RIGHTS OF PATIENTS (Hansard, 26 January 1972)

§ Mrs. Joyce Butler (Wood Green)

I beg to move, That leave be given to bring in a Bill to clarify the rights of patients to privacy when receiving hospital treatment under the National Health Service, and in regard to medical experiments on human beings. The Bill which I seek leave to introduce enters a comparatively new area of consumer protection and underlines the rights of patients in one particular respect. Although the principle of the patient's right to unconditional treatment in any hospital is now well established, only a few hospitals completely respect that right in practice. Although successive Ministers responsible for the Health Service have confirmed that right and have stated that no teaching hospital makes treatment conditional, the Patients' Association which is very zealous on behalf of patients's rights continues to receive letters from patients and intending patients about hospitals which completely disregard that right.

I have received many letters expressing the shock which people have experienced when they have found themselves lying in a hospital bed, suddenly surrounded by a group of students accompanying the consultant. Many such patients had hardly realised they were in a teaching hospital and they were completely unprepared for the experience of being used for teaching purposes, including questioning and examination by students. For some patients that experience flatly been so traumatic that they have flatly refused to go back to hospital again whatever the need may be.

I had one very grave case reported to me of a patient who had recovered from breast cancer but her experience in being used for teaching purposes in the hospital, in addition to the suffering of her condition, made her determined not to go to see her doctor when fresh, alarming symptoms occurred. She still has not done so because she will not go back to hospital for the necessary treatment.

A young girl who was an out-patient for psychiatric treatment was so alarmed and concerned by the constant questioning and discussion about her case which was undertaken by students that she too 1402 has refused to continue with treatment. Another woman patient with a history of mental trouble, only two months after the death of her husband reported: In a very painful interview I was asked to describe my husband's death to the consultant and a group of student doctors. I felt that I was being used as an object lesson for the sake of the doctors and I received no help at all. That case was apparently what is known as a "case conference" and there were nine people present including a ward sister, social workers and an occupational therapist. I appreciate that this case conference was probably quite necessary for the woman's condition and I realise the difficulty of this type of case, but surely some explanation could have been given to her which would have prevented the outrage to her feelings and susceptibilities which she experienced and which have had a lasting effect on her.

What can happen is illustrated by a maternity case which was reported at the end of last year. The patient's first baby had been damaged in delivery by a medical student and she was naturally particularly concerned about her second confinement. She attended the hospital clinic where it was the practice for two students, in this patient's words, " … to be let loose on the patients before the doctor came ". In her case the two students described the awful mistakes students can make, and she was naturally very upset.

On the advice of the Patients' Association she wrote to the consultant and the practice of having two students present was dropped. She was also assured that she would not be attended by a student at delivery. The hospital added these extraordinary words: This is open to all nervous mothers-to-be but, of course, not advertised. I am sure that any mother and very many other people concerned would ask, "Why not? Why should the patient not be told that they do not need to have students present?" It is precisely because of this hospital attitude that I am convinced that the patients' rights need to be written into legislation.

As it is, one elderly lady categorically said that when she asked if she could be examined without students being present the consultant said, "No, that is the price one pays for the superior care given in 1403 teaching hospitals". The hospital has denied this, but the lady concerned sticks by her statement.

In contrast, and being quite fair, I must say that I have had a number of letters from people who were very proud to be used to help further the cause of medical science, and I have received reports from former patients of treatment by students in which they very happily co-operated because of the kind and courteous manner of both the students and consultants concerned. This is really the key to the whole problem. We cannot legislate for human behaviour, but what can be done is to write into the law the patient's right to refuse to be used as teaching material and the hospital's duty to inform him of that right.

That is the purpose of this Bill. It will then be incumbent upon all hospitals to follow the example of the best and to seek the co-operation of the patients with the same consideration as the practitioners of any other profession have to show in securing the confidence and the cooperation of their clients. In the process it would seem that hospitals will increasingly have to follow the recommendations of the Royal Commission on Medical Education, namely that students should observe only in very small numbers, that patients should be consulted first by the teacher and that no hospital should make treatment conditional on the patient's co-operation in teaching. If these rules are followed the majority of patients would agree to co-operate quite happily and the teaching services of the hospital would not suffer. They would rather be improved by the development of a more sensitive patient approach which would be beneficial to the students when they begin practising.

Because of the public concern that has been aroused by reports of human 1404 guinea pigs in hospitals, I have included a reference to this in the Bill. Hospitals have been asked to establish ethical committees, and the Department of Health and Social Security is at present making inquiries about how many hospitals have done this and how the committees are functioning.

I am sure that members of the public, and after all any member of the public is liable at any time through illness or injury to find himself in hospital, would be reassured if all clinical investigations on human beings in hospitals which are not of direct benefit to the patient concerned had to be referred to the hospital ethical committees for approval. I have written this provision into the Bill.

I do not think it is necessary to add that the sponsors of the Bill have the greatest respect for the work of the teaching hospitals and a deep appreciation of the need for students to have practical experience in them. We believe that the services and the teaching which these hospitals provide is perfectly compatible with respect for the rights and wishes of patients and that teaching services will be greatly improved if the provisions of this Bill become law.