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Abortion Bill Hl

Volume 273: debated on Thursday 22 December 1966

The text on this page has been created from Hansard archive content, it may contain typographical errors.

4.12 p.m.

Report stage resumed.

My Lords, there is little I need add to what has been said already by the noble Baroness in moving this Amendment and by the most reverend Primate in supporting it, but I think I should say something about what I believe to be the views of many doctors, of probably the majority of doctors. If the state of a pregnant woman is such that another child would be a serious physical or mental strain, carrying with it the risk of a deterioration in her physical and mental health, this contingency is already covered, I am sure, by paragraph (a). If some lesser effect on health than this is contemplated, in my view, it would be extremely hard to assess.

Doctors already take extremely seriously their responsibilities when it comes to a decision about recommending and carrying out abortion. As it is, the existing requirements are often a source of considerable anxiety to them. In my view, it would be an impossible task and an intolerable burden on doctors, if they were asked to decide what is meant by physical or mental inadequacy. On the other hand, if physical and mental inadequacy are not to be based purely on medical considerations, but are also to depend, as the noble Lord, Lord Silkin, implied in what he said in the Committee stage debate, upon social considerations, then these issues ought not to be left to doctors—or, at any rate, not to doctors alone. I believe this to be the view of the large majority of doctors. I have here the views of the British Medical Association, which I think have already been sent to the noble Lord, Lord Silkin. They say:
" Quite apart from difficulties of definition, we do not think that termination is justifiable on grounds of physical or mental inadequacy to be a mother."
I have done my best to ascertain the views of private gynæcologists and psychologists and they have all come to the same view. They are, in fact, opposed to the paragraph to which this Amendment is proposed. Therefore, I support the Amendment.

My Lords, this Amendment is identical with one moved on Committee stage, which your Lordships passed by a large majority. It is concerned with the mother who will survive childbirth but who may be mentally inadequate, the centre of a problem family, or who may be suffering from some disability. I observed that the most reverend Primate did not mention any specific conditions. May I remind your Lordships that these would include women who are crippled, blind, epileptic, arthritic, diabetic or suffering from some chronic condition. I do not agree with noble Lords who have said that the medical profession would regard paragraph(a)as covering these conditions. May I remind the House that since we last discussed this problem there has been a case, which was given prominence in the newspapers, of a woman who had two abnormal children and went to get an abortion, but was refused, and who subsequently was delivered of a stillborn child and died?

I suggest to my noble colleague who has just spoken that he has been rather sweeping. We find that doctors, like lawyers and laymen, approach this matter in entirely different ways. My noble friend Lord Amulree belongs to the University College Hospital, one of whose doctors, Professor Nixon, a wonderful man, probably known to many of your Lordships, died last week. Professor Nixon was a man with a big heart, who would have interpreted the first part of this Bill in a way all of us who believe in what I am now saying would appreciate. Doctors are different. Some have big hearts and some have desiccated little hearts. Some are moved by their consciences and some would say, "Let us think of this poor devil of a woman, who has this chronic complaint and has to live under these appalling conditions, and give her some relief". We cannot put all doctors in one category. But we have to legislate for the whole country and for the surgeon in a little town who perhaps fears that everybody is watching him or that the church may think of him very unfavourably if he interpreted the first part of the Bill in the way I should like him to do. What we are asking for is that every surgeon should have the freedom to do as his heart, as well as his intelligence, demands.

To my noble friend who spoke about the woman who sought an abortion because she was married to man who did not want another baby, I would say that the maternal instinct is so strong that few women would allow their husbands to force them to do that. We really must not be guided by the assumption that, if this paragraph were included in the Bill, some women would he persuaded not to have babies though they were healthy, had enough money and had good homes. In these circumstances, a woman would defy her husband. Again, a woman will have to go to a surgeon with some gynecological experience in a hospital. There is no question of her going to a general practitioner who would feel himself under pressure. We altered this on the first stage, so that a woman would go to the best people in the country.

My Lords, may I interrupt my noble friend? The Bill provides that two medical practitioners have this power, either the woman's regular doctor or a practitioner employed in a hospital. So, she may go to her own doctor.

I am sorry, but we have amended it. The Amendment in the name of the noble Viscount, Lord Dilhorne, was the first one on the Marshalled List, and I supported it. My noble friend is reading from the wrong Bill.

With respect to the noble Baroness, perhaps I can help. The noble Baroness, Lady Summerskill, supported me in moving into the Bill the Amendment that the noble Baroness, Lady Wootton of Abinger, read. There are Amendments down for discussion next Monday to define more precisely, as the noble Baroness, Lady Summerskill, wanted, the kind of medical practitioner to give the certificate.

I think that I may indulge in a little intelligent anticipation. The Committee agreed with the noble and learned Viscount when he put the case that the doctor who should be chosen should be one from a hospital (it can be, in the first place, the woman's own doctor), but that she should also be advised by a surgeon with gynæcological experience. I am pleased to say that the Amendment uses the words that I used. That will be the position. When she goes to the hospital these doctors will be under no pressure to do something which they do not want to do. She will have the best possible advice.

I ask your Lordships to think of the woman with a chronic condition who, on becoming pregnant, feels that she is incapable of coping with another child, because the burden will be too great. We want, therefore, all the surgeons in the country to be free to help this woman. I feel, having listened to the most reverend Primate, and before him, on the Committee stage, to the right reverend Prelate the Bishop of Exeter, that the question before us to-day, so far as the Church is concerned, is whether precedence should be given to the wishes of this mother, with her fully developed personality, and with the responsibilities of her children, her husband and her home, or to the survival of a few weeks' old fœtus. I have not been favoured with Divine guidance. I can speak in this debate only as a mother, and as one with 40 years' experience of medical practice, during which time I have met very many of these women: I cannot enter into the arena of theological disputation. But I think it should be drawn to the notice of those who might be influenced at this stage by the fact that the name of the most reverend Primate appears on this Amendment that I do not think he has received a mandate to speak for the whole Church, or for the mothers of the country.

I would remind your Lordships that the National Opinion Poll that was taken on the subject revealed that 73 per cent. of the population would like a change in the abortion laws. I would remind your Lordships that women's organisations, one after the other, have pressed for this relief in their lives. On the subject of the Church's approach, we must realise this. InThe Timesof February 17—only last Thursday—under the heading, "Church Assembly Confusion Over Abortion Report", the Church correspondent wrote this—and I think it should be on the Record:
" Attempts by the Church Assembly yesterday to clarify the attitude of the Church of England towards abortion, and at the same time provide a lead to the legislature now considering amendments in the law, did little towards this end. The debate became so confused that the Archbishop of Canterbury, Dr. Ramsey, rescued it from—as he said—running into chaos, by rescinding what had been decided and starting again…Confusion arose when five amendments and an amendment to one of them were introduced. The report itself…argues that abortion should be allowed if the health or wellbeing of the mother is endangered.
" The Rev. D. Stevens, Lichfield, wanted the Assembly to add the words: ' Reaffirms that the vital principle involved is the sanctity of human life ', and the Bishop of Leicester, Dr. Williams, chairman of the board, wanted ' Christian compassion' as well as the sanctity of human life."

My Lords, if I may interrupt the noble Lady, I think there are two points which might be made.

Perhaps I might finish the quotation first. The report goes on:

" Dr. Williams said …' The Church has erred in the past and can still err '. He went on: 'We erred over the burning of heretics, and the burning of witches. No doubt many of the arguments heard in this debate were heard then. We had to eat our words, and I think that Rome is showing signs that it may have to eat its words over contraception. Even the Pope has made one exception to the question of abortion, and I think that doctors who have spoken have made it plain that they make exceptions.'
" Finally, the Assembly decided that they welcomed the report because ' it stresses the principle of the sanctity of life for mother and foetus and urges the church to preserve and demonstrate a balance between compassion for the mother and proper responsibility for the life of the unborn child.' "
My Lords, I am asking this House to-day to show that Christian compassion for which the Church asked last Thursday for the mother, for which the more liberal members of the Church ask, rather than be committed to dogma. If it is a question of balance, then give first consideration to the needs of a full-grown woman with her children and home responsibilities.

My Lords, I intervened in the speech of the noble Baroness only because she said she wished this to go down as a record of the proceedings of the Church Assembly. I read the report the following morning, and noted two things. There was a confusion, but, rather like the introductory business of this House, it was a procedural confusion and not a confusion concerning the issue of debate. Secondly, the noble Baroness quoted from my brother the right reverend Prelate the Bishop of Leicester, again from The Times.The Times significantly omitted the first part of his speech, which said that, along with the exercise of Christian compassion, there was also the other principle, with which I am sure the noble Lady would agree: that Christian man had to recognise that modern knowledge gave to man a greater responsibility concerning the processes both of living and dying than hitherto had been exercised, and that such processes must be exercised responsibly, though humbly. He then went on to talk about Christian compassion. The report suggested that all that the right reverend Prelate said was to speak about compassion, without first having made the Church Assembly think about the more important principle.

4.28 p.m.

My Lords, The Times in a leading article to-day said that this Bill ought to be withdrawn because so much confusion has been aroused. I think that a number of things have emerged quite clearly from our debate. There is complete unanimity, in which the Bench of Bishops join, that abortion in certain circumstances should be legalised. There is almost universal agreement that it is desirable that legislation should lay down that abortion is justifiable in order to preserve the life or health of the mother. There is a fair degree of agreement, also, that abortion is justified where there is a great likelihood of a severely abnormal child being born.

The paragraph we are discussing at the moment, however, goes rather further than that. I think that the issue which is now before the House is this: are the only circumstances in which abortion is justified those which relate to the health, physical or mental, of the mother, and the probable abnormality of the child? That, as I understand it—although I do not find the ethical discussion of abortion by the Church Assembly entirely easy to follow—is as far as the Bench of Bishops is prepared to go.

I hope that the House as a whole will be prepared to say that there are other circumstances in which an abortion is justifiable: the birth of a child into a family which is very vicious, which is habitually criminal, where there is illhealth—which, I should have thought, did not fall within paragraph (a) that we have been discussing—and where a family is so numerous that almost any addition to the family will be greatly to the disadvantage of the existing members of the family, as well as to the newborn child. In many circumstances of this kind, which we can all imagine but which it is extremely difficult to define in a single word, or even in a great many words, I should think that abortion is also justifiable. I should have thought that it was wrong for us to stop at this particular point of physical or mental illness.

It has been argued, notably by the noble Lord, Lord Amulree, and also by the noble and learned Viscount, Lord Dilhorne, that most of the cases—that is what Lord Dilhorne said—to which I have drawn attention, and with which he himself said he had great sympathy, would be included in paragraph(a). As the noble Lord, Lord Taylor, said in the Committee stage debate, in order to include these cases for which we all have compassion it means straining the words of paragraph (a). The noble Lord, Lord Taylor, went so far as to say that it was dishonest to interpret that paragraph in that way. I certainly think it is wrong to legislate with narrow words, intending those words to be widely interpreted by those responsible.

There is another point. Those who will have to interpret the words are doctors. It is not for them to have any extensive knowledge of the law, and if they feel, in looking at the words and reading them as a layman would, that they are narrow words, they will not be disposed to interpret them more widely, because they will be fearful of the consequences—the danger of criminal proceedings and, what is perhaps worse, serious charges of unprofessional conduct. Therefore, if it is the case that noble Lords in this House—and I refer particularly to my noble and learned friend Lord Dilhorne, who expressed his sympathy in these cases—wish these hard cases to be included, then, surely, it is right and wise for us to include a paragraph which deals with them explicitly.

It is not easy, in discussing an Amendment of this kind, to see what the Bill is ultimately going to be. I will not take up your Lordships' time by referring to the special problem of mental deficiency, because that should come up under a subsequent Amendment, but it may well be that if your Lordships accept paragraph (c), with its wider ambit, it may not be necessary for us to press so strongly the special provision for mental deficiency, which we shall certainly have to press if paragraph (c) is dropped.

There is another extremely important matter closely connected with this, and I hope no one will say that it is not a reasonable and proper argument to put forward. One of the main purposes of codifying and, as I hope, extending the law legalising abortion, is in order to make it unnecessary for so many women to have recourse to the illegal abortionist in the back streets. A very large number of the cases who feel that they are driven to those illegal abortionists are those who cannot really come under paragraph (a) or paragraph (b), but who would come under paragraph (c). For that important sociological reason I urge your Lordships to take a broad and generous view of this measure, and to resist the Amendment which will narrow its ambit.

4.35 p.m.

My Lords, I should like to reply straight away to the noble Lord, Lord Molson, because I think his speech requires an immediate answer. It is all very well to say that the words of paragraph(a)are narrow and restrictive, and then to say that we must go further from there without regard to the words which it is proposed to leave out and which are now contained in paragraph(c). I wonder whether my noble friend recognises that not only does paragraph (a) go in some respects beyond the existing law, but how widely that paragraph is interpreted at the present time by the medical profession. When he posed the question: Are the only circumstances those of the health of the mother or the child?—again, the answer to that question depends to a great extent on what are the circumstances the medical profession can take into account in considering the health of the mother or the child. This Bill makes it clear. I do not think my noble friend observed that regard can be had to the health of the mother or the child before, at, or after birth. In the hard cases which he mentioned, where there would be a disadvantage to the existing family—a case which was dealt with, I think, at some length by the right reverend Prelate the Bishop of Exeter on Second Reading—surely the doctors would be entitled to have regard to the effect on the mother if the family's economic circumstances were such as to subject her to an intolerable strain, mental or physical.

The fallacy in my noble friend's argument is to suppose that every other kind of case which he, for one, would like to see included, is covered by paragraph (c). We are not being asked to decide whether paragraphs (a) and (b) go far enough, but to decide whether paragraph (c) should be included. The terms of paragraph (c) are not nearly as wide as my noble friend would think. They are narrow, but difficult of interpretation, because all that doctors have to look at in relation to paragraph (c) is the question of the physical or mental adequacy of the woman. I would say to my noble friend that if you are considering the physical or mental adequacy of the woman to be a mother, you are not considering the size of her family, or the effect on the other members of the family. I hope the House will not be misled by that sort of observation.

My noble friend went on to suggest that the wording of paragraph (a) would be strained. I do not think it is strained, and I should like to give some information to your Lordships which I have received since the Committee stage. The noble Baroness, Lady Summerskill, referred to the National Opinion Polls. I agree, as I think we all do, about the desirability of having a Bill on the Statute Book. But it is another thing to say that a National Opinion Poll is in favour of this particular provision. I do not believe that for a moment.

If I may, I should now like to express my pleasure that the noble Baroness, Lady Wootton of Abinger, has tabled to-day the Amendment which I moved in Committee, and I express my gratitude to her for moving it in such an eloquent and persuasive fashion. I think she put the real point of this extremely well: Are we really to say that people of whom we do not approve should not be allowed to propogate? I know there are those whose hold a sincere belief that any woman should have the right to have her pregnancy terminated if she so desires. I am not sure, but I think this is the view of the noble Lord, Lord Silkin, and of the noble Baroness, Lady Summerskill, particularly in view of what she said to-day. But, my Lords, if that is their view it would be easy to draw a Bill to give effect to it, and then we could have a direct vote on it; but I suspect that such a Bill would stand little chance of passing.

I think it is the case that this Bill, with paragraph (c), will produce the effect, and is intended to produce the effect, as nearly as possible, as if a specific and clear right had been given to the woman to have her pregnancy terminated at her request at any time. Might I remind your Lordships of the original terms of paragraph (c). They read as follows:
" The health of the patient or the social conditions in which she is living (including the social conditions of her existing children) make her unsuitable to assume the legal and moral responsibility for caring for a child or another child."
On that the noble Lord, Lord Stonham, said—and I quote from Hansard:
" This proposal is not included in the declared aims of the Abortion Law Reform Association, and I venture to think that it will not command the same sympathy as some of the other proposals. It is aimed against a very real social problem: the situation, for example, of the harassed mother who already has a family of children and simply cannot cope with another; and it is stimulated by concern not only for the mother but also for the unborn child."
That seems to me almost to summarise the speech of my noble friend. The noble Lord, Lord Stonham, continued:
" But many, I think, will feel that the proposed ground is too imprecise. It is not primarily a medical ground, and it is arguable that it should not be left to doctors to decide. Social conditions ', would presumably cover the case of a woman with five or six children living in two rooms. It may be undesirable to bring another child into the world in such conditions; but it is surely arguable that rehousing, not abortion, is the answer."—[OFFICIAL REPORT, Vol. 270 (No. 11), col. 1168: 30/11 /65.]
My Lords, I entirely agree with what the noble Lord, Lord Stonham, said, and it seems to me that the words he then uttered are equally applicable to this particular provision in the light of the interpretation sought to be put upon it by the noble Lord, Lord Silkin, the noble Baroness, Lady Summerskill, and the noble Lord, Lord Molson. In Committee I suggested that these words meant that if a pregnant woman went to a doctor and said, "I do not want this child", the doctor would be entitled to say that she would not be an adequate mother to the unwanted child. What would have to be looked at is not her health, or that of her child, not her social conditions but just her personal physical or mental adequacy; and of that the medical profession is to judge.

When the noble Lord, Lord Silkin, replied to me in Committee he did not deny this. He did not deal with it at all, and if I am right about this it means that this provision provides for abortion, not directly but indirectly, if the woman can find two doctors who will say this, at the request of the pregnant woman. Instead of dealing with this point the noble Lord, as we know, gave a long list of the kind of cases he intended to be covered by this provision. The noble Lady referred to the first one again to-day, epileptics. Is it really the case that a woman who has suffered, most unfortunately, from epilepsy is an inadequate mother? Surely there are many adequate mothers who have children at the present time and also have the misfortune to suffer to some degree with epilepsy.

Women in prison, persistent offenders, shoplifters, women married to drunkards and ne'er-do-wells, women who go out to work—those were some of the cases mentioned. They are not really covered by this provision at all, because this provision relates only to a woman's mental or physical inadequacy, not to her social condition. So it would seem from what the noble Lord said that he has tried, by the use of another form of words, to cover the same ground as that covered by his original paragraph (c) which was so severely and rightly criticised by the noble Lord, Lord Stonham.

Listening to these discussions I wonder whether it is sufficiently realised how far the present law goes, and how dangerous this operation is, even if it is performed in hospitals under the best of conditions. From the debates we have had on this Bill the impression might well have arisen that the operation is one of the simplest character, with very little risk attached. My Lords, after the Committee stage I received a letter from a distinguished surgeon whom I have never met but who is head of the gynecological department of a big hospital. He wrote—and I should like to quote to your Lordships his words:
"The termination of pregnancy is a dangerous operation with mortality in the best conditions. No safe technique has yet been devised and no responsible doctor would countenance the death of a woman from abortion unless her pregnancy constituted a real risk to her life, health or family security."
Now, my Lords, I put this question to Her Majesty's Government. Have not a number of deaths occurred in the last year following upon the termination of pregnancies, lawfully terminated in hospitals in proper circumstances?

I asked the surgeon who wrote to me whether he could give me any further information, of his own knowledge; and he did. He has written to tell me that in the last five years there were 59 terminations of pregnancy at his hospital, lawfully performed under the existing law. Thirty were done for psychiatric reasons; in 23 cases there were medical reasons—disease; in 6 cases there were obstetric reasons—risks associated with childbirth or pregnancy. In two of those six cases it was done because of German measles infection early in pregnancy, which made the birth of an abnormal child likely. All those cases were dealt with under the existing law.

Now, what of the consequences? The consequences were as follows: two women very nearly died; two women had very severe infections from the operation. Of the 59 women 44 had some fever after the operation, and 14 of them had temperatures above 100°F. Eight needed treatment by antibiotics and three required blood transfusion. One of those who nearly died had a severe infection. So that there were six cases in which the consequences were serious—the two near-deaths, the serious infection and blood transfusion cases. That amounts to this, in the records of one particular hospital: that in nearly 10 per cent. of the cases following upon a lawful abortion properly performed there were serious consequences to the patient.

My Lords. could the noble and learned Viscount make it clear whether at this particular hospital he is dealing with what we usually call therapeutic abortions, or all abortions, including unavoidable ones?

I was giving the entire figures for the abortions performed at this hospital. I gave the reasons, psychiatric, obstetric and medical. I think those figures cause one to think very seriously indeed. I do not know (I am no doctor) whether they apply generally over the whole of the country. But it means that we ought to think long and hard before extending the right to termination to grounds other than those of health, as is proposed by this paragraph (c). It may be difficult, but doctors are the people who are surely best qualified to weigh the risks to the health of the woman or of the child if the pregnancy is allowed to go on against the risks involved in the operation. But what will happen if this Amendment is not carried? They will not have to consider the health of the woman or the child at the present time; they will have to assess the adequacy of the woman as a mother when no health considerations are involved, and they will have to try to balance that against the risks of the operation. It seems to me that if we do not pass this Amendment cutting out paragraph (c) we shall be placing the medical profession in a very unenviable position.

Many people appear to be under the impression, as I say, that this is a minor operation involving little risk, but if doctors, knowing the risk, refuse to terminate the pregnancy of a woman who wants that done and who has satisfied them of her inadequacy as a mother, that woman will have a grievance against society and against the medical profession. And judging from the pamphlet I have recently received from the Abortion Law Reform Society it would seem that their real complaint is not so much that the present law is inadequate—because of all the cases they set out in that pamphlet the vast majority were cases where there had been termination under the existing law—but that doctors, knowing the risks involved, are reluctant, and I would say rightly reluctant, to perform these operations. I do not want to repeat the arguments I advanced last time or review the arguments which have been so ably put forward on both sides, but I hope for the reasons that have been put forward we shall soon—as I think myself most of the arguments have been fully covered—proceed to a Division upon this matter and reject paragraph (c).

4.54 p.m.

My Lords, reluctant as I am to detain the House at this stage, I feel nevertheless it would be quite wrong to be silent and not voice some of the very serious doubts and misgivings which I have about paragraph (c). I should like to put to the House the doubts that must run through the minds of a great many general practitioners if this particular paragraph is retained in the Bill. I feel, in common with many other noble Lords who have already spoken, that from the general practitioner's point of view the shorter, the simpler form of Bill that we pass into law the easier it will be for the doctor to carry out the intention of the promoters of this Bill. What I cannot quite accept from my noble friend Lady Summerskill is the absolute degree of finality with which she expects the general practitioner to approach this problem. Unfortunately, general practitioners are not represented in this House. That is something which the House, I hope, in the future might seek to remedy. Even if we had here three or four general practitioners in active practice, the chances are we should find that they themselves would disagree almost violently about some of the provisions of this Bill, and notably about this paragraph (c). I cannot for a moment accept the degree of finality of judgment that my noble friend Lady Summerskill put forward to the House.

Every doctor knows that during the course of normal pregnancy in the early months a mother may approach her coming confinement with a great deal of misgiving and anxiety which may later on become pathological. But equally it is true—and I would ask my noble friend, Lady Summerskill, to deny this if she can—that during the course of the pregnancy, especially after the fifth or sixth month, the whole outlook of the mother tends to undergo a change, and over and over again an expectant mother will go to the doctor and say quite frankly, "I am feeling better now than I have ever felt at any time before in my life". And equally the doctor, who may form a decisive judgment during the third or fourth month of the pregnancy, if he retains an open mind and allows the pregnancy to go on, will often have to admit to himself, "I was wise not to terminate this pregnancy ". I just put forward these considerations which the House must take into account before it seeks to add to the difficulties with which a general practitioner would be faced.

Over and over again, although it is many years now since I was last in general practice, I have had a mother come to me and say, "I was very glad later on that I decided to have this child ". In instances where a husband has been a confirmed alcoholic, the mother has said, " Well, at least I have the child by me to look after. My husband has deserted me, my home has been broken up. At least I have this child to care for and look after during my life ", and she is so thankful that the child has been spared to her. According to some of the grounds for abortion which have been put before the House, chronic alcoholism might be considered as a sufficient ground for terminating pregnancy.

We have even had the question of kleptomania brought up. I am glad the noble Lord, Lord Silkin, had the wisdom to withdraw that word. Imagine a doctor faced with a doubt: "Here is an expectant mother coming to ask me to perform an abortion. I personally cannot see any ground for performing it. All I need do is to tell this mother, ' Just go round the corner and indulge in a little bout of kleptomania. Do it so that it is seen, and this might be sufficient ground for committing the abortion '." Surely this is a case of reform run riot. I am very glad that my noble friend, Lord Silkin, asked that this word be forgotten.

Well, at least he did not persist in putting that forward as ground for justifying committing abortion. I have a great deal of misgivings about this paragraph (c). I have thought it over for a long time, and I am still open to be convinced by my noble friend, Lord Silkin, when he comes to reply. But I cannot accept any finality of judgment, either of the doctor or of the expectant mother, during those anxious first few weeks when she comes to discover that she has become pregnant.

Something else which has struck me over and over again is the errors of judgment to which the general practitioner is liable. My noble friend Lady Wootton of Abinger spoke about the difficulties of adoption. I remember vividly cases where a mother, twenty years after her child was adopted, has been on the verge of a severe nervous breakdown, torn by the agony of a child that she allowed to be adopted twenty years before. So there is no finality about this Bill; there is no finality about the doctor's judgment; there is no finality about the judgment of an expectant mother in the early weeks of pregnancy.

One of the things that impressed me, perhaps more than any other, in my own experience in general practice was the extraordinary capacity of the average child to rise above conditions of adversity. During the previous stages of the debate on this Bill there has been mention of various distinguished men who were brought up in difficult circumstances, or born of doubtful parentage. I cannot help feeling that two recent Prime Ministers in the history of this country, one of Welsh origin, the other of Scottish origin, were brought up under conditions of extreme adversity. One may say, "Yes, but why inflict these conditions upon them? Why not give them, as most children are entitled to have, a decent start in their lives?" Perhaps they, too, would have been glad of these things; but I am sure they would have been the first to admit that if they had been brought up under ideal conditions, surrounded by a proper parental home, the possibility is that neither of them would have ended up by becoming Prime Minister. So we have to accept the circumstances of life. We have to accept the fallibility of human judgment. We have to approach this Bill, not with an air of absolute conviction, of dogmatism, that we know what is best. Let us rather approach it from a human point of view, from the point of view of sympathy and profound understanding.

My noble friend Lady Summerskill quoted, as an argument in favour of the retention of paragraph (c), the tragic instance of an inquest which was held quite recently. But surely this, to my mind, is an argument amply covered by paragraph(a). If for just a moment I may detain the House, that case referred to a sergeant who said that his wife had already given birth to three subnormal children and had difficulty with the birth of one of them, and in August, 1965, she was found to be pregnant. After examination at two hospitals it was suggested that the pregnancy should be ended. She was admitted to a hospital where an Army psychiatrist did not agree that the pregnancy should be terminated. Something obviously went wrong. If she had accepted the advice of one or two of the previous consultants and had the pregnancy terminated without being referred to the psychiatrist for advice, her life would have been saved. Later she developed toxæmia and, on admittance to a hospital, the child was found to be dead. A sterilisation operation was carried out with her consent. After making a good recovery from the operation she collapsed and died.

The risks of this operation have already been pointed out by the noble and learned Viscount, Lord Dilhorne. Her case did not require the retention of paragraph(c). That she collapsed and died after the quite straightforward sterilisation operation is presumably due to the fact that she was suffering from toxemia, which has always been recognised in the majority of cases as ample medical grounds for termination of pregnancy.

I am afraid that I have already detained the House too long. But I have spoken now because I am all in favour of the shortest and the simplest possible drafting of this Bill. Heaven knows! a general practitioner is already beset by so many doubts and difficulties in everyday practice. Why should we inflict on him extra doubts and extra advice, as it is proposed to do by lengthening the clauses of this Bill? I should almost be willing to retain only paragraph (a), extending it by saying
" the continuance of pregnancy would involve serious risk to the life or grave injury to the health whether physical or mental of the pregnant woman or of the child "
and leave it at that, so that the doctors can use their own judgment and allow for a possible change of view on the part of the woman if the pregnancy were allowed to develop.

I think we are making a mistake in some of the other Amendments to this Bill, where we say that the registered medical practitioner may take into account such circumstances; where we are trying to presume to give advice to a general practitioner, not as to what he should not do, but requiring him to take into account certain circumstances. Is this not going a little beyond the point of our confidence in the good sense and wisdom of our general practitioners? I conclude by again saying that I have had a great deal of doubt about the retention of paragraph(c). On balance, I am still in favour of supporting my noble friend Lady Wootton of Abinger and other noble Lords who have spoken in favour of having it deleted. But I am still open to be convinced by my noble friend Lord Silkin when he rises to reply.

5.8 p.m.

My Lords, I feel in harmony with the noble Lord, Lord Molson. I am in favour of the retention of paragraph (c). Unlike so many of my noble friends, I am not a doctor, and so cannot speak from that partisan attitude. Unlike some of my noble friends, I am not even a woman, and so cannot speak from their specific point of view. I noticed that my noble friend Lord Segal—and this was one of the many "red herrings" that has been drawn across the discussion of this problem—mentioned certain Prime Ministers who perhaps spent their early years under difficult circumstances. But neither of those Prime Ministers come within the category mentioned in paragraph (c) which we are discussing to-day. So please let us keep our minds directed upon paragraph (c) and the various qualifications which are enumerated there.

I agree with my noble friend Lord Segal that there are many cases where a woman, in the early period of her pregnancy, feels that she does not want a baby—she says, "I have been caught", and that is something horrible from her point of view. However, later, as the baby begins to move, she begins to feel a certain maternal affection and she is glad that she went on with the pregnancy. I concede all that. But another of the "red herrings" that was drawn across our path was that drawn by the noble and learned Viscount, Lord Dilhorne, who told us of 59 cases of abortion which took place in a hospital. There were two who nearly died. But they did not die. There were two who were severely affected. But they did not die. There were several who had high temperatures. But they did not die. There were three cases of blood transfusions being given. But the women concerned did not die. Nearly 10 per cent. of the cases had serious consequences, as the noble and learned Viscount told us. But the women did not die. Surely all those 59 examples about which the noble and learned Viscount told us were arguments for not permitting the extension and expansion of this back-street abortion business, and for allowing the operation to take place in hospitals where the women would receive up-to-date medical attention and their death would thus be prevented.

This is a very delicate question and, as a mere man, who is only a 50 per cent. partner in this, I feel rather hesitant, but there are a few things that should be said. One of the right reverend Prelates said in the course of his remarks that the Press had misrepresented a statement made by one of his right reverend brethren. I have been engaged in the production of newspapers in this country for over forty years, and I know that people who make speeches and issue documents sometimes incorporate in them all sorts of equivocations and qualifications. But I know that the normal journalist on a national daily newspaper is capable of pushing aside all those qualifications and getting down to the "guts" of the impression which the person wanted to create. So whether or not the right reverend Prelate wants to blame the Press for alleged misrepresentation of a statement, I say that the impression which it was desired to create was the one the Press took notice of.

We have heard many technicalities in this debate. I think it is time we heard about the human considerations. We have heard the voice of the doctors—some on one side, some on the other, some against abortions, some in favour of taking money in regard to operating for abortions. We have heard the voice of the clerics, perhaps in some way muted, on the lines, "We are prepared to go so far, but not to go all the way ". But the voice of the ordinary person, the ordinary husband, the ordinary wife, has also to be heard. We have in recent weeks heard the voice of the Church pronouncing in favour of sodomy. That may be correct; it may be not. Personally I find myself differing—

My Lords, may I interrupt the noble Lord to say that I cannot believe that anybody would speak in praise of sodomy.

Sodomy has been pronounced upon by the Church as a sin, but it has been pronounced by the Church as something which, within the law of the land, may take place between adult persons in private. I am not going to equivocate upon this. I am saying that that is in favour of sodomy. Therefore, I do not find myself compelled to have regard to the voice of the Church when I make up my mind on the moral aspects of this issue. I do not feel that pregnancy is an act of God. I think that pregnancy is the result of an operation in which two human beings are concerned.

Now we come to the gist of the whole matter. I feel that the woman has a right to say what shall happen within her own body and with her own body. If she says she does not want to have a child, I think her voice must be regarded. I would not say that that is the final voice. In the case of married couples, the voice of the husband should also be heard. I am very regretful of the fact that the voice of the husband has never been heard in any of our debates on this Bill up to the present.

My Lords, may I ask the noble Lord one question on this? I always listen with interest to what he says. Would he apply what he says to a case that took place in India, the case of Suttee, where there was no question of a third party—because I should regard the foetus as a third party —and where only two persons were concerned, the wife and the husband? It was made illegal in India after a good deal of thought. We did try to keep it legal by having a magistrate's opinion that it was in order.

I am quite sure that if I were the Prime Minister of India, or an Indian Prince, I should be able to legislate satisfactorily for the needs of that country. But I am discussing the state of affairs in the United Kingdom, and that is the matter to which I wish to direct my observations. I say that the woman should determine what happens to her own body and within her own body. If she happens to be a married woman, the voice of her husband should be clearly heard. I think that their views should prevail.

Let us come back to the actual provisions of paragraph (c) of the Bill. We have skated rather outside that in our discussions from all sides of the House. What does paragraph (c) say. It refers to the pregnant woman being
" physically or mentally inadequate to be the mother of a child ".
We are men of the world; we have had experience of life. We know that there are physical conditions which would make it extremely dangerous for a respectably married woman to proceed with a further pregnancy. There are questions of albuminuria, toxemia and conditions like it, apart from physical malformations.

My Lords, has the noble Lord overlooked the fact that those are covered by paragraph (a)?

The noble Lord has not overlooked anything. He is discussing paragraph (c) at the moment. That is the matter to which your Lordships should direct your attention. Paragraph (c) says "physically or mentally inadequate". As to the word "physically", I suggest there are certain circumstances in which it would be really dangerous for a wife to proceed with her pregnancy. If a doctor corroborates that point of view, it is desirable that the pregnancy should be terminated.

Paragraph(c)goes on to say "mentally inadequate" as a reason for terminating a pregnancy. I have been a member of a county council for twenty years; I have known examples of mentally inadequate women, mentally subnormal women, and it would be cruel, it would be against all that we believe is right in life, for those people to be able to reproduce their kind. I think paragraph (c) properly covers that kind of woman as making her eligible for termination of pregnancy.

Paragraph (c) also deals with the case of girls under sixteen. Which of your Lordships is going to hold up his hand and say, "That girl of sixteen must go on and have her baby "? I am not concerned with questions of morality—

Would the noble Lord pay attention to the fact that there is no reference in paragraph (c) to girls under 16?

Paragraph (c), according to the typewritten version of the Bill which is before me, says

" or of another child as the case may be";
or that
" the pregnant woman is a defective or became pregnant when under the age of sixteen ".

Perhaps the noble Lord would look at the Bill as amended in Committee, which is the Bill before the House.

The spirit of the debate is that girls under sixteen should be allowed to go on and have their babies, and I say that they should not. That is the difference between my noble friend Lady Wootton of Abinger and myself. There is the danger that two "quack" doctors— and I hope this example will not offend my noble friend, Lady Summerskill— could get together and say, "We will run an abortion racket". I think that situation has already been coped with by the provision that one of the doctors shall be a hospital doctor under the National Health Service.

From all these points of view, I feel that I should be a hypocrite if I said to a woman, "You are ill. You are suffering from toxæmia. You are suffering from some malformation which would make it very dangerous indeed for you to have this further baby. Nevertheless, I say, with all my virtue, that you must go on and have it." Because paragraph (c) deals with such questions, I am wholeheartedly in support of it.

My Lords, I shall detain the House only a very few moments. I think the point was so admirably put by the noble Baroness, Lady Wootton of Abinger, in proposing this Amendment, and on the whole it has been so well argued, that I wish only to supplement two points. The most reverend Primate quoted me as making a very similar statement to one which he had made in the country, and I think that there is no difficulty in justifying what we both said. I would remind the noble Lord who has just sat down that we are not considering now whether anything additional to what is contained in paragraphs(a) or (b) is or is not required; we are considering the merits of what is contained in paragraph (c). The reason why I said that the paragraph might mean anything is quite simple. If a woman goes to a doctor and says, "I want an abortion", the doctor could bona fide hold that that in itself showed that she was mentally inadequate within the meaning of paragraph (c). That is why I said, and why I think the most reverend Primate was quite right in saying, that this paragraph could be taken as meaning almost anything, and it is to my mind an impossible provision with which to amend the criminal law.

The only other point I wish to mention is the argument, which puzzled me, of the noble Lord, Lord Soper. He was interested in the philosophy behind all this—as, if I may say so, am I. He thought there was something very artificial in holding that the fœtus could be said to have, in an important and moral way, a life and soul. But I wonder at what point he thinks that a soul does come into existence? I was wondering, when he was attacking the philosophy that underlay the view of the most reverend Primate, for example, and some of the other speakers, what his own philosophy was.

If the paragraph that we are now considering is right, why is the exposure of infants at birth not equally right? Indeed, if the pregnancy is very far advanced, so that the operation permitted under this Bill would be dangerous to the mother, might not the exposure of the infant be infinitely preferable? I bring this matter into consideration only in order to show the noble Lord, Lord Soper, that some who may have a philosophy on this subject are not, perhaps, people who have thought out the matter less than he has, and may not differ from him in humanity. Because I think that, for the reasons given by those who oppose it, this paragraph is impossibly wide and dangerous, I shall support its deletion.

5.25 p.m.

My Lords, I know that the House wants to divide, but I am sure you will feel it is right that I, as the author of the original provision, should have the opportunity of saying a word in its favour. Of course we have had a very good debate this afternoon, as we had on the occasion of the Committee stage a fortnight ago. On that occasion we had two hours of debate on this particular provision, we had sixteen speeches, and we eventually had a Division in which the clause as it stood was carried by 75 votes to 51—a very large vote which I should have thought represented the opinions of this House. On that occasion we did not have the benefit of contributions from the most reverend Primate or from my noble friend Lady Wootton of Abinger. They had other business to attend to, and of course that is quite understandable. But we have heard them to-day, and they have taken advantage of the opportunity to reopen the whole matter on Report.

I want to say, quite frankly, to my noble friend Lady Wootton of Abinger that she produced no single new argument in favour of deleting this provision. Everything that she said had already been said—nobody can say it as well as she—in the course of the debate on Committee. Nor, with great respect to the other speakers, have they said anything new. We have had all this already, and it is going to be very difficult for me to say anything new in support of paragraph (c) as it stands. But I should like to ask noble Lords who have doubts about this, whether they would not agree that there is such a thing as inadequacy in a mother.

We can have differences of opinon as to what constitutes inadequacy. I mentioned kleptomania, and what I had in mind was the kind of home where theft was the practice and where people went to prison (I used the words "in and out of prison ") and I thought of a child being brought up under those conditions. That might well be an example of inadequacy of the mother as a result of mental defect. But I gave other examples, and nobody has referred to those. I mentioned the case of a mother who has deliberately ill-treated her children or neglected them. Nobody thought it right to mention that example of mine. Would your Lordships think that a mother who had been convicted of ill-treating her children would make an adequate mother? You may say, "Of course not, but even that should not be a ground for abortion." I could understand the most reverend Primate saying that—that is the view which the Church takes—but I cannot understand ordinary people taking the view that a mother should be regarded as adequate when she already has children whom she has deliberately ill-treated or neglected.

I would ask noble Lords, who have already accepted the principle of abortion, to accept this as one of the grounds on which abortion should take place. I do not know whether it is sufficiently realised—it certainly was not in the course of the debate—that no abortion can possibly take place unless the mother wishes it, unless she applies for it. There cannot be an abortion without her consent. My noble friend Lady Wootton of Abinger made some play on the fact that we were deleting a provision about written consent. I am sure she does not believe that nonsense. Of course, no abortion will be carried out unless the patient wants it and asks for it.

The form in which the consent is given is not really material—that is a point which we can debate later. But it will be on the initiative of the mother herself, and there will be two doctors who will have to form a judgment as to whether, by reason of her mental or physical defects, she will be adequate as a mother. It is a difficult judgment to make—I admit that—but doctors are accustomed to making difficult judgments, not only on mental or physical questions but generally. One is constantly going to one's doctor and seeking advice on questions where the factors of one's physical or mental condition are subsidiary. Doctors are able to form a judgment as to whether a mother is likely to be adequate or not. Very often, they know the conditions of the mother. Where they do not, it is always possible for them to refuse: they are under no obligation. If the case is not made out, and they are not satisfied, they are under no obligation to agree to an abortion. If the first doctor the mother sees agrees to it, there has still to be a second opinion, that of a gynæcologist. It is only where the mother wants an abortion and both doctors are satisfied that the conditions apply that an abortion will take place.

There is, of course, the further possibility, especially now that it is proposed that the abortion should take place, in a hospital or a clinic, of getting the opinion of a social worker in difficult conditions. The woman may have made out a plausible or prima facie case, but the doctor may not be satisfied and he might very well say, "I am not quite satisfied; I should like to get the opinion of a social worker". It is only after he has done that that he need agree that the abortion should take place.

So the real question for the House this afternoon, as it was in Committee, is whether, having accepted the principle of abortion—and abortion not only on the ground of the health of the mother but also on the ground that there is a likelihood of the child being born deformed—we should extend it so that we provide for the case where a mother it to give birth to a child which she is wholly incapable, for one reason or another, or being able to rear. I hope that the House will reaffirm the decision we arrived at a fortnight ago, and will allow this paragraph to remain in the Bill.

My Lords, I know that the House is anxious to divide, but I hope that I may reply, very shortly, to this debate. I think the essence of the matter has been put most eloquently by the most reverend Primate and by the noble and learned Viscount, Lord Dilhorne: that is, that the genuine cases in which an abortion is legitimate, or should be legitimate, are covered by paragraph (a). I think it is significant that most of the argument against this Amendment has really not dealt with the Amendment at all. My noble friend Lady Summerskill argued on the basis that Amendments which are not yet before your Lordships' House were already carried; my noble friend Lord Leatherland argued from a version of the Bill which is not before your Lordships' House; and the bulk of the argument of those who have opposed the Amendment has not dealt with the specific terms of the Amendment. It has dealt with the general case of women in circumstances of distress being allowed to have an abortion. Compassion has been invoked—a compassion which, I must assure my noble friend Lady Summerskill, I share with her and, indeed, is the reason for my support of a Bill that would deal with those genuine cases.

But there is one crucial point that I think has not been given due weight. The noble Lord, Lord Silkin, said that the initiative lay with the woman. There is nothing whatever in this Bill that gives the initiative to the woman. There is nothing whatever in paragraph (c) that gives the initiative to the woman—and this is a very important point. It may well be that the initiative will not be with the woman, and that all the woman has to do is to sign a paper which possibly she does not fully understand. I must remind your Lordships that if a woman is beguiled by a salesman into purchasing a refrigerator which she does not want, she has three days in which she can revoke that consent. If a woman wants her child to be adopted, she must sign her consent before a magistrate and she has power to revoke it right up to the moment of the court hearing. But at present this Bill says simply that she gives her consent in writing, with no other safeguards whatever; and there are no indications that the initiative is necessarily with her.

I can very well see that a woman may go to her doctor and say, "If I have a child I shall be a nervous and physical wreck", but this is provided for in paragraph (a).

If she is convinced that she will be a nervous and physical wreck, it is, because paragraph (a) provides for an abortion in cases where there is grave injury to her health, and to be a nervous and physical wreck is indeed to suffer grave injury to health. But I cannot see that a woman is going to take the initiative and go to her doctor and say, "I am unfit to be a mother; I shall be an inadequate mother." For this reason I think that this paragraph opens the door to other people's decisions about the capacity of particular women to be mothers.

CONTENTS

Alport, L.Elliot of Harwood, Bs.Milvertin, L.
Amherst, E.Emmet of Amberley, Bs.Montgomery of Alamein, V.
Ampthill, L.Exeter, L. Bp. [Teller.]Morris of Borth-y-Gest, L.
Amulree, L.Ferrers, E.Mowbray and stourton, L.
Ashbourne, L.Forster of Harraby, L.Newton, L.
Atholl, D.Fortescue, E.Norwich, L. Bp
Attlee, E.Furness, V.Ogmore, L.
Auckland, L.Goschen, V.Parker of Waddington, L.
Audley, Bs.Grenfell, L.Perth, E.
Barrington, V.Gridley, L.Rennell, L.
Bowles, L.Harlech, L.Rockley, L. St.
Brain, L.Hawke, L.St. Just, L.
Brock, L.Henderson, L.Saltoun, L.
Brooke of Ystradfellte, Bs.Howard of Glossop, L.Sandford, L.
Canterbury, L. Abp.Iddesleigh, E.Segal, L.
Chesham, L.Ilford, L.Selkirk, E.
Colville of Culross, V.Inglewood, L.Shephered, L.
Conesford, L.King-Hall, L.Simonds, L.
Craigmyle, L.Lilford, L.Somers, L.
Daventry, V.Lincoln, L. Bp.Strange of Knokin, Bs.
Derwent, L.London, L. Bp.Swanborough, Bs.
Devonshire, D.Longford, E.Thurlow, L.
Dilhorne, V.Lothian, M.Waverly, V.
Drumalbyn, L.Luke, L.Winchester, L. Bp.
Dudley, L.Margadale, L.Wootton of Abinger, Bs. [Teller.]
Dundee, E.Massereene and Ferrard, V.
Ebbisham, L.Mersey, V.Ypres, E.
Eccles, V.

The noble Baroness, Lady Summerskill, said that some doctors had "desiccated little hearts." That is not a statement I would ever have dared to make about her distinguished profession: still less would I dare to say that any of them have desiccated little heads. But I would say, my Lords, that if we are going to ask the medical profession, in their present state of knowledge, to make these amateur exercises in pseudo-eugenics, we are really asking them not to have desiccated little heads but enormously swollen heads. I think this is a very dangerous provision. It is a dangerous provision to say that two men—who, after all, are only human, even if they are doctors—should have the right to say whether a woman is or is not fit to be the mother of her child. I think it is dangerous because it is the thin edge of a wedge that might lead us a great deal further than we think.

5.38 p.m.

On Question, Whether the said Amendment (No. 5) shall be agreed to?

Their Lordships divided: Contents, 81; Not-Contents, 51.

NOT-CONTENTS

Addison, V.Gardiner, L. (L. Chancellor.)Mottistone, L.
Ailwyn, L.Gifford, L.Moynihan, L.
Albemarle, E.Greenway, L.Plummer, Bs.
Archibald, L.Henley, L.Raglan, L.
Arwyn, L.Hertford, M.Rusholme, L.
Blyton, L.Hilton of Upton, L.St. Davids, V.
Burton of Coventry, Bs.Kirkwood, L.Shackleton, L.
Byers, L.Latham, L.Silkin, L.
Campbell of Eskan, L.Leatherland, L. [Teller.]Soper, L.
Cholmondeley, M.Listowel, E.Stocks, Bs.
Chorley, L.Lloyd of Hampstead, L.Strabolgi, L.
Citrine, L.MacAndrew, L.Strange, L.
Colwyn, L.Mitchison, L.Summerskill, Bs.
Effingham, E.Molson, L.Taylor, L.
Falkland, V.Monsell, V.Wellington, D.
Ferrier, L.Monson, L.Willis, L.
Gaitskell, Bs.Morrison, L.Winterbottom, L. [Teller.]

Resolved in the affirmative, and Amendment agreed to accordingly.

5.48 p.m.

My Lords, as the House knows, we still have a lot of Business before us, and we have had a long debate. I believe the next Amendment raises another matter of principle and I wonder whether it would be the wish of the House—I believe my noble friend Lord Silkin is agreeable—that we should complete the Report Stage now and then proceed with what Amendments the House wishes to put down on the recommittal on Monday. If that be the case, I wonder whether my noble friend Lord Silkin could express his views in agreement.

My Lords, I am perfectly willing not to move the remainder of the Amendments and to ask that the Bill be recommitted.

My Lords, so far as I am concerned, that course is perfectly satisfactory. I do not know whether the noble Lady will take the same view; but I can assure her that if she does, as we are again on the same side on Monday, if she cannot be here—and I hope she will be—I will do my utmost to put the case as persuasively and eloquently as she has put the case to-day.

My Lords, that is very acceptable. I understand that we have to call all the Amendments in order that the Report stage be completed properly. I hope that nobody will respond to the calling of the Amendments.

My Lords, I beg to move that the Bill be now re-committed to a Committee of the Whole House.

Moved, That the Bill be now re-committed to a Committee of the Whole House.—( Lord Silkin.)

On Question, Motion agreed to, and Bill re-committed accordingly.