§ 8.27 p.m.
§ Moved, That the Report be now received.—(Lord Amulree.)
§ Clause 1 [Provision of voluntary vasectomy services]:
LORD BROCK moved Amendment No. 1:
Page 1, line 10, leave out from ("amended") to end of line 19 and insert (" by the insertion after subsection (2) of the following new subsections:—
'(2A) A local health authority in England or Wales may, with the approval of the Minister of Health, and to such extent as he may direct shall, make arrangements for the giving of advice on voluntary vasectomy, the medical examination of persons seeking advice on voluntary vasectomy for the purpose of determining what advice to give and for treatment for voluntary vasectomy.
(2B) A local health authority may, with the approval of the Minister of Health, recover from persons to whom advice is given, or treatment provided, under subsection (2A)
above or from such persons of any class or description such charges (if any) as the authority consider reasonable, having regard to the means of those persons'").
§ The noble Lord said: My Lords, I should explain that I was abroad attending an international congress in an official capacity when the House was in Committee on this Bill and thus could not move the amendments that I wished. I felt that I must make an attempt to obtain an Amendment of the form of this Bill in which actual surgery is dealt with so unsatisfactorily. On Second Reading I pointed out how objectionable it is to class an act of surgery, an operation, with various "substances and appliances" such as lubricant jellies, occlusive pessaries and condoms. I commented that this was mean and demeaning, even though not intentionally. I did not oppose the Bill's intent to add voluntary vasectomy to the facilities available under the National Health Service via local health authorities. The Times reported that I said that the vasectomy Bill was mean and demeaning. That I did not say, but, in contrast, I said that it was the way surgery was lumped together with "substances and appliances" that was mean and demeaning.
§ I therefore wish to propose that surgery should be accorded the dignity that it deserves in this matter. I realise that it is more convenient to amend the Bill by merely adding some words to a sentence already prepared, but that is not good enough. Even if it means making the wording longer and somewhat more elaborate, surgery should be separated from "substances and appliances". It is for this reason that I have suggested the Amendment in my name, and I hope that your Lordships will accept it in the spirit in which it is intended; namely, to confer on an act of surgery the dignity and responsibility that rightly belongs to it and of which it is deprived by the present wording. It in no way interferes with the basic intent of the Bill. I beg to move.
§ LORD AMULREE
My Lords, I listened to what the noble Lord, Lord Brock, said on Second Reading and again to-day. I think I feel equally the honour and dignity of the profession to which we both belong, but if it would make the noble Lord, Lord Brock, feel more comfortable I am prepared to accept the Amendment.
§ BARONESS BIRK
My Lords, while I do not want to delay the House, I really must say a quick word. I think it is a pity that this Amendment has been moved and I rather hope that the noble Lord, Lord Brock, will think again about it. I do not think there is any question of indignity or the demeaning of surgery in the drafting of the Bill. It is a small enabling Bill to bring vasectomy into the range of contraceptive services covered by the 1967 Act. My objection to the Amendment is that it puts vasectomy almost in quote marks and removes it from the range of services available to patients. From a merely contraceptive point of view, that seems to me quite wrong. I should have thought that the Bill as originally drafted, with the Amendments put forward on the Committee stage, quite adequately covered the question. I am also against adding to legislation anything which is unnecessary; and I think that this Amendment is completely unnecessary.
§ LORD GARDINER
My Lords, I do not wish to take up too much time but I, too, rather regret this Amendment and I do not really understand its purpose. If a physician prescribes a contraceptive pill he does it as a physician. Why something has to be dignified for surgeons but not for physicians I do not really quite follow. The noble Lord, Lord Brock, says—and I agree—that the wording proposed does not make any difference to the practical nature of the Bill except that what is at present done in 12 words will now take 115 in order that surgeons may feel more dignified than physicians. I cannot think myself that it can prove to be necessary.
§ 8.33 p.m.
LORD BROCK moved Amendment No. 2:
After Clause 1 insert the following new clause:
§ Conscientious objection to participation in treatment
§ " . No person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection:
§ Provided that in any legal proceedings the burden of proof of conscientious objection shall rest on the person claiming to rely on it."274
§ The noble Lord said: My Lords, as I explained earlier, I was abroad on official business when the amended Bill was committed and was thus prevented from moving the Amendments that I indicated I would do in my Second Reading speech. I felt that I could not remain silent although I had missed the Committee stage. Surgeons stand to be deeply affected by this Bill and it is for this reason that I am asking that a conscience clause be inserted as set out. I have been told that this will have but little effect, that it may be unnecessary and that in any case this is only a simple enabling Bill. I am not persuaded that the matter is so simple. The Bill seeks to introduce an entirely new matter; namely, the performance of an operation. This is vastly different from prescribing, or dispensing and supplying, substances and appliances.
§ On Second Reading it was stated that the provision for vasectomy was only permissive and that my expressed fears about the potential harmful implications for surgeons were ill-founded. I am unconvinced of that, especially when I see and read of the pressures put upon certain surgeons as a result of the Abortion Act, of which I have given examples and which I note have been reinforced by the recent announcement of the Abortion Law Reform Association in its written evidence to the Lane Committee, reported in The Times of May 22. Whatever statements are made now on the harmless nature of this present Bill, it affects surgeons and will affect surgeons who will undoubtedly be expected to carry out the operative procedure as opposed to merely providing substances and appliances. The noble Lord, Lord Platt, actually stated in Committee that the Bill will give a new situation in which vasectomy will become a common operation and large numbers of people will be available for study and research.
§ I am convinced that it can involve great inconvenience to surgeons and great distractions from their routine and ethical duties. They already have plenty to do. This is my reason for suggesting that a conscience clause is needed. I would draw your Lordships' attention to the fact that an operation is, or ought to be, an entirely individual and personal matter between patient and surgeon. It cannot, or should not, be part of a mass production procedure or policy. This is a simple 275 but fundamental matter which deserves the attention of your Lordships and would surely receive it if your Lordships individually were going to have an operation. You would certainly expect the procedure to be entirely personal between patient and surgeon.
§ My interpretation of ethics is conventional and correct for to-day, even though some may say it is not what will be thought to-morrow and that the ethics of to-day need to be changed. My interpretation has the approval and support of many surgeons and others who desire that a protective clause should be added to the Bill. I hope that your Lordships will agree to this Amendment. It can do no harm to the intention of the Bill. I beg to move.
§ LORD ABERDARE
My Lords, if I may intervene briefly, I think we all appreciate why the noble Lord, Lord Brock, has moved this Amendment to insert a conscience clause: he made it quite clear on Second Reading that he was going to do so. But I would say to him that I think this is entirely unnecessary in the circumstances and I hope that he will agree to withdraw the Amendment.
The fact is that we must realise this Bill is not, as the Abortion Act partly is, concerned with operations in the Hospital Service, nor with vasectomies provided in the private sector. It is concerned solely with the arranging of vasectomies by local authorities, and it is important to consider how local authorities will use this power. They could for example merely pay for the cost of the vasectomy which is needed by someone who has been accepted for treatment by a voluntary body but who cannot meet the charge. Or the local authorities might agree to send patients selected for treatment under the Bill to a voluntary body having suitable facilities for vasectomy operations. Or they might send patients to a surgeon willing to carry out the operation. They may also perhaps employ surgeons directly in order to provide their own vasectomy sessions. But what is common to all the possibilities open to the local health authority is that not one of them involves any duty on any doctor to carry out a vasectomy 276 against his wishes. Should a doctor have a conscientious objection such as the noble Lord has spoken of, then quite simply he would not be involved and would take no part in these arrangements. They are all voluntary arrangements. I hope very sincerely that the noble Lord will realise this and will not press this Amendment.
§ 8.38 p.m.
§ LORD AMULREE
I should like to thank the noble Lord, Lord Aberdare, for what he has said. There is not a great deal more for me to say except to emphasise once more than this Bill has nothing to do with the medical practice of vasectomy. It merely enables a local authority to arrange for vasectomies to be done if the patient is willing and the surgeon is willing to perform the operation. There is no contract as there is in the National Health Service and under the Abortion Act. This is merely a voluntary arrangement. The local authority can go to one surgeon, and if that surgeon is not willing to undertake the operation then they will go to the next one. I very much hope therefore that the noble Lord will not press this Amendment, because I do not think it is necessary, considering the purpose of the Bill.
§ LORD VERNON
I wonder if I could just put this point to the noble Lord, Lord Brock, before he decides whether to press his Amendment. In the Second Reading debate and again this afternoon I think he has drawn a distinction between an operation for medical reasons, which is justified, and an operation for social reasons, which is not. But I wonder whether that distinction is in fact valid or whether in this field the distinction is not rather blurred. Take what is happening in India at the moment. I understand that vasectomies are being performed on a very large scale. It is important to think what would happen if these vasectomies were not performed. It is part of the Indian Government's policy to reduce the birthrate, and if these vasectomies were not carried out the consequences would be likely to be that a large number of Indians might die. Surely, in those circumstances the operation would in effect be carried out for medical reasons. If it is right in 277 India, it must surely be right also to do it in this country. I would ask the noble Lord to consider that point in reaching his decision.
§ 8.40 p.m.
§ LORD SEGAL
My Lords, I would add one or two words in support of what the noble Lord, Lord Aberdare, has said. This operation is performed in India on a vast scale—I think something like 2 million vasectomies are already credited with having been performed in India. What rather grieves me about this question is this. Vasectomy is a perfectly legal operation which can be obtained to-day by anyone who is able to afford its cost. Nursing homes advertise in medical papers their willingness to perform vasectomies without restriction. What grieves me is that those patients who cannot afford to pay for this operation to be done owing to lack of private means would be debarred from having it done if this Bill were not passed. It is a social measure, and no doctor is compelled to operate against his own conscience. This clause is definitely unnecessary, and I am anxious to see it deleted from the consideration of the House this evening. I hope that the noble Lord will withdraw his Amendment.
§ BARONESS BIRK
My Lords, I would say one word on a point that the noble Lord, Lord Brock, made, because I agree entirely with what the Minister and other noble Lords have said. He made the point that the relationship between the doctor, the surgeon and the patient should be entirely personal. I cannot see how this Amendment alters that in any way at all. Nowhere in the Bill is there any indication that there should he a duty on anybody to do anything. Therefore we are to have a negative put in a Bill which is not balanced at all by a positive in any other part of the Bill. The personal relationship between the patient and the doctor is the same in any event, whether this provision goes in or not. While I think we all appreciate what the noble Lord is concerned about, because he has explained it fully both on Second Reading and now, I hope that his concern will have been put at rest, particularly by what the Minister has said, and that he will not press his Amendment.
§ LORD BROCK
My Lords, I am even more disturbed by what I have listened to, and particularly the suggestion that practice in this country should be formed on what is done in India. Performing this operation in railway stations or camps set up for the purpose, and giving transistor radios to encourage patients to come along, is something I hope will not happen in this country. I have heard all the arguments and it would be proper for me not to carry this matter further. I therefore beg leave to withdraw the Amendment.
§ Amendment, by leave, withdrawn.