible body charged with the duty of making such a selection, and which would be generally acceptable to the medical profession.
With that brief intervention I urge the House, in the light of what we have heard in the debate, that it should support some form of selectivity.
§ Mr. R. H. Turton (Thirsk and Malton)
I entirely agree with the hon. Member for Glasgow, Shettleston (Sir M. Galpern) that this is primarily a medical matter. I think it a pity that there has been introduced into this question the arguments pro and against the Bill as a whole. I was disturbed, and disappointed, when the Minister of Health rejected out of hand, in a rather slighting way, the considered views of the Royal College of Obstetricians and Gynaecologists and the British Medical Association. I think it unfortunate that he paid so little attention to their views, which I myself believe to be right.
I should like to see the law on abortion clarified. I would like to see termination of pregnancies carried out under the National Health Service. I fear that the attitude of the Minister and of the hon. Gentleman sponsoring this Bill will, as the hon. Member for Shettleston said, make many more expensive abortions carried out by perhaps less desirable members of the profession.
At present, in my county termination of pregnancy operations are being carried out satisfactorily in National Health hospitals, except that the Minister has not provided sufficient facilities for them because there is a time lag in the gynaecological wards in the hospitals in the area.
I have here the views of 28 out of 29 of the gynaecologists who serve the Leeds Regional Hospital Board. They say that in their view
§ "our present practice of terminating a pregnancy where well-established medical indication exists will be unchanged if the Bill passes into law and we do not expect to terminate more pregnancies than before."
They go on to say:
In our view, the Bill will not reduce the number of abortions carried out by the unqualified.
§ This seems to me to be the nub of the whole of this question. If there are not at the same time sufficient beds required for this increased load for the termination of pregnancies and for the very large number of gynaecological cases, which cannot be treated quickly, I am afraid that by the Bill there will be an increased expectation by the mother that she can be relieved of pregnancy, but there will not be the facilities available for her—except by the unqualified, or, if you like, for the qualified abortion carried out by the medical racketeer.
§ That is why I personally believe some form of Amendment on the lines of this one moved by my hon. Friend the Member for the Isle of Thanet (Mr. Rees-Davies) and supported by my right hon. and learned Friend the Member for Warwick and Leamington (Sir J. Hobson) is desirable. I can see the Minister's difficulty of not wanting to be the judge between one medical practitioner and another, but I would have thought it not beyond the wit of Parliament and the medical profession to have devised a form of words which would have saved us from the dangers of racketeering, which, I believe, are inherent, unless we can put in some Amendment like this, and which would help the Minister to secure that as many as possible of the terminations of pregnancy are carried out in the National Health Service, and not otherwise.
§ Mr. C. Pannell rose in his place and claimed to move, That the Question be now put.
§ Question put, That the Question be now put:—
§ The House divided: Ayes 184, Noes 116.491
|Division No. 342.]||AYES||[1.27 p.m.|
|Allen, Scholefield||Barnes, Michael||Binns, John|
|Armstrong, Ernest||Barnett, Joel||Bishop, E. S.|
|Atkins, Ronald (Preston, N.)||Beaney, Alan||Booth, Albert|
|Atkinson, Norman (Tottenham)||Bell, Ronald||Bossom, Sir Clive|
|Bacon, Rt. Hn. Alice||Bennett, James (G'gow, Bridgeton)||Boston, Terence|
|Bagier, Gordon A. T.||Bessell, Peter||Bradley, Tom|
|Balniel, Lord||Bidwell, Sydney||Bray, Dr. Jeremy|
|Brown, Hugh D. (G'gow, Provan)||Heffer, Eric S.||Parkyn, Brian (Bedford)|
|Brown,Bob (N'c'tle-upon-Tyne,W)||Henig, Stanley||Pavitt, Laurence|
|Brown, R. W. (Shoreditch & F'bury)||Higgins, Terence L.||Perry, Ernest G. (Battersea, S.)|
|Bruce-Gardyne, J.||Houghton, Rt. Hn. Douglas||Prentice, Rt. Hn. R. E.|
|Buchan, Norman||Howell, David (Guildford)||Quennell, Miss J. M.|
|Buchanan, Richard (G'gow, Sp'burn)||Howie, W.||Rees, Merlyn|
|Butler, Mrs. Joyce (Wood Green)||Huckfield, L.||Reynolds, G. W.|
|Cant, R. B.||Hughes, Emrys (Ayrshire, S.)||Richard, Ivor|
|Carmichael, Neil||Hunt, John||Ridley, Hn. Nicholas|
|Conlan, Bernard||Hunter, Adam||Roberts, Gwilym (Bedfordshire, S.)|
|Corbet, Mrs. Freda||Iremonger, T. L.||Robinson, Rt.Hn.Kenneth (St.P'c'as)|
|Crawshaw, Richard||Jackson, Peter M. (High Peak)||Robinson, W. O. J. (Walth'stow, E.)|
|Crossman, Rt. Hn. Richard||Jeger,Mrs. Lena (H 'b' n&St. P' cras, S.)||Roebuck, Roy|
|Crouch, David||Jenkins, Hugh (Putney)||Rogers, George (Kensington, N.)|
|Dalyell, Tam||Jenkins, Rt. Hn. Roy (Stechford)||Rowlands, E. (Cardiff, N.)|
|Davidson, James (Aberdeenshire,W.)||Johnson, Carol (Lewisham, S.)||Scott, Nicholas|
|Davies, Dr. Ernest (Stretford)||Johnson, James (K'ston-on-Hull, W.)||Shaw, Arnold (Ilford, S.)|
|Davies, Ednyfed Hudson (Conway)||Jones, T. Alec (Rhondda, West)||Sheldon, Robert|
|de Freitas, Rt. Hn. Sir Geoffrey||Judd, Frank||Shore, Peter (Stepney)|
|Dewar, Donald||Kelley, Richard||Short, Mrs. Renée(W'hampton,N. E.)|
|Diamond, Rt. Hn. John||Kerr, Dr. David (W'worth, Central)||Silkin, Hn. S. C. (Dulwich)|
|Dickens, James||Kerr, Russell (Feltham)||Silverman, Julius (Aston)|
|Digby, Simon Wingfield||Lawson, George||Sinclair, Sir George|
|Doig, Peter||Ledger, Ron||Small, William|
|Driberg, Tom||Lee, John (Reading)||Snow, Julian|
|Dunnett, Jack||Lestor, Miss Joan||Spriggs, Leslie|
|Dunwoody, Mrs. Gwyneth (Exeter)||Lipton, Marcus||Steel, David (Roxburgh)|
|Dunwoody, Dr. John (F'th & C'b'e)||Loughlin, Charles||Steele, Thomas (Dunbartonshire, W.)|
|Eadie, Alex||Luard, Evan||Strauss, Rt. Hn. G. R.|
|Edwards, Robert (Bilston)||Lubbock, Eric||Swingler, Stephen|
|Ellis, John||McCann, John||Taverne, Dick|
|Ensor, David||MacColl, James||Thatcher, Mrs. Margaret|
|Evans, Gwynfor (C'marthen)||MacDermot, Niall||Thornton, Ernest|
|Evans, Ioan L. (Birm'h'm, Yardley)||McKay, Mrs. Margaret||Thorpe, Rt. Hn. Jeremy|
|Fernyhough, E.||Mackie, John||Tuck, Raphael|
|Finch, Harold||Mackintosh, John P||Urwin, T. W.|
|Fletcher, Raymond (Ilkeston)||MacPherson, Malcolm||Varley, Eric G.|
|Fletcher, Ted (Darlington)||Marquand, David||Vaughan-Morgan, Rt. Hn. Sir John|
|Foot, Michael (Ebbw Vale)||Mendelson, J. J.||Vickers, Dame Joan|
|Forrester, John||Mikardo, Ian||Walden, Brian (All Saints)|
|Fowler, Gerry||Miller, Dr. M. S.||Wallace, George|
|Fraser, Rt. Hn. Tom (Hamilton)||Mitchell, R. C. (S'th'pton, Test)||Watkins, David (Consett)|
|Freeson, Reginald||Molloy, William||Weitzman, David|
|Gardner, Tony||Morris, Alfred (Wythenshawe)||Wellbeloved, James|
|Garrett, W. E.||Morris, Charles R. (Openshaw)||Whitaker, Ben|
|Gilmour, Ian (Norfolk, C.)||Moyle, Roland||Whitlock, William|
|Ginsburg, David||Murray, Albert||Williams, Alan (Swansea, W.)|
|Gordon Walker, Rt. Hn. P. C.||Newens, Stan||Williams, Alan Lee (Hornchurch)|
|Gray, Dr. Hugh (Yarmouth)||Ogden, Eric||Winnick, David|
|Gregory, Arnold||Orbach, Maurice||Winstanley, Dr. M. P.|
|Grey, Charles (Durham)||Orme, Stanley||Yates, Victor|
|Griffiths, David (Rother Valley)||Owen, Dr. David (Plymouth, S'tn)|
|Griffiths, Rt. Hn. James (Llanelly)||Pannell, Rt. Hn. Charles||TELLERS FOR THE AYES:|
|Hale, Leslie (Oldham, W)||Pardoe, John||Mr. Edward Lyons and|
|Hamling, William||Park, Trevor||Mr. Christopher Price.|
|Haseldine, Norman||Parker, John (Dagenham)|
|Allason, James (Hemel Hempstead)||Fletcher-Cooke, Charles||Knight, Mrs. Jill|
|Alldritt, Walter||Foley, Maurice||Langford-Holt, Sir John|
|Beamish, Col. Sir Tufton||Fortescue, Tim||Lever, L. M. (Ardwick)|
|Bellenger, Rt. Hn. F. J.||Galpern, Sir Myer||Longden, Gilbert|
|Bence, Cyril||Giles, Rear-Adm. Morgan||McAdden, Sir Stephen|
|Bennett, Sir Frederic (Torquay)||Gilmour, Sir John (Fife, E.)||McBride, Neil|
|Biffen, John||Goodhew, Victor||Macdonald, A. H.|
|Biggs-Davison, John||Grieve, Percy||McGuire, Michael|
|Black, Sir Cyril||Griffiths, Eldon (Bury St. Edmunds)||Mackenzie, Alasdair (Ross & Crom'ty)|
|Blaker, Peter||Gurden, Harold||Maclean, Sir Fitzroy|
|Boyd-Carpenter, Rt. Hn. John||Hamilton, James (Bothwell)||McMaster, Stanley|
|Braine, Bernard||Harris, Frederic (Croydon, N.W.)||McMillan, Tom (Glasgow, C.)|
|Brown, Sir Edward (Bath)||Harvie Anderson, Miss||McNamara, J. Kevin|
|Costain, A. P.||Hawkins, Paul||Mahon, Peter (Preston, S.)|
|Crosthwaite-Eyre, Sir Oliver||Heald, Rt. Hn. sir Lionel||Marten, Neil|
|Cullen, Mrs. Alice||Hiley, Joseph||Maude, Angus|
|Cunningham, Sir Knox||Hobson, Rt. Hn. Sir John||Maydon, Lt.-Cmdr. S. L. C.|
|Currie, G. B. H.||Hogg, Rt. Hn. Quintin||Mellish, Robert|
|Dalkeith, Earl of||Kowarth, Harry (Wellingborough)||Monro, Hector|
|Delargy, Hugh||Howarth, Robert (Bolton, E.)||Montgomery, Fergus|
|Dempsey, James||Hutchison, Michael Clark||More, Jasper|
|Dodds-Parker, Douglas||Jones, Dan (Burnley)||Morrison, Charles (Devizes)|
|Doughty, Charles||Kerby, Capt. Henry||Mott-Radclyffe, Sir Charles|
|English, Michael||Kimball, Marcus||Munro-Lucas-Tooth, Sir Hugh|
|Errington, Sir Eric||King, Evelyn (Dorset, S.)||Murton, Oscar|
|Nabarro, Sir Gerald||Benton, Rt. Hn. Sir David||Tinn, James|
|Neave, Airey||Rodgers, Sir John (Sevenoaks)||Turton, Rt. Hn. R. H.|
|Oakes, Gordon||Rossi, Hugh (Homsey)||Wall, Patrick|
|O'Malley, Brian||Russell, Sir Ronald||Walters, Dennis|
|Onslow, Cranley||St. John-Stevas, Norman||Ward, Dame Irene|
|Page, Graham (Crosby)||Sharples, Richard||Weatherill, Bernard|
|Pearson, Sir Frank (Clitheroe)||Smith, John||Wells, William (Walsall, N.)|
|Peel, John||Stainton, Keith||Williams, Mrs. Shirley (Hitchin)|
|Pink, R. Bonner||Stodart, Anthony||Wills, Sir Gerald (Bridgwater)|
|Price, David (Eastleigh)||Stoddart-Scott, Col. Sir M. (Ripon)||Worsley, Marcus|
|Price, Thomas (Westhoughton)||Symonds, J. B.||Wylie, N. R.|
|Pym, Francis||Taylor,EdwardM. (G'gow, Cathcart)|
|Ramsden, Rt. Hn, James||Teeling, Sir William||TELLERS FOR THE NOES:|
|Rawlinson, Rt. Hn. Sir Peter||Temple, John M.||Mr. Simon Mahon and|
|Rees-Davies, w. R.||Tilney, John||Mr. James A. Dunn.|
§ Question put accordingly, That the Clause be read a Second time:492
§ The House Divided: Ayes 124, Noes 187.493
|Division No. 343.]||AYES||[1.36 p.m.|
|Allason, James (Hemel Hempstead)||Higgins, Terence L.||O'Malley, Brian|
|Alidritt, Walter||Hiley, Joseph||Onslow, Cranley|
|Beamish, col. Sir Tufton||Hobson, Rt. Hn. Sir John||Page, Derek (King's Lynn)|
|Bellenger, Rt. Hn. F. J.||Hogg, Rt. Hn. Quintin||Page, Graham (Crosby)|
|Bennett, Sir Frederic (Torquay)||Howarth, Harry (Wellingborough)||Pearson, Sir Frank (Clitheroe)|
|Bitten, John||Howarth, Robert (Bolton, E.)||Pink, R. Bonner|
|Biggs-Davison, John||Hoy, James||Price, David (Eastleigh)|
|Black, Sir Cyril||Hutchison, Michael Clark||Price, Thomas (Westhoughton)|
|Blaker, Peter||Jones, Arthur (Northants, S.)||Pym, Francis|
|Boyd-Carpenter, Rt. Hn. John||Jones, Dan (Burnley)||Ramsden, Rt. Hn. James|
|Braine, Bernard||Kerby, Capt. Henry||Hawlinson, Rt. Hn. Sir Peter|
|Brown, Sir Edward (Bath)||Kimball, Marcus||Rees-Davies, W. R.|
|Buchanan, Richard (G'gow, Sp'burn)||Knight, Mrs. Jill||Ronton, Rt. Hn. Sir David|
|Costain, A. P.||Langford-Holt, Sir John||Rodgers, Sir John (Sevenoaks)|
|Crosthwaite-Eyre, Sir Oliver||Lever, L. M. (Ardwick)||Rossi, Hugh (Homsey)|
|Cullen, Mrs. Alice||Lewis, Kenneth (Rutland)||Russell, Sir Ronald|
|Cunningham, Sir Knox||Longden, Gilbert||St. John-Stevas, Norman|
|Currie, G. B. H.||McAdden, Sir Stephen||Smith, John|
|Dalkeith, Earl of||McBride, Neil||Stainton, Keith|
|Dance, James||Macdonaid, A. H.||Stodart, Anthony|
|Delargy, Hugh||McGuire, Michael||Stoddart-Scott, Col. Sir M. (Ripon)|
|Dempsey, James||Mackenzie, Alasdair(Ross&Crom'ty)||Symonds, J. B.|
|Dodds-Parker, Douglas||Maclean, Sir Fitzroy||Taylor.Edward M.(G'gow,Cathcart)|
|Doughty, Charles||McMaster, Stanley||Teeling, Sir William|
|English, Michael||MacMillan, Malcolm (Western Isles)||Temple, John M.|
|Errington, Sir Eric||McMillan, Tom (Glasgow, C.)||Tilney, John|
|Eyre, Reginald||McNamara, J. Kevin||Tinn, James|
|Fitt, Gerard (Belfast, W.)||Maddan, Martin||Turton, Rt. Hn. R. H.|
|Fletcher-Cooke, Charles||Mahon, Peter (Preston, S.)||Wall, Patrick|
|Foley, Maurice||Mahon, Simon (Bootle)||Walters, Dennis|
|Fortescue, Tim||Marten, Neil||Ward, Dame Irene|
|Galpern, Sir Myer||Maude, Angus||Weatherill, Bernard|
|Ciles, Rear-Adm. Morgan||Maydon, Lt.-Cmdr. S. L. C.||Wells, William (Walsall, N.)|
|Gilmour, Sir John (Fife, E.)||Mellish, Robert||Williams, Mrs. Shirley (Hitchin)|
|Glover, Sir Douglas||Monro, Hector||Wills, Sir Gerald (Bridgwater)|
|Goodhew, Victor||Montgomery, Fergus||Wood, Rt. Hn. Richard|
|Grieve, Percy||More, Jasper||Worsley, Marcus|
|Griffiths, Eldon (Bury St. Edmunds)||Morris, Charles R. (Openshaw)||Wylie, N. R.|
|Hamilton, James (Bothwell)||Morrison, Charles (Devizes)|
|Harris, Frederic (Croydon, N.W.)||Mott-Radclyffe, Sir Charles||TELLERS FOR THE AYES:|
|Harvie Anderson, Miss||Murton, Oscar||Mr. Harold Gurden and|
|Hawkins, Paul||Naliarro, Sir Gerald||Mr. James A. Dunn.|
|Heald, Rt. Hn. Sir Lionel||Oakes, Gordon|
|Allen, Scholefield||Bidwell, Sydney||Butler, Mrs. Joyce (Wood Green)|
|Armstrong, Ernest||Binns, John||Cant, R. B.|
|Atkins, Ronald (Preston, N-)||Bishop, E. S.||Carmichael, Neil|
|Atkinson, Norman (Tottenham)||Booth, Albert||Conlan, Bernard|
|Bacon, Rt. Hn. Alice||Bossom, Sir Clive||Corbet, Mrs. Freda|
|Bagier, Gordon A. T.||Boston, Terence||Crawshaw, Richard|
|Balniel, Lord||Bradley, Tom||Crossman, Rt. Hn. Richard|
|Barnes, Michael||Bray, Dr. Jeremy||Crouch, David|
|Barnett, Joel||Brooks, Edwin||Dalyell, Tam|
|Beaney, Alan||Brown, Hugh D. (G'gow, Provan)||Davidson, James (Aberdeenshire, W.)|
|Bell, Ronald||Brown, Bob (N'c'tle-upon-Tyne,W.)||Davies, Dr. Ernest (Stratford)|
|Bence, Cyril||Brown, R. W. (Shoreditch & F'bury)||Davies, Ednyfed Hudson (Conway)|
|Bennett, James (G'gow, Bridgeton)||Bruce-Gardyne, J.||de Freitas, Rt. Hn. Sir Geoffrey|
|Bessell, Peter||Buchan, Norman||Dewar Donald|
|Diamond, Rt. Hn. John||Jones, T. Alec (Rhondda, West)||Richard, Ivor|
|Dickens, James||Judd, Frank||Ridley, Hn. Nicholas|
|Digby, Simon Wingfield||Kelley, Richard||Roberts, Gwilym (Bedfordshire, S.)|
|Doig, Peter||Kerr, Dr. David (W'worth, Central)||Robinson, Rt. Hn. Kenneth (St.P'c'as)|
|Driberg, Tom||Kerr, Russell (Feltham)||Robinson, W. O. J. (Walth'stow, E.)|
|Dunnett, Jack||Lawson, George||Roebuck, Roy|
|Dunwoody, Mrs. Gwyneth (Exeter)||Ledger, Ron||Rogers, George (Kensington, N.)|
|Dunwoody, Dr. John (F'th & C'b'e)||Lee, John (Reading)||Ross, Rt. Hn. William|
|Eadie, Alex||Lestor, Miss Joan||Rowlands, E. (Cardiff, N.)|
|Edwards, Robert (Bilston)||Lipton, Marcus||Scott, Nicholas|
|Ellis, John||Loughlin, Charles||Shaw, Arnold (Ilford, S.)|
|Ensor, David||Luard, Evan||Sheldon, Robert|
|Evans, Gwynfor (C'marthen)||Lubbock, Eric||Shore, Peter (Stepney)|
|Evans, Ioan L. (Birm'h'm, Yardley)||Mabon, Dr. J. Dickson||Short, Mrs. Renée(W'hampton, N. E.)|
|Fernyhough, E.||McCann, John||Silkin, Hn. S. C. (Dulwich)|
|Finch, Harold||MacColl, James||Silverman, Julius (Aston)|
|Fletcher, Raymond (Ilkeston)||MacDermot, Niall||Sinclair, Sir George|
|Fletcher, Ted (Darlington)||McKay, Mrs. Margaret||Small, William|
|Foot, Michael (Ebbw Vale)||Mackie, John||Snow, Julian|
|Forrester, John||Mackintosh, John P.||Spriggs, Leslie|
|Fowler, Gerry||Macleod, Rt. Hn. Iain||Steel, David (Roxburgh)|
|Freeson, Reginald||MacPherson, Malcolm||Steele, Thomas (Dunbartonshire, W.)|
|Gardner, Tony||Marquand, David||Strauss, Rt. Hn. G. R.|
|Garrett, W. E.||Mcndelson, J. J.||Swingler, Stephen|
|Gilmour, Ian (Norfolk, C.)||Mikardo, Ian||Taverne, Dick|
|Ginsburg, David||Miller, Dr. M. S.||Thatcher, Mrs. Margaret|
|Cordon Walker, Rt. Hn. P. C.||Mitchell, R. C. (S'th'pton, Test)||Thornton, Emest|
|Gray, Dr. Hugh (Yarmouth)||Molloy, William||Thorpe, Rt. Hn. Jeremy|
|Gregory, Arnold||Morris, Alfred (Wythenshawe)||Tuck, Raphael|
|Grey, Charles (Durham)||Morris, John (Aberavon)||Urwin, T. W.|
|Griffiths, David (Rother Valley)||Moyle, Roland||Varley, Eric G.|
|Griffiths, Rt. Hn. James (Llanelly)||Murray, Albert||Vaughan-Morgan, Rt. Hn, Sir John|
|Hale, Leslie (Oldham, W.)||Neave, Airey||Vickers, Dame Joan|
|Hamling, William||Newens, Stan||Walden, Brian (All Saints)|
|Haseldine, Norman||Ogden, Eric||Wallace, George|
|Heffer, Eric S.||Orbach, Maurice||Watkins, David (Consett)|
|Henig, Stanley||Orme, Stanley||Weitzman, David|
|Houghton, Rt. Hn. Douglas||Owen, Dr. David (Plymouth, S'tn)||Wellbeloved, James|
|Howell, David (Guildford)||Pannell, Rt. Hn. Charles||Whltaker, Ben|
|Howie, W.||Pardoe, John||Whitlock, William|
|Huckfield, L.||Park, Trevor||Williams, Alan (Swansea, W.)|
|Hughes, Emrys (Ayrshire, S.)||Parker, John (Dagenham)||Williams, Alan Lee (Hornchurch)|
|Hunt, John||Parkyn, Brian (Bedford)||Winnick, David|
|Iremonger, T. L.||Pavitt, Laurence||Winstanley, Dr. M. P.|
|Jackson, peter M. (High Peak)||Peel, John||Yates, Victor|
|Jeger,Mrs.Lena(H'b'n&St.P'Cras,S.)||Perry, Ernest G. (Battersea, S.)|
|Jenkins, Hugh (Putney)||Prentice, Rt. Hn. R. E.||TELLERS FOR THE NOES:|
|Jenkins, Rt. Hn. Roy (Stechford)||Quennell, Miss J. M.||Mr. Edward Lyon and|
|Johnson, Carol (Lewisham, S.)||Rees, Merlyn||Mr. Christopher Price.|
|Johnson, James (K'ston-on-Hull, W.)||Reynolds, G. W.|