§ 3.54 p.m.
§ Mrs. Sally Oppenheim
I beg to move,That leave be given to bring in a Bill to amend section 8 of the Family Law Reform Act, 1969 to provide that, in respect of this section only, medical practitioners are not bound by normal medical ethics as to confidentiality with regard to the parents of patients below the age of 18 years, but may use discretion in some cases.The Bill which I hope to introduce will go some way towards the clarification of a situation which is currently causing bewilderment in the medical profession and concern to parents throughout the country and to those children between the ages of 16 and 18 who are involved.
Section 8 of the Family Law Reform Act, 1969, which gives a right to persons over the age of 16 to give valid consent to medical treatment, is not in essence challenged. It was the result of the Report of the Latey Committee which provided valuable evidence for the reform of family law. But I cannot think that the House could have foreseen some of the difficulties that have arisen as a result of that Section. Had the House done so, it might have sought to amend it then, as I am doing now, to give guidance to the medical profession in a complicated and confusing situation in which medical, legal, psychological, moral and social problems are all intertwined.
Indeed, the Section might already have been amended but for an unfortunate accident. On Report stage of the Bill on 9th July, 1969, in column 1407, my hon. Friend the Member for Bury St. Edmunds (Mr. Eldon Griffiths) sought to amend it and put to the House most cogently the general apprehensions and anxieties which were widespread among school physicians with regard to the problems involved in medical ethical secrecy regarding minors at residential schools. He revealed in his speech that, unfortunately, his letter putting these important points to the Home Office in December, 1968 was lost for four months between Departments and that by the time he received a reply he was abroad and the Latey Committee recommendations had been included in the Bill which by that time had completed its passage in another place.
1516 In replying to him in that debate on the question of the prohibition of a 16 year old patient from discussing her case with her mother the then Attorney-General absolved himself from involvement in a legal answer to the problem by saying:Whether a doctor accepted the prohibition would be a matter for his conscience, of what he thought to be right and what he thought to be appropriate."—[OFFICIAL REPORT, 9th July, 1969; Vol. 786, c. 1421.]That is an interpretation which I accept but which, apparently, is not acceptable to the B.M.A. or the G.M.C.
A doctor was recently brought before the Disciplinary Committee of the G.M.C. accused of breach of professional conduct in respect of breach of confidentiality of a 16-year-old patient. The ruling of the G.M.C. on that occasion, which, in effect, said that the doctor was wrong in what he did but right to do it, was hardly the clear, definitive ruling that most people think was necessary. I believe that doctors, particularly family doctors, should be allowed to use their discretion in some cases where their patients are below the age of 18, and I regret that so much emphasis has been placed on the more sensational and most publicised aspect of it—the pill. Although the pill forms a considerable part of the problem, it is incidental to the much more serious medical considerations which are involved. I have had brought to my attention cases in which youngsters aged 17 or 18 may be suffering from a serious medical or psychological illness, for example, severe depression, thrombosis, peritonitis, septic abortion or V.D., all of which involve risk to life and some of which necessitate medication which may have side effects.
Then there is the other type of case not immediately serious but potentially so, in which a doctor who knows that there is a long family history of thrombosis, when he is approached by his 16-year-old patient, may be reluctant to prescribe a contraceptive pill and feel that it is his duty to warn her parents to watch out for symptoms. Surely the parents of minors, for whom they are still legally responsible, should have the right to know in such serious circumstances as I have mentioned, the medical position of their children. Surely this is just the time when communications 1517 within the family unit are vital, when parental affection, guidance, sympathy and practical help are urgently needed. But, as the situation stands, if in respect of any of those cases a doctor breaches the confidentiality of his young patients, he is in danger of being brought before the Disciplinary Committee of the G.M.C. I cannot believe that one hon. Member would advocate that.
Where it is possible in such cases he should try to obtain the permission of his young patient to discuss his case, but clearly where it is not he must be free, as he is not now, to use his discretion —not in the moral interests but purely in the medical interests of his patient, in the full knowledge that he holds the ultimate responsibility for his decision, and that first and foremost in his medical code of ethics is his consideration of his patient's medical or psychotherapeutic interests, and he must have legal protection for the interpretation of those interests.
I now turn to the social grounds and points of principle upon which I also seek this amendment. It is very fashionable in some circles to advocate a move away from parental influence, to say that teachers, doctors and even broadcasters are better qualified to advise children than their parents. Such people often fail to make the distinction between permitting and encouraging, and such teaching, sometimes deliberately, leads children to believe that they will not receive understanding or sympathy from their parents. Whereas this is true in the minority of cases, in the majority of cases—I believe that good parents are in the majority—it is not.
I particularly deplore any inference that poor or deprived parents are necessarily bad or inadequate ones. I have done social work—[Interruption.] I have done social work for some years in one of the most necessitous parts of the country, in which I met these families, and among them I met more good parents who loved, understood and cared for their children than anyone else. After all, who but the parents—[Interruption.]
§ Mr. Speaker
Order. The hon. Member for Manchester, Ardwick (Mr. Kaufman) must not shout things across the Chamber.
§ Mrs. Oppenheim
After all, who but the parents have the best interests and 1518 welfare of their children at heart? It is their advice at a very vulnerable age which is motivated by their love and affection which is usually the best advice that children can get. Therefore, on these grounds too there is some justification for parents of a child below 18 to be told of serious medical circumstances concerning their children—not so that they can forbid, frighten or veto, but so that they can discuss and evaluate the problem with them. Very often the family doctor is the only link between parents and children in such circumstances.
Of course, I accept that no clear boundary can be drawn while a minority of parents are unable to accept this responsibility, and while there are some family relationships which will make it undesirable, even in the case of some children under 16. It is for this reason that I have added the words "in some cases at his discretion". Naturally I accept that confidentiality must be respected in the vast majority of cases.
The opponents of this Amendment will say that it will result in girls being scared to consult their doctors and clinics. [HON. MEMBERS: "Hear, hear."] I can only refer them to The Economist of 13th March, which pointed out that, far from discouraging them, the recent verdict in favour of Dr. Brown had prompted an unprecedented rush of business at a well-known Birmingham clinic. Equally it is easy to reel off a list of examples of parents who are inappropriate to receive confidences, but such selectivity hardly proves the case.
Finally, if it is reactionary to believe that family influence is a great force for good in our society, which should be reinforced and not undermined, and that it will be eroded if parents are not allowed to exercise their responsibility in some cases, I stand condemned as a reactionary, because this is what I believe. It is on these two important grounds, the medical-legal one and the social one, that I beg leave to amend Section 8 of the Family Law Reform Act, 1969.
§ 4.5 p.m.
§ Miss Lestor
Yes, Mr. Speaker, I do.
1519 First, Section 8 of the Family Law Reform Act to which the Bill relates has nothing whatever to do with the confidentiality of a patient. It deals only with the problems of a minor of 16 consenting to medical treatment which might otherwise be an assault, such as a surgical operation. It has no relevance whatever to the confidential information disclosed by the patient to the doctor. The Latey Committee, which proposed this change, which resulted in Section 8, made no reference to the problem of the confidential relationship in that context, except in paragraph 482, which I advise the hon. Member for Gloucester (Mrs. Sally Oppenheim) to read.
As the hon. Member knows, any doctor is under a duty to preserve the confidentiality of any patient by reason of the code of ethics of the profession. Any breach of that duty, as happened, can be charged before the General Medical Council, which is what happened in the case of Dr. Brown and his young patient —the fact that she was taking the pill came to his knowledge through the family advisory clinic—but this duty has to go with the law of the land. The only obligation in law to preserve confidentiality is probably under the right to preserve information by an action in the Chancery Division. This was upheld and explained by the Secretary of State for Social Services in an Answer to my hon. Friend the Member for Pontypool (Mr. Abse).
One of the things which worries me about the Bill is that there is no evidence at all that the medical profession wants it. In fact, the opposite seems to be the case. The Secretary of the British Medical Association has expressed grave concern at the suggestion which has followed from the General Medical Council's recommendation that confidentiality between doctor and patient was being eroded. The B.M.A. has said that it will pronounce on what has happened in due course.
It would therefore ill become the House to allow this Bill to have a Second Reading when we do not yet know what the B.M.A. will tell us. What we do know is that they are not bewildered but are exceedingly worried about the effect of this decision upon people who have always regarded going to a doctor as confidential.
1520 The hon. Member for Gloucester said that this had very little to do with the pill, but it was not until the question of the young girl getting the pill came up that this was ever raised. Her own Greater London Young Conservatives have opposed this suggestion of hers and have tied it very closely to the pill. They and others have made the point that what this would do is stop young people not from indulging in sexual relationships but from seeking effective advice and will encourage them to take ineffective precautions.
This suggestion is also opposed by the Health Education Council, particularly on the grounds of V.D., because the figures of V.D. among the age group 16 to 18 are very high. One of the main reasons that one has been able to encourage people to take treatment for V.D. is that they know when they go for treatment that it will be treated in confidence. The fear of all of us who are concerned with young people is that this, again will not stop them from having sexual relationships but will stop them from seeking advice on how to treat V.D., because they will fear that it will not be in confidence.
This is also true on the whole question if illegitimate births. A total of 15,000 live illegitimate births were recorded in 1969 to girls between the ages of 11 and 18. This is a very drastic increase. The same argument applies exactly. One will not stop the new attitude to sex relationships among young people. One will discourage them from seeking advice. We have a rise in the figures for abortions, which this would also affect.
The hon. Lady spoke about young people between the ages of 16 and 18. But will it affect all of them? It will not affect those who are married, or boys who can obtain supplies of contraceptives without ever going to a clinic or a doctor? Will it affect young people between the ages of 16 and 18 who were in the care of a local authority but who are no longer in care, or young people who are living away from home?
In making the case about preserving the dignity and closeness of family life, the hon. Lady is trying to distinguish between groups of people. This would only apply to young people who are living at home. 1521 All sorts of groups of people are excluded.
I entirely agree with the hon. Lady that family life is very important. It is good, proper, right and desirable that young people talk to their parents, discuss matters with them and receive advice from them. Unhappily, it is not true of all of them. The Bill will damage the fabric of many family relationships, because the confidentiality which the young person wishes to preserve will be destroyed and the knowledge which he does not wish his parents to have will automatically come to them. This could result in breakdowns of family life.
§ I ask hon. Members to think carefully about how they vote. The Bill will act as a strong deterrent against young people seeking essential medical advice if they are to preserve some sort of responsibility in many of their relationships.
§ Question put, pursuant to Standing Order No. 13 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of Public Business):—
§ The House divided: Ayes 106, Noes 155.1523
|Division No. 337.]||AYES||[4.12 p.m.|
|Allason, James (Hemel Hempstead)||Hall, Miss Joan (Keighley)||Oppeniheim, Mrs. Sally|
|Baker, Kenneth (St, Marylebone)||Haselhurst, Alan||Owen, Idris (Stockport, N.)|
|Baker, W. H. K. (Banff)||Hiley, Joseph||Parkinson, Cecil (Enfield, W.)|
|Bell, Ronald||Hill, John E. B. (Norfolk, S.)||Peel, John|
|Bennett, Sir Frederic (Torquay)||Hill, James (Southampton, Test)||Percival, Ian|
|Benyon, W.||Holland, Philip||Pink, R. Bonner|
|Berry, Hn. Anthony||Hornby, Richard||Proudfoot, Wilfred|
|Biffen, John||Howell, Ralph (Norfolk, N.)||Ramsden, Rt. Hn. James|
|Biggs-Davison, John||Hutchison, Michael Clark||Rees, Peter (Dover)|
|Body, Richard||Iremonger, T. L.||Rees-Davies, W. R.|
|Boscawen, Robert||Irvine, Bryant Godman (Rye)||Renton, Rt. Hn. Sir David|
|Bossom, Sir Clive||James, David||Rhys Williams, Sir Brandon|
|Boyd-Carpenter, Rt. Hn. John||Jennings, J. c. (Burton)||Roberts, Michael (Cardiff, N.)|
|Braine, Bernard||Jessel, Toby||Roberts, Wyn (Conway)|
|Bray, Ronald||Kaberry, Sir Donald||Rodgers, Sir John (Sevenoaks)|
|Burden, F. A.||Kellett, Mrs. Elaine||Russell, Sir Ronald|
|Carlisle, Mark||Kilfedder, James||Shaw, Michael (Sc'b'gh & Whitby)|
|Chapman, Sydney||Kinsey, J. R.||Skeet, T. H. H.|
|Chichester-Clark, R.||Knight, Mrs. Jill||Soref, Harold|
|Clark, William (Surrey, E.)||Lane, David||Spence, John|
|Cockeram, Eric||Le Marchant, Spencer||Sproat, Iain|
|Costain, A. P.||Longden, Gilbert||Taylor, Edward M.(G'gow.Cathcart)|
|Deedes, Rt. Hn. W. F.||McAdden, Sir Stephen||Taylor, Robert (Croydon, N.W.)|
|Elliot, Capt. Walter (Carshalton)||Maclean, Sir Fitzroy||Temple, John M.|
|Elliott, R. W.(N'c'tle-upon-Tyne, N.)||Mather, Carol||Thompson, Sir Richard (Croydon,S.)|
|Fenner, Mrs. Peggy||Maude, Angus||Trew, Peter|
|Fidler, Michael||Mawby, Ray||Turton, Rt. Hn. R. H.|
|Finsberg, Geoffrey (Hampstead)||Meyer, Sir Anthony||Vickers, Dame Joan|
|Fox, Marcus||Mills, Peter (Torrmgton)||Wall, Patrick|
|Fry, Peter||Moate, Roger||Warren, Kenneth|
|Galbraith, Hn. T. G.||Monks, Mrs, Connie||White, Roger (Gravesend)|
|Gardner, Edward||Morgan-Giles, Rear-Adm.||Woodhouse, Hn. Christopher|
|Gorst, John||Morrison, Charles (Devizes)|
|Gower, Raymond||Neave, Airey||TELLERS FOR THE AYES:|
|Gray, Hamish||Nicholls, Sir Harmar||Sir Gerald Nabarro and|
|Green, Alan||Normanton, Tom||Mr. Fergus Montgomery.|
|Grylls, Michael||Onslow, Cranley|
|Albu, Austen||Campbell, I. (Dunbartonshire, W.)||Edelman, Maurice|
|Allaun, Frank (Salford, E.)||Castle, Rt. Hn. Barbara||Edwards, Robert (Bilston)|
|Archer, Peter (Rowley Regis)||Clark, David (Coins Valley)||Ellis, Tom|
|Armstrong, Ernest||Cocks, Michael (Bristol, S.)||English, Michael|
|Ashton, Joe||Coleman, Donald||Evans, Fred|
|Atkinson, Norman||Concannon, J. D.||Faulds, Andrew|
|Bagier, Gordon A. T.||Crosland, Rt. Hn. Anthony||Fernyhough, Rt. Hn. E.|
|Balniel, Lord||Crossman, Rt. Hn. Richard||Fisher, Mrs. Doris(B'ham, Lady wood)|
|Barnes, Michael||Cunningham, G. (Islington, S.W.)||Fletcher, Ted (Darlington)|
|Barnett, Joel||Dalyell, Tam||Foley, Maurice|
|Benn, Rt. Hn. Anthony Wedgwood||Davis, Clinton (Hackney, C.)||Foot, Michael|
|Bidwell, Sydney||de Freitas, Rt. Hn. Sir Geoffrey||Ford, Ben|
|Bishop, E. S.||Dell, Rt. Hn. Edmund||Freeson, Reginald|
|Blenkinsop, Arthur||Doig, Peter||Galpern, Sir Myer|
|Booth, Albert||Douglas, Dick (Stirlingshire, E.)||Garrett, W. E.|
|Brown, Bob (N'c'tle-upon-Tyne,W.)||Douglas-Mann, Bruce||Gilbert, Dr. John|
|Callaghan, Rt, Hn. James||Eadie, Alex||Ginsburg, David|
|Golding, John||Lipton, Marcus||Rhodes, Geoffrey|
|Gordon Walker, Rt. Hn. P. C.||Mabon, Dr. J. Dickson||Roberts, Rt.Hn.Goronwy (Caernarvon)|
|Gourlay, Harry||McBride, Neil||Robertson, John (Paisley)|
|Grant, George (Morpeth)||McCartney, Hugh||Roderick, Caerwyn E.(Br'c'n&R'dnor)|
|Hamilton, James (Bothwell)||McCrindle, R. A.||Rodgers, William (Stockton-on-Tees)|
|Hamilton, William (Fife, W.)||Mackenzie, Gregor||Roper, John|
|Hamling, William||Maclennan, Robert||Ross, Rt. Hn. William (Kilmarnock)|
|Hannan, William (G'gow, Maryhill)||McMillan, Tom (Glasgow, C.)||Sheldon, Robert (Ashton-under-Lyne)|
|Hardy, Peter||Marks, Kenneth||Short, Rt.Hn.Edward(N'c'tle-u-Tyne)|
|Harper, Joseph||Marquand, David||Short, Mrs. Renée (W'hampton, N.E.)|
|Healey, Rt. Hn. Denis||Marsh, Rt. Hn. Richard||Silkin, Hn. S. C. (Dulwich)|
|Heffer, Eric S.||Mayhew, Christopher||Skinner, Dennis|
|Horam, John||Mellish, Rt. Hn. Robert||Small, William|
|Houghton, Rt. Hn. Douglas||Mendelson, John||Smith, John (Lanarkshire, N.)|
|Howell, Denis (Small Heath)||Mikardo, Ian||Spearing, Nigel|
|Huckfield, Leslie||Miller, Dr. M. S.||Stallard, A. W.|
|Hughes, Mark (Durham)||Milne, Edward (Blyth)||Steel, David|
|Hughes, Robert (Aberdeen, N.)||Morris, Alfred (Wythenshawe)||Stewart, Donald (Western Isles)|
|Hughes, Roy (Newport)||Morris, Charles R. (Openshaw)||Stoddart, David (Swindon)|
|Hunter, Adam||Mulley, Rt. Hn. Frederick||Strang, Gavin|
|Jeger, Mrs.Lena (H'b'n&St.P'cras,S.)||O'Halloran, Michael||Strauss, Rt. Hn. G. R.|
|Jenkins, Rt. Hn. Roy (Stechford)||Orbach, Maurice||Summerskill, Hn. Dr. Shirley|
|John, Brynmor||Orme, Stanley||Taverne, Dick|
|Johnson, James (K'ston-on-Hull, W.)||Oswald, Thomas||Thorpe, Rt. Hn. Jeremy|
|Johnson, Walter (Derby, S.)||Paget, R. T.||Urwin, T. W.|
|Jones, Dan (Burnley)||Pannell, Rt. Hn. Charles||Wainwright, Edwin|
|Jones, Rt.Hn.Sir Elwyn(W.Ham,S.)||Pardoe, John||Walden, Brian (B'm'ham, All Saints)|
|Kaufman, Gerald||Parker, John (Dagenham)||Watkins, David|
|Kelley, Richard||Pavitt, Laurie||White, James (Glasgow, Pollok)|
|King, Tom (Bridgwater)||Pentland, Norman||Whitehead, Phillip|
|Lamble, David||Perry, Ernest G.||Wilson, Alexander (Hamilton)|
|Latham, Arthur||Prescott, John||Wilson, William (Coventry, S.)|
|Lawson, George||Probert, Arthur|
|Lee, Rt. Hn. Frederick||Rankin, John||TELLERS FOR THE NOES:|
|Leonard, Dick||Reed, D. (Sedgefield)||Mr. Alexander W. Lyon and|
|Lestor, Miss Joan||Rees, Merlyn (Leeds, S.)||Mr. John Fraser.|