§ Motion made and Question proposed, That this House do now adjourn.—[Mr. Heathcoat-Amory.]
§ 10.6 pm
§ Miss Ann Widdecombe (Maidstone)
I am most grateful for the opportunity to raise this issue tonight. I thank you, Mr. Speaker, for selecting this debate on the topic of the Carlisle baby. The case has been raised in questions to various Ministers and also as part of the general abortion debate, but it raises so many issues of national importance, affecting all regional and district health authorities and hospitals where abortions are carried out, that it really deserves a debate of its own.
I have given my hon. Friend the Minister notice of the principal questions that I intend to raise in the hope that many of those hitherto unanswered questions will be answered, and that certain things that went on in Carlisle will finally come out into the light of day.
In raising the issue, I have confined myself to the material contained in affidavits, sworn properly before a solicitor, information given to the priest, the chaplain of Carlisle city general hospital, and certain press coverage that has gone unchallenged.
Nevertheless, I recognise that not all hon. Members share my concern about the events in Carlisle in July 1987. I offered my hon. Friend the Member for Berkshire, East (Mr. MacKay), who I know to be entirely honourable and who would therefore have confined his time appropriately, the opportunity, if he wished, to intervene in the debate, but, alack, this place is as empty of himself as the arguments of the pro-abortionists on the subject are of reason and merit.
In summary, on 21 July 1987, a woman was admitted to Carlisle city general hospital, 21 weeks pregnant, for an abortion. No injection was used to ensure that the child would be born dead, and the method used was the prostaglandin method. In the event, the child was born alive. She lived for three hours, during the course of which she was baptised by one of the nurses. She was left gasping on a kidney dish. No ventilation or incubation equipment was available. Two nurses were left to cope with the situation alone without proper supervision. When the child died, no death certificate was issued, and no birth certificate has ever been issued.
The mother did not find out for six months that the child had lived. When eventually the facts came to light, through the good offices of a Catholic priest, a police file was prepared on the case that led the coroner in Carlisle to recommend that it was in the public interest that an inquest should be held. Normally it is routine that an inquest would follow, but on this occasion it did not.
The case raises a large number of questions, both about the compliance of our hospitals—in the NHS and the private licensed clinics—with the Infant Life (Preservation) Act 1929 and about the conduct of late abortions in general.
The 1929 Act states:any person who, with intent to destroy the life of a child capable of being born alive, by any wilful act causes a child to die before it has an existence independent of the mother, shall be guilty of … child destruction".That is any child capable of being born alive—and the Carlisle baby was born alive.
That same Act states that at 28 weeks thereshall be prima facie proof461 that the child will be capable of being born alive. It does not say "before 28 weeks there is no proof". It simply gives absolute protection after 28 weeks. If anyone has reason to assume that a child before that time is capable of being born alive, to procure its death is an act of child destruction. That is made very clear under the 1929 Act, and it is clear in the Abortion Act 1967 that nothing in it negates the provisions of the 1929 Act.
We are faced with a very strange situation. A piece of law states that it is child destruction to kill a child before it has an independent existence from its mother if it is capable of being born alive. Yet widely practised in the private clinics is the diabolical method of D and E in which the child is dismembered alive, without anaesthetic, in the womb. Is my hon. Friend the Minister really satisfied that our NHS hospitals and the private clinics that he must license are complying with the law? In the NHS hospitals, where that diabolical method is not practised, an injection of urea or saline is given to a child before abortion by the prostaglandin method. How does ensuring that the child is born dead possibly comply with the 1929 Act? As we now know that children can survive independently of the mother as early as 24 and possibly 23 weeks, what possible reason can there be for allowing any abortions after those weeks if the 1929 Act is to be complied with? That has been generally recognised.
We have another complaint, because not only is it permissible to kill those children in hospitals, despite the 1929 Act, but, just to make a sop in the direction of complying with the Act, there is a set of regulations. They were enunciated by the then Secretary of State, Mrs Barbara Castle, on 21 October 1975, when she said:In the National Health Service the Select Committee's recommendation that terminations after the twentieth week of pregnancy"—the Carlisle baby was 21 weeks—should be carried out only in hospitals possessing appropriate facilities, including resuscitation equipment, have been accepted, and discussions have been held with regional medical officers who will be responsible for the implementation of the recommendations."—[0fficial Report, 21 October 1975; Vol. 898, c. 245.]Furthermore, in approving private clinics the Secretary of State demands that they have ventilation and incubation if they are to carry out terminations after the 20th week; demands that there should be staff instructed in their use and available to use them; demands that arrangements be made for the child to be taken to the nearest special baby care unit. I am sure that we do not expect less from the NHS than we expect from the private sector. I ask my hon. Friend the Minister whether at any time the East Cumbria health authority gave notice to him, or to any of his predecessors, that it could not comply with the conditions set out in 1975 and re-enacted ever since.
Was my hon. Friend under the impression that Carlisle city general hospital could comply with those regulations? If he was not, what steps has he taken to ensure that other hospitals, in other areas, that have not had the horror of this case and therefore have not come to public notice, can comply with those simple provisions about ventilation, incubation and trained staff?
Why were two nurses left unsupervised? Why were no instructions given by the consultant who had authorised and, indeed, started the abortion? Why was their only telephone contact with a junior doctor who was on duty 462 that night? What was done by senior medical staff in Carlisle city general hospital that night? Is all that normal procedure at Carlisle? Is it normal for nurses to be left unsupervised to cope with very complicated and unexpected cases? If so, is that also done elsewhere? Is my hon. Friend aware that the junior doctor on duty that night did not wish to participate in abortions? Wherefore the workings of the conscience clause?
I come now to the cruellest point of all. It appears that the diagnosis was possibly wrong. The abortion was carried out under section 1(1)(b) of the 1967 Act, which states that abortion is permissible where "there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped."
In this case the diagnosis was that the father had a mild form—and it was mild—of Ehlers Danlos syndrome, which the child in turn had only a 50 per cent. chance of inheriting and which ranges from a very minor disability to being quite serious in some forms. Can that be described as a substantial risk? If the Minister had to take a bet on such odds, would he think it likely that the odds were in favour of the child coming out handicapped? No proper analysis was made of whether that diagnosis was right or wrong.
We come to the aftermath of the Carlisle case and to what I can only describe as a massive cover-up. There was a police investigation and a recommendation for an inquest. It is not my hon. Friend's responsibility to approve inquests, but may I ask him to say in how many other instances of death in an NHS hospital where a coroner has recommended an inquest has that recommendation been turned down? How often does that happen?
Is there or is there not a law which says that live births shall be registered? Why was the Carlisle baby not registered'? Why, when it had lived for three hours—wanted, normal and baptised—was there no death certificate? Why was the mother not offered the option of a funeral, which is offered even in the case of stillborn babies, let alone those who have lived'? Why was not the mother told of the true situation for six months? Why was it left to a priest to bring the matter into the light of day, and why was the priest's contract not renewed? Is it true, as the nurses have stated, that their union advised them to keep quiet and not to take any legal action?
Will the Minister admit that a thorough overhaul of procedures is needed and that what happened in Carlisle that night brings credit to nobody and that the regional health authority must answer properly for its implementation of the ventilation and incubation requirements'? Will he also agree, chillingly, that there was a similar case in 1983, alas not the subject of so much publicity?
When that little light was extinguished in Carlisle, a great darkness fell on the NHS, on its civilisation and on its compliance with basic law. Does the Minister agree that for a live, wanted, normal, baptised child to live for three hours on a kidney dish—not even in a warm cot and not in its mother's arms—not in an incubator but on a kidney dish, is a disgrace? Will he join me in regretting that the case was not resolved in the light of day?
I now make a statement of fact and I do not make it threateningly. I have not tonight named any of the staff involved, the chairman of the regional health authority, the hospital administrator or anybody else, not even under privilege, but if a similar case occurs again in any part of 463 the country a considerable body of parliamentary opinion will insist that that case is solved in the light of day, even if it means coming up with names and personal identities in the House.
I summarise my questions to the Minister and I would like him to answer all of them. I hope that I have left him sufficient time in which to do that. How does killing a child before birth tie in with the Infant Life (Preservation) Act 1929? What is the point of insisting that ventilation equipment shall be available if the child is allowed to be killed? Will the Minister consider outlawing completely the barbaric D and E method? Does he expect the NHS to match the standards that he lays down for private hospitals? Did East Cumbria ever indicate that it could not comply with the regulations and, if not, why was ventilation not available that night? Why were two nurses left alone unsupervised? In how many other instances of death on NHS premises has a recommended inquest been refused? Why was there no birth certificate? Why was there no death certificate?
Does the Minister agree that there was a cover-up and, if he does, what disciplinary action was taken, and if none was taken, what steps will be taken to ensure that this never occurs again? Why was the mother not told for six months that the child had lived? Why was the priest's contract not renewed? Is the Minister satisfied that the abortion complied with section 4 of the 1967 Act, and does he agree that that section is widely abused and that this is only one instance of it? What steps has he taken to revise the regulations or to re-emphasise them, in the light of the Carlisle case, to all regional health authorities? Why was there no option of a funeral?
I hope that the Minister will answer those questions. They all need answering. If they are not answered, this issue will be properly raised again in the House.
§ Mr. Ken Hargreaves (Hyndburn)
I am grateful to my hon. Friend the Member for Maidstone (Miss Widdecombe) for allowing me to make a brief contribution to the debate. We should be grateful to her for raising this important case and to the Minister for being here for the Adjournment debate this evening. I believe he has replied to every Adjournment debate this week, and I am grateful to him.
The Carlisle baby case is disturbing, as the facts outlined by my hon. Friend the Member for Maidstone have brought home to us. On Tuesday, the Under-Secretary of State for Health said:The Abortion Act has to be read alongside the Infant Life (Preservation) Act 1929, whose basic purpose is to protect the life of the unborn child, except where termination of pregnancy is necessary to save the life of the mother."—[Official Report, 6 June 1989; Vol. 154, c. 206.]That did not happen in this case. There was no protection for the child under the Infant Life (Preservation) Act. It was not only capable of being born alive, but was actually born alive. There is no doubt about that. However, there was no prosecution, and not even an inquest.
Nobody comes out of the case well. The hospital authorities, the Home Office, and the health authority do not. The Church does not because it could have done more to ensure that the chaplain was reinstated. Many people have a lot to answer for. We intend to continue to press this case until we have satisfactory answers.
§ Mr. David Amess (Basildon)
I entirely endorse the comments of my hon. Friend the Member for Maidstone (Miss Widdecombe) and I admire her tenacity on this issue and all her supportive remarks about abortion.
In December, I and a number of colleagues raised, at Home Office questions, the Carlisle baby case and my hon. Friend the Under-Secretary for the Home Department was frank in his replies. He said:There has been only one conviction for child destruction in the past ten years.He continued:There is quite clear and compelling evidence that the rebuttable presumption should arise not at 28 weeks but at 24 weeks,"—[Official Report, 15 December 1988, Vol. 143; c. 1074.]I recently asked my hon. Friend the Minister a number of questions about abortion and I shall not detain the House with his answers today. He was frank and the number of late abortions carried out make one sad, particularly the fact that an abortion was carried out on a 10-year-old.
In an Adjournment debate in 1986, I raised the issue of abortions in private clinics. I am not happy with the procedures carried out. I do not expect my hon. Friend to respond tonight, but I hope that in due course he will write to tell me what advice his officials give to private clinics.
Is it a wonder that we face social problems and that life has become cheap when the number of abortions carried out in the United Kingdom is so high? I certainly hope, as would the majority of hon. Members, that well within the lifetime of this Parliament we shall have a clear opportunity to vote on the stage at which abortions can be carried out in this country. I very much hope that we shall vote to reduce the legal limit and that the Infant Life (Preservation) Act will no longer be the nonsense which it so clearly is today.
§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)
My hon. Friend the Member for Maidstone (Miss Widdecombe) was fortunate to secure this Adjournment debate tonight. I think that she described the case as distressing and sad, and I agree with her. Her contribution to the debate and those of my hon. Friends the Members for Hyndburn (Mr. Hargreaves) and for Basildon (Mr. Amess) were illuminating and important.
In the 11 minutes left I can answer but a few of the points raised, but I shall study the reports of this debate. My hon. Friend raised a number of issues and was kind enough to give me an outline of the points that she intended to raise. I hope that she will bear with me and accept an answer in correspondence to many of the points that she raised. Likewise, I shall write to my other hon. Friends.
The debate has centred on the Carlisle baby case—a termination of pregnancy on grounds of likely serious physical handicap which took place in Carlisle hospital in July 1987. I am anxious to demonstrate to the House that this case has been closely examined by the health authority and by the Department of Health, and also, as regards the matter of an inquest, by the Home Office. But in doing this I have to bear in mind two different matters. The first is that of patient confidentiality. Termination of pregnancy is for the women concerned inevitably stressful and it is 465 therefore clearly important that the usual standards of confidentiality should be adhered to with particular rigour. The second is the question of possible legal proceedings on behalf of the women. I am advised that this question is still outstanding and I have therefore to bear this closely in mind in what I say briefly tonight.
When the various concerns about the case became apparent the East Cumbria health authority set up an internal committee of inquiry which included an independent gynaecologist, and produced conclusions and recommendations. The committee concluded that the termination of pregnancy was properly performed within the requirements of the Abortion Act but that there was some disregard of the patient's right to confidentiality and lapses in communication at and after the event. Its report, which identifies the staff involved and gives details about the patient's circumstances, is confidential. In the light of the committee's findings and recommendations the authority has tightened its procedures in various ways to ensure that they are in line with best practices. Written guidance to both medical and nursing staff has been strengthened and staff have been reminded that all information relating to patients must be kept confidential.
My hon. Friend asked first about resuscitation equipment and the 1975 Select Committee report. The Committee's recommendation that termination after the twentieth week of pregnancy should be carried out only in hospitals possessing appropriate facilities was accepted and in the NHS responsibility for its implementation has been the responsibility of regional medical officers. The Committee's recommendation was discussed with RMOs in September 1975. They said that there would be no difficulty in implementing the recommendation.
In March 1983 RMOs were reminded that the Department wanted to ensure that all NHS gynaecological staff who undertook late abortions were aware of the requirement that resuscitation equipment should be available. The RMOs felt that this requirement was sufficiently well known and observed by NHS consultant gynaecologists, and saw no need for the Department to issue particular guidance on the subject. In the Carlisle baby case the position is that if a decision had been made by the doctor concerned to resuscitate the foetus the necessary equipment was available on site and would have been on the scene within a matter of a very few minutes.
My hon. Friend asked about the Infant Life (Preservation) Act 1929 which makes it an offence to destroy the life of a child which is capable of being born alive. In any particular case it is a matter for the clinical judgment of the individual doctor whether a foetus, at any age, is capable of being born alive. Doctors are properly mindful of the requirements of the Act and do not carry out an abortion, by any method, when they consider that a child is capable of being born alive. As for the method used to perform an abortion, that too is a matter for the clinical judgment of the doctor involved having regard to all the circumstances of the particular case.
I am sure that my hon. Friend will agree that we should not put ourselves in the position of clinicians, making a judgment about whether a child is capable of being born alive. It is for the courts to make a determination given the circumstances of a particular case and I would not wish to go further than that.
466 My hon. Friend asked about the supervision by the nursing staff and specifically about the nursing staff present at the termination. They were not alone and they were not unsupervised. Two nurses were caring for the woman under the supervision of a sister. The doctor was called on delivery and attended quickly. He decided not to attempt to resuscitate the foetus and informed nursing staff to that effect. That was entirely a matter for his clinical judgment.
The question of deaths on National Health Service premises where a recommendation for an inquest is turned down, is a matter for my right hon. Friend the Home Secretary and I will see that my hon. Friend's comments are brought to his attention.
My hon. Friend asked me why the baby's birth was not registered. The Births and Deaths Registration Act 1953 requires that any child born alive shall be registered and if the child subsequently dies the death also falls to be registered. Where more than 12 months have transpired since a birth or a death the registrar general's authority is required for the registration. In considering any such application for registration after 12 months the registrar general needs to be satisfied that a registerable live birth or death has occurred. I understand that no such application has been made in this case.
My hon. Friend asked why the mother was not told for six months that the baby had lived. The doctor made a clinical judgment that this was not a live birth. In the circumstances staff decided to say nothing to the mother after the doctor made his decision.
My hon. Friend asked about policy on burial arrangements. At the time to which these events refer it was the health authority's general policy to offer ordinary burial for stillbirths but not for terminations of pregnancy. This policy has now been extended to cover situations in which the foetus is over 20 weeks' gestation and guidelines have been issued to staff that burial of the foetus should be offered to the mother in these circumstances.
As regards the incineration of the foetus, this was the health authority's normal practice at the time, but, as I have already said, the procedure has now been changed. In cases over 20 weeks' gestation the foetus is now retained for 48 hours to allow for a request for burial.
My hon. Friend asked about the priest's contract. As she knows, the Department of Health does not intervene in the decisions of statutorily independent health authorities as they relate to questions of employment of individuals, and it would not therefore be appropriate for me to comment.
My hon. Friend asks for an assurance that the lessons from the Carlisle baby case will be learned. It is clear that this was in many ways an exceptional case. It attracted considerable publicity and has been closely studied in the Department, culminating in correspondence between the Minister for Health and the chairman of the authority, who assured us that the lessons of this very sad episode have been fully learned. The Department will also take close account of this case in its future administration of the Abortion Act 1967.
My hon. Friend implied that the diagnosis of handicap in this case was wrong. This is a misunderstanding of the position under the Abortion Act 1967. The Act requires that in cases such as this doctors should give an opinion, in good faith, that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped. This is a 467 matter of clinical judgment and I have no reason to believe that the Abortion Act is not being properly observed on that point.
I have gone into some detail, as far as the requirements of confidentiality and possible legal action allow, about the facts of the particular case which has given rise to concern. I hope that hon. Members will accept my assurances and those of the Minister for Health, who has also looked into this matter, and of the Home Office that this case has in its various aspects been closely studied. On the general question of late abortions, my Department will continue to ensure that the law and practice on this extremely difficult subject are administered as closely as possible. This is of course entirely without prejudice to any changes in the law on abortion which Parliament may see fit to adopt in the future and which it would not be right for me to discuss in any detail in this Adjournment Debate. I am, however, grateful to my hon. Friend for giving me the opportunity to set out the position.
On the general question of abortions, let alone late abortions, it has of course been long-standing practice in the House for Members to be able to express their own personal views on this issue. As regards that general policy, the Government have been consistent and, like my 468 hon. Friend, I find this case extremely distressing and sad. Whatever my own personal feelings, I see it as my duty tonight and in future correspondence with my hon. Friend to answer the facts of the case so as better to inform not only my hon. Friend but all hon. Members. In answering those questions of fact, one's own personal views or opinions concerning the issues that have been raised are in no way implied.
I undertake to write at length and to answer as comprehensively as possible the points raised by my hon. Friend.
§ Miss Widdecombe
With the leave of the House, Mr. Speaker, may I thank my hon. Friend for his very comprehensive reply to a long series of questions? I am grateful to him. Throughout his reply ran the theme that a live child does not have rights so long as it is the product of an abortion. To take the burial question, it was a live child; it should have been registered; it should have had a death certificate. Merely because it was the product of an abortion does not mean that it had fewer rights than a child born prematurely.
Question put and agreed to.
Adjourned accordingly at half-past Ten o'clock.