§ 3.15 p.m.
§ LORD AMULREEMy Lords, I beg to move that the House do now resolve itself into Committee on this Bill.
§ Moved, That the House do now resolve itself into Committee.—(Lord Amulree.)
§ On Question, Motion agreed to.
§ House in Committee accordingly.
§ [The LORD DERWENT in the Chair.]
§ Clause 1 [Provision of voluntary vasectomy services]:
§ LORD ABERDARE moved Amendment No. 1:
§
Page 1, line 19, at end insert—
("(2) It shall be the duty of any local health authority providing voluntary vasectomy services
1292
by virtue of this section to make to the Secretary of State, at such times as he may require, periodical reports as to those services, and the report for any period—
and for that purpose a local health authority shall keep such records as the Secretary of State may from time to time direct.")
§ The noble Lord said: As I indicated on Second Reading the Government do not wish to oppose the Bill, but we have some reservations about Clause 2, most of which was added to the original Bill at Report stage in another place.
§ Clause 2 is in general concerned with the keeping of records and the making of reports, both admirable objects in themselves, but both entailing considerable administrative action; and it is largely on administrative grounds that we are not happy with the clause as it stands. It is divided into three subsections. The first subsection begins by laying a duty on local health authorities to make reports, and this we readily accept. It is contained in substance in the new subsection which I am now moving. But the original subsection goes on to require the Secretary of State to publish all these reports (and there will be 175 of them) within one month and to put them on sale to the general public. We do not think this either practicable or necessary and, if your Lordships agree to the Amendment, I can give an assurance that we will prepare a summary of reports received from local health authorities and make it available in some convenient form.
§ Subsection (2) places a duty on local health authorities to keep records showing how many patients under the age of 30 sought a vasectomy were refused and applied again. This may not he immediately apparent from the wording. but the provision would in fact require arrangements to be made to identify patients who were refused treatment in one area and subsequently sought it in another. 1293 This would entail elaborate and costly administrative machinery out of proportion to any benefits that it might bring. I suggest to your Lordships that the right course is to replace this provision by a requirement that the local authority should keep such records as the Secretary of State directs and for my Department to discuss with local authority associations what arrangements could best be made to give effect to the wishes of Parliament in this respect.
§ Subsection (3) I am afraid the Government find totally unacceptable. This provision would require every local health authority to make a report to the Secretary of State annually on any significant effects on the circumstances or social relationships of men who have been vasectomised under the Bill. This provision would involve quite unacceptable intrusion into the lives of families where the husband has had a vasectomy. Indeed. the thought of such annual check ups could well deter people from having vasectomies under this Bill, despite the fact that they may have a pressing need for the operation.
§ For these reasons I shall be moving the deletion of Clause 2 and the substitution of a new subsection to Clause 1. This will ensure that proper records are kept and that reports are made. I beg to move.
§ 3.19 p.m.
§
LORD STRANGE rose to move, as an amendment to the Amendment:
In line 7 of the Amendment, at end insert—
("() shall show what proportion of those people who have received treatment have a genetic history of mental disturbance or insanity; and").
§ The noble Lord said: I beg to give the background to this Amendment which I put down. Small boy 1911 reads regimental history of experiments on garden peas. Small boy a little older experiments in garden peas. Bigger boy experiments on tame rabbits. Man does large-scale farming with all sorts of livestock experiments and knows by this time that he can identify a genetic character on sight. In older age he experiments and goes through his own family tree to find out what he has inherited in the genetic line. The result is not all that encouraging, because genetic inheritance cannot be altered. He then goes over 1294 his children and watches them growing up, and his grand-children, and now he has reached the stage of being able to tell genetic inheritance characters in many people. I am afraid to say that he even recognises them in Members of your Lordships' House. He tries from what is available to find out where they came from.
§ That is the background to the Bill. At my age I have realised, and I confess, that I am 90 per cent. automatic: I give myself 10 per cent. free will purely out of pride. In the 61 years that this has been going on in my mind, in my practice, I have noticed a great many changes take place. In the 'twenties Freud's theory swam into my ken. That caused—in fact, I think it is still causing—a great deal of comment and experiment. At that time somebody hit the wonderful idea that all men would be equal were it not for early environment or wealth. I think that is a lovely idea, and I am glad that somebody thought of it, because when we look back on our lives and find the colossal mistakes that we have made and the failures that we have had it is nice to know that it was not our fault. But it does not really ring true to-day.
§ If I suffered from a lethal early environment, it is possible that working in a factory I might go bald from some chemical accidentally sprayed over me. But if I have inherited early baldness, I will go bald whatever the conditions are. If I am rich, I may be left with complexes and one thing and another; I may sit on couches or I may lie on them; I may hear everything that has to be said. But I will never cure (if I may put it that way) the genetic inheritance that made me rich and will go on making me rich when conditions alter, because my genetic inheritance is fly enough to make me see round this point. Genetic inheritance cannot be altered: we have it; we succeed to it; and it is not our fault. If we could alter it we should fall to bits.
§ I know that this is an unusual Amendment and it is an unusual background, but, as I usually am, I am sincere in what I say. We come to the point about madness, insanity. Insanity in itself is not hereditary; but the physical factors 1295 which cause it are. I could go into this at depth and prove my point, but I should need a great number of books, your Lordships would probably all go bald while I was doing it and it would lead to a lot af arguments. So I will merely give two examples. The first, whom I shall call X was a member of a family of six children. Five of them went through their lives in and out of what he called the "bin"; and one was perfectly sane and normal. I could give your Lordships the genetic background for that, but I will not bore you by making this talk longer than I have to. All I would mention is that X said to me: "My sister is getting married." I said to him: "Which one?"—hoping that it would be the one I wanted it to be. He said that it was so-and-so—I will not mention her name. I said: "Where did she meet her husband?", and he replied: "She met him in the 'bin'". I did not say anything. But that is an expression that has haunted me for 30 years, and I shall never get it out of my mind as long as I live. That is just one example of what is at the back of my mind.
§ The other example is an unusual one, and I do not mind if your Lordships recognise the character in it. A man whom I thought very distinguished, good-looking, charming and intelligent had a sister who was insane. He went over the whole of his family history—a very distinguished family history—and came to the conclusion that insanity was hereditary in his family. He married a lady who was too old to have children: he wanted his line to come to an end; and so it has. That is an example of what can be done about insanity, which is a perfect nuisance in all its forms in the world to-day.
§ I do not want to go on for too long, but I think I should explain a little clearer the reason for this Amendment. I would put it in this way. Normally evolution takes care of all this. The mad people are not fly enough—they get killed off; the tribe kill them off. Or we have population explosions—I think of the rather attractive little mammal in Norway which swims down the fiords to its death. Occasionally the ladybird, 1296 to give it the popular name, has a population explosion, and they are swept up all over the country. But our species of creature has managed to evolve to such an extent that we are going under our own steam. We have got beyond the power of the evolution system to control us. We can control ourselves only by these ghastly and lethal wars. In my lifetime, at any rate, we have become so clever at making things that we are destroying our world. When I say "we are destroying our world", I mean that it is the people who have genetic faults, like the one that I have mentioned, who cannot stop destroying it. A tremendous greed comes to them through genetic inheritance. I mentioned the case of the rich man psychiatrist. They cannot avoid it; it is nobody's fault.
§ I think the time will come when we have to face genetic inheritance and forget the rest. The point is that you do not have to go to a psychiatrist to be cured of biases, complexes and inhibitions; you can cure them yourself by recognising them, if you have the guts and the intelligence to do it. The only thing that we have to worry about in future is genetic inheritance. We all hope that we do not know how we are going to end up. in a Jules Verne period of time. It does not look very good. Now intelligent people have made these wild saucers, and they are going into space to find out if there are any other animals who are similar to us. Well, if there are any other animals who are similar to us they will not answer back. because they will have killed their world millions of years ago, just as we are now trying to kill ours. Our only hope for the future is to try to restrain ourselves—or, if I may use a modern expression, perhaps make an A.I. bank of really good genetic inheritance that may be used in the future.
§ I have spoken in a visionary way, because you get to the time in this House when people have heard you often enough; and you want to say what you really think, quite seriously, without too many jokes, while you have the opportunity of doing so. That is the background of the Amendment, which starts in such a mild way: it is insidious. The essence of it is that somebody who wishes, 1297 for no particular reason, to be castrated—I do not think that is quite the right word—
§ BARONESS SUMMERSKILLSterilised.
§ LORD STRANGEI am obliged. I was thinking of farming and animals. We do what we call a "short cut" on them, but we never castrate the pedigree bulls on whom we have spent years of genetic research in order to build them up into what we want. We preserve them. That is the background of this Amendment.
I do not expect anyone in your Lordships' House to have followed me throughout my remarks, or to have agreed with me, but I am glad to have been able to say what I have said. I shall probably withdraw this Amendment later on.
§ 3.31 p.m.
§ LORD AMULREEI should like to thank the noble Lord, Lord Strange, for giving us such an interesting talk on the subject of genetics and heredity in general. I could not quite follow all that he said, but I did understand a great deal of his speech. However, I should like to point out that it really seemed to me to have no bearing on this Bill.
§ LORD AMULREEThe Bill we are now talking about is an enabling Bill, pure and simple, so that local authorities may include the operation of vasectomy among their family planning activities: nothing more than that. The information that may be required by the Department or by the Secretary of State would be available if needed. I am greatly inclined to accept Amendment No. 1 and therefore I feel that the Amendment of the noble Lord does not really apply. There are many things that need to be known: for example, the number of people who write with their left or their right hand; the number of people who have red or black hair, and so on. But these things do not come into the Bill we are now discussing. I very much hope that the noble Lord will see fit to withdraw his Amendment and not press it.
If I may now speak to the first Amendment, may I say that I am very grateful to the noble Lord, Lord Aberdare, for having put down this new subsection, 1298 which in many ways seems preferable to the original Clause 2. Therefore, when the other Amendment is moved, to leave out Clause 2, I shall have great pleasure in accepting it.
§ LORD STRANGEI thank the noble Lord, Lord Amulree very much for his kind remarks about what must have been to all doctors present in your Lordships' house, and indeed to everybody else, a difficult and, indeed, embarrassing speech. I made it for obvious reasons, and because I wanted to get it off my chest while I am still available to do so. But, to do it justice, I personally do not think this Bill will see the light of day. I should vote for it if it did, but I am pretty sure that it will not reach the Statute Book. I am not debating the Bill, but what I would settle for is that the noble Lord should say to me, "I will think it over", which is a very nice remark from the Front Bench: it means nothing and it lets me out.
§ 3.34 p.m.
§ LORD ABERDAREMy Lords, may I say just a word about the Amendment of the noble Lord, Lord Strange? The thing that surprised me was that he took credit for only 10 per cent. of free will. I should have thought that anyone who showed a greater percentage of free will than the noble Lord would be hard to find in your Lordships' House—otherwise he must have a most potent combination of genes. But we appreciated the noble Lord's interest in genetics, and I would only say that there is every possibility that this Bill will find its way on to the Statute Book. It has already been through another place, and if your Lordships pass it through its Committee stage to-day there is every possibility of its reaching the Staute Book. I should like to make this point: that if there are genetic factors which make vasectomy desirable, that operation could be performed on health grounds and could therefore be done in hospital. This Bill will merely enlarge the possibility and allow local authorities to undertake vasectomies in certain instances. However, I hope that the noble Lord will withdraw his Amendment to the Amendment.
§ LORD STRANGEI thank the noble Lord very much. He always displays the utmost civility. I did not quite hear all he said, but I thought he said, "I 1299 will think it over "—and I thank him very much. I am sure that we in this House all know that I was putting on rather an act and I can only ask your Lordships to forgive me. I beg leave to withdraw my Amendment to the Amendment.
§ Amendment to Amendment, by leave, withdrawn.
§ LORD SEGALIf I may refer for a moment to the main Amendment moved by the noble Lord, Lord Aberdare, to add a new subsection to Clause 1, I hope that the House will support it and will delete Clause 2 as it stands. I have always felt that it is rather invidious to lay down a definite age limit, and Clause 2(2) says:
… to keep a record for the first two years of operation of this Act showing how many patients under the age of thirty years applied for but were refused treatment …".As we all know, the age of maturity has varied during the last ten or twenty years. People are now becoming adult at a much earlier age than was hitherto believed possible, and it may often happen that someone under the age of thirty years may produce very strong and justifiable grounds for having this operation done. I think it is a definite advance that the age of thirty years is to be deleted from the noble Lord's Amendment.The other point that I would raise concerns paragraph (c) of the proposed new subsection (2), which states that the local health authority's report
shall give such other information possessed by or available to the authority as the Secretary of State may request …".At the present time most of the vasectomy clinics go meticulously into the factors that must operate before this operation is undertaken—and that, too, with reference to the Amendment which the noble Lord, Lord Strange, has just withdrawn. In spite of his persuasive tones, I felt that his case might have been stronger had lie worded his Amendment to show what proportion of those people who have not received treatment has a genetic history of mental disturbance or insanity: because, as the noble Lord, Lord Aberdare, has just mentioned, one of the strongest factors that would justify such an operation is the existence of a genetic history of mental disturbance or insanity. But again I would stress that the most meticulous details have to be 1300 studied before any operation of this nature is agreed upon.I have a list of the details that are required from any applicant. The third question asks for a record of the husband's health. The fourth question concerns the wife's health, general health. obstetric health, and gynæcological health. Even after the Family Planning Association's doctor has recommended that this operation should be performed, he has to explain to any applicant the full implication of it. Out of a list of thirteen items which he is required to explain to the applicant, the first one is to make clear that the operation must be regarded as irreversible. The second is that the consent of the general practitioner is essential; and here I would say that I hope that in every case the general practitioner will be approached by anyone who is in charge of the clinic and a full history of any mental insanity or disturbance will be recorded before anything in the nature of such an operation is sanctioned. I consider that the proposed new paragraph (c) requires all kinds of information which may be deemed necessary to be returned by the local authority accepting, as he was so clear to stress, that absolute insistence of secrecy shall be maintained at all times. I have no hesitation in hoping that the Committee will adopt the Amendment moved by the noble Lord, Lord Aberdare, and add the new subsection to Clause 1.
§ BARONESS BIRKI should like to support the Amendment of the noble Lord, Lord Aberdare. It is a great improvement on what was originally in the Bill. I agree with my noble friend Lord Segal on the age limit of 30. I think this is an extremely worrying point. One of the advantages of the Amendment is that it puts the whole matter much more neatly and more formally where it should be in the whole range of the contraceptive service rather than it being a very special area. The special part about it is the irreversibility; but this applies to women who are sterilised. I was not quite happy with regard to the point about the consent of the general practitioner being obligatory. Perhaps the Minister can help us on that point. We have had many letters to the Health Education Council indicating for all sorts of reasons, religious and otherwise, that the general practitioner has been against the whole idea 1301 and concept of vasectomy. I had hoped and envisaged that, as a result of this Bill going on the Statute Book, there would be the opportunity, particularly in those cases, for the patient to see another doctor who may take a different view. If the G.P. is against vasectomy—and this applies to all forms of contraception—it does not seem right that a person should be denied help because of the views of his own doctor. Because the age limit has been removed and because of the whole flavour of this Amendment, I think it is a great improvement to the Bill. I hope it will be accepted and that the Bill will go on the Statute Book.
§ LORD PLATTAs a former President of the Family Planning Association, I feel that I should add my congratulations to the Minister on this Amendment which is a great improvement. Although the noble Lord, Lord Strange, has withdrawn his Amendment to tile Amendment, perhaps I would not be out of order in saying that the Amendment we are now discussing would give ample opportunities for research to bodies such as the Eugenic Society, of which I have also been President, to make use of the new situation in which vasectomy will become a common operation and large numbers of people can be studied by proper scientific methods. Also, a certain amount of information which will be helpful to people like the noble Lord, Lord Strange, who are worried about the inheritance of mental diseases, will probably conic out of these investigations.
§ LORD ROBBINSWill the Minister give us an assurance that the consent of an objecting G.P. on religious or philosophical grounds will not be an obstacle to the provision of this facility?
§ 3.44 p.m.
§ BARONESS SUMMERSKILLI was going to raise this matter. I am rather concerned about this point because the general practitioner of the average patient is the doctor whom he has chosen under the National Health scheme. This doctor will have a full record of the patient. I quite understand that the general practitioner's advice is important because he alone has the patient's record. But when the patient first chose the doctor he may not have been thinking in terms of vasectomy and did not ask his neighbours, "Has this doctor any religious objection 1302 to sterilisation?" But as the years pass and the patient decides to have a vasectomy operation he realises that this particular doctor, his general practitioner, as is defined in the Bill, would have religious objections. I should like the noble Lord to tell me what will be the position in that case. Would be consider a further Amendment giving a patient who wishes to have a vasectomy but who, nevertheless, has a general practitioner who has religious objections to it, permission to go to some other doctor, or can we rely upon the advice from the hospital or the doctor who already has been recognised as the individual who will perform a vasectomy?
§ LORD LEATHERLANDWe have had speeches from five very experienced and distinguished doctors. It may not be inappropriate if the voice of an ordinary man is raised. I am not a medical man; I have never touted for a clinic; I have never been vasectomised. However, just as I supported the Bill with one or two small qualifications on Second Reading, so I support the Amendment put forward by the noble Lord, Lord Aberdare. The original Clause 2 imposed upon the local authorities far too great a responsibility for providing far too much information in a red tape manner. whereas the Amendment of the noble Lord, Lord Aberdare, simplifies this and gives the authorities all the information that they need. For instance, it does away with the suggestion in the original Clause 2 that an annual report should be made available for sale to the general public. I hardly think that that is necessary; the newspapers will give good coverage to such information as the Ministry discloses. Speaking as an old newspaper man. I recollect that if the word "sex" appeared in a Government report it was certain of being given a good show in the general newspapers.
I feel that the Amendment moved by the noble Lord, Lord Aberdare, is an improvement; but I am rather sorry, perhaps for personal reasons, that the noble Lord, Lord Strange, has withdrawn his Amendment. I think the information regarding any mental instability in a family would have been very valuable data for inclusion in such reports as local authorities had to make. Another reason why I should have been glad to have come to the support of the noble Lord, 1303 Lord Strange, involves our families. Back in the early years of the 15th century, when the noble Lord's family were the rulers of the Isle of Man, they were confronted with a revolution and so a Lieutenant-General had to be appointed to quell that revolution. The name of the Lieutenant-General was Leatherland. Just as we went to the rescue of the Stranges in those days, so I should have been willing, had the noble Lord's Amendment remained before the Committee, to go to his support on this occasion. Nevertheless, I support the noble Lord, Lord Aberdare.
§ LORD AMULREEMay I intervene for one moment in this debate to point out once more that this Bill is a Bill merely to enable local authorities to include vasectomy in their family planning work? It does not compel anyone to be vasectomised; it does not stop anybody. It is merely there to enable the authorities to include advice, which may be pro or may be con, about this kind of facility, and if the advice is that the operation should be done it may be carried out. We tend to get lost about an extremely simple purpose in this Bill.
§ LORD ABERDAREI am grateful to all your Lordships who have spoken on this Amendment—all, happily, supporting it. As the noble Lord, Lord Amulree, has just said, we have gone rather wide of the Amendment itself which is concerned purely with the keeping of records and the making of reports. However, I take it that your Lordships are content with that. The noble Lord, Lord Segal, started the rot, I think, by referring to the requirements of consultation with the general practitioner, which point was taken up by the noble Lord, Lord Robbins, and the noble Baroness, Lady Summerskill. As I said on Second Reading, the Chief Medical Officer has set up a group of professional people who will advise medical officers of health on the provision of vasectomies under the local authority. This is a professional matter for this group to consider and decide what their advice will be. But I will certainly make sure that what has been said this afternoon is drawn to their attention. I suspect that certainly the advice of the person's general practitioner would be taken. But, on the other hand, it would not follow that necessarily his 1304 consent would be required if the person concerned wished to have the operation performed and satisfied the clinic that this was an essential operation.
§ BARONESS BIRKMay I raise a point on my noble friend's comment on that question? I believe it is right to say that what he was referring to was a questionnaire put out by the Family Planning Association at the moment; that this in fact is not obligatory at all, it really has not any connection with this Bill, and that it would not necessarily be in any guidelines which are put out by the Ministry to the local health authorities. We ought to be quite clear about that because, although it may be a red herring, it has been brought into this issue.
§ LORD ABERDAREThis is perfectly true. We are straying away from the Amendment. But there will be this group and a circular will be issued from the Department, first of all, to the local authorities. There will also be this professional guidance from the working group which has been set up by the Chief Medical Officer.
§ LORD SEGALWould the noble Lord not agree that in cases where the operation of vasectomy has been performed it would be only right, while accepting fully the safeguards of secrecy, that the general practitioner of the patient, possibly in the interests of both the patient and his wife, ought to be notified?
§ LORD ABERDAREI would think as a layman that this would be absolutely essential, as the noble Lord says, but I would prefer that it should be left to the Chief Medical Officer's working group finally to advise the medical officers of health.
§ BARONESS PHILLIPSI am not quite sure whether I should put this point to the Minister as a layman or to one of the noble Lords who is a doctor. Several noble Lords are rather concerned about the question of what is the difference between general health records and health records relative to obstetrics and gynæcological records. It seemed to me that general health would cover all these areas. In any event, I am not sure of the difference between a gynæcologist and an obstetrician; but this is a finer point.
§ LORD ABERDAREI am really rather straying from the Amendment now. I do not see either the word "obstetrics" or "gynæcology" in the Amendment. We are considering purely the records that will be kept by the local authority. There will be two kinds of records. The local authority will go into the case of the person concerned before the operation is performed. That is a confidential inquiry to make sure that the operation is required. Then, also, they will be keeping records from which the Secretary of State may be able to make a summary eventually for the information of the general public. What will be in these returns will be discussed between my Department and the local authority associations, if your Lordships agree to this Amendment.
§ On Question, Amendment agreed to.
§ Clause 1, as amended, agreed to.
§ Clause 2 [Reports to be made and records to be kept by local health anthorities]:
§ LORD ABERDAREI beg to move Amendment No. 3, to leave out Clause 2. This clause is replaced by the new subsection in Amendment No. 1, which has been accepted.
§ Amendment moved—
§ Leave out Clause 2.—(Lord Aberdare.)
§ On Question, Amendment agreed to.
§ Remaining clauses agreed to.
§ House resumed: Bill reported, with the Amendments.