- Email: [email protected]
MEDICAL SECRECY AND ABORTION
676 What of resuscitation ?Light-cradles, heated sleepingbags, and friction are less effective than rapid rewarming by direct immersion in water at temperatures of up to 50°C, maintained until peripheral vascular spasm is dispelled. Characteristically, the subject gives a sharp outcry, and then the laboured respiration and muscular rigidity disappear. With brisk rubbing and wrapping in warm blankets the temperature is restored to normal in about three hours.
to respect the confidence of the patient," this advised the practitioner to urge his patient to make a statement to the police ; but if such a statement is refused, he is under no legal obligation to take further action and should continue to treat the patient. It is less easy to give any definite answer to the further question which the incidents in Germany may raise herenamely, whether the records of patients and treatment which have to be forwarded to the local executive council under the National Health Service regulations, and the written clinical information which may be requested by the medical officer of health, are, in theory or even in practice, open to similar misuse. There is, however, some authority for suggesting that, if the Government department concerned were to object to the revelation of such documents to the police, the courts would uphold the objection on the ground that the papers are protected as State documents.
obligation
MEDICAL SECRECY AND ABORTION Ix our leading article of Feb. 24 we drew attention to the legal safeguards which foreign systems, in contrast to the common law, have established to protect confidential communications between doctors and their patients. Happenings in two towns of Western Germany at the end of February show that even these measures to prevent breaches of medical secrecy may not go far enough. They also illustrate how jealously the public CARE OF THE TEETH on the Continent resist any attempt to whittle down, by THOUGH its causes lie chiefly in diet, much dental official action, what they have come to regard as a caries could be prevented or checked if people could be fundamental right of the individual. Under a statute of 1935, re-enacted in 1946-47, practi- induced to keep their mouths clean and see a dentist tioners in Western Germany have to notify to the publicregularly. Recognising that, for many years at least, most dental surgeons will be occupied mainly in dental health authorities, for the purpose of registration and statistics, any abortions among patients under their repairs, Mr. G. H. Leathermanbases his scheme of care. There seemed to be no danger in such action until preventive care on the employment of women dental it occurred to the public prosecutor of the town of ancillaries, or hygienists," who would undertake Weinheim (Baden) that the information thus assembled scaling and polishing, and would help to instruct patients might be useful for tracking down professional abor- or parents in the elements of oral hygiene and home tionists, whose activities have lately increased. The treatment. V’hereas adults, and possibly adolescents, prosecutor asked the local health authority to give him should be seen first by the dental surgeon, who would a copy of the relevant list of women treated for haemorrefer the patient to the hygienist for any minor treatthe six in and due course ment required, Mr. Leatherman thinks that for the very &c., months, past during rhages, the police were told to summon and interrogate the young the sequence should be reversed, because it is women named in the list. Perhaps in an excess of zeal, psychologically better for the child to be introduced to the local chief of police ordered a raid during which some dental care by a woman. He recommends that polishing 200 women and girls from the town and neighbourhood of the teeth, mouth charting, and the taking of " wingwere taken in vans to the police station and kept there bite " radiographs should be done by the hygienist several hours for questioning and further investigation, before the child goes to the dental surgeon for detailed on no other ground than that they had been treated examination and treatment. This proposal, however, within the last six months for miscarriage. when he made it before the British Dental Association How far this measure succeeded in its purpose is not at Birmingham was strongly criticised,2mainly on the yet known ; for this aspect of the affair has been sub- ground that diagnosis should precede treatment and merged by a wave of protests from the doctors of the that scaling alters the diagnostic picture. Mr. A. F. district and from the public. Concern has been aroused Stammers did not regard scaling as by any means minor all over Germany, particularly since it became known dental work : it was, he said, the most important thing a that a similar attempt to get evidence of criminal dental surgeon could do for his patient. Mr. E. Daviesabortions from official returns of miscarriages had been Thomas, at the Children’s Hospital, Birmingham, had made by the police at Garmisch (Bavaria). In its indigmade a rule that nobody should talk to the child except nation over the high-handed action of the police, the himself, and in this way he established a personal German press has not lost sight of the wider principles understanding. In the care of the teeth at home, Mr. Leatherman involved, and much of the outcry has been directed against the public-health officials for their " gross breach believes that the basic need from childhood is to prevent of. medical secrecy " in passing the list of names to the gingivitis, and, where gingivitis and its sequelae have has The local medical public prosecutor. organisation developed, to see that the causes are removed and the advised its members to suspend all notifications of supporting structures rendered healthy. The patient abortion until the legality of the recent police action has should be made to understand that the supporting been investigated, and an information has been laid structures of the teeth require as much attention as the against the health officials concerned for breach of medical surfaces of the teeth themselves, and to this end the term and official secrecy. This step has been endorsed by the toothbrush should be changed to mouthbrush. He medical chamber of the Land, which demands new favours the use of a mouthwash of full-strength hydrogen legislation to provide legal safeguards against such peroxide (10 volumes), or ’Milton’ (1part to 4 parts breaches of medical secrecy, if the present rules- should be water), or sodium chloride and sodium bicarbonate found insufficient. After this sharp reaction of public (1/2 teaspoonful of each in half a glass of warm water). and medical opinion in Western Germany such attempts The teeth and mouth are brushed first thing in the to circumvent medical secrecy are not likely to be morning and last thing at night with salt powder, ora repeated, the more so since German law clearly says powder of urea and ammonium ; though what really that in no circumstances can such a breach be ordered matters is not what is on the brush but how and when even for the purpose of pursuing punishable conduct. the brush is used. The brush of choice, according to In this country the duties of medical practitioners in Mr. Leatherman, is one of natural bristle, of medium relation to cases of criminal abortion which have come to consistence, 6-8 rows long, the bristles being all of the their knowledge in the course of treatment were the subsame length ; and more than one brush is necessary, for ject of a resolution passed by the Royal College of 1. Brit, dent. J. 1950, 89, 119. 2. Ibid, p. 125. Physicians in- 1916. After emphasising " the moral "
to respect the confidence of the patient," this advised the practitioner to urge his patient to make a statement to the police ; but if such a statement is refused, he is under no legal obligation to take further action and should continue to treat the patient. It is less easy to give any definite answer to the further question which the incidents in Germany may raise herenamely, whether the records of patients and treatment which have to be forwarded to the local executive council under the National Health Service regulations, and the written clinical information which may be requested by the medical officer of health, are, in theory or even in practice, open to similar misuse. There is, however, some authority for suggesting that, if the Government department concerned were to object to the revelation of such documents to the police, the courts would uphold the objection on the ground that the papers are protected as State documents.
obligation
MEDICAL SECRECY AND ABORTION Ix our leading article of Feb. 24 we drew attention to the legal safeguards which foreign systems, in contrast to the common law, have established to protect confidential communications between doctors and their patients. Happenings in two towns of Western Germany at the end of February show that even these measures to prevent breaches of medical secrecy may not go far enough. They also illustrate how jealously the public CARE OF THE TEETH on the Continent resist any attempt to whittle down, by THOUGH its causes lie chiefly in diet, much dental official action, what they have come to regard as a caries could be prevented or checked if people could be fundamental right of the individual. Under a statute of 1935, re-enacted in 1946-47, practi- induced to keep their mouths clean and see a dentist tioners in Western Germany have to notify to the publicregularly. Recognising that, for many years at least, most dental surgeons will be occupied mainly in dental health authorities, for the purpose of registration and statistics, any abortions among patients under their repairs, Mr. G. H. Leathermanbases his scheme of care. There seemed to be no danger in such action until preventive care on the employment of women dental it occurred to the public prosecutor of the town of ancillaries, or hygienists," who would undertake Weinheim (Baden) that the information thus assembled scaling and polishing, and would help to instruct patients might be useful for tracking down professional abor- or parents in the elements of oral hygiene and home tionists, whose activities have lately increased. The treatment. V’hereas adults, and possibly adolescents, prosecutor asked the local health authority to give him should be seen first by the dental surgeon, who would a copy of the relevant list of women treated for haemorrefer the patient to the hygienist for any minor treatthe six in and due course ment required, Mr. Leatherman thinks that for the very &c., months, past during rhages, the police were told to summon and interrogate the young the sequence should be reversed, because it is women named in the list. Perhaps in an excess of zeal, psychologically better for the child to be introduced to the local chief of police ordered a raid during which some dental care by a woman. He recommends that polishing 200 women and girls from the town and neighbourhood of the teeth, mouth charting, and the taking of " wingwere taken in vans to the police station and kept there bite " radiographs should be done by the hygienist several hours for questioning and further investigation, before the child goes to the dental surgeon for detailed on no other ground than that they had been treated examination and treatment. This proposal, however, within the last six months for miscarriage. when he made it before the British Dental Association How far this measure succeeded in its purpose is not at Birmingham was strongly criticised,2mainly on the yet known ; for this aspect of the affair has been sub- ground that diagnosis should precede treatment and merged by a wave of protests from the doctors of the that scaling alters the diagnostic picture. Mr. A. F. district and from the public. Concern has been aroused Stammers did not regard scaling as by any means minor all over Germany, particularly since it became known dental work : it was, he said, the most important thing a that a similar attempt to get evidence of criminal dental surgeon could do for his patient. Mr. E. Daviesabortions from official returns of miscarriages had been Thomas, at the Children’s Hospital, Birmingham, had made by the police at Garmisch (Bavaria). In its indigmade a rule that nobody should talk to the child except nation over the high-handed action of the police, the himself, and in this way he established a personal German press has not lost sight of the wider principles understanding. In the care of the teeth at home, Mr. Leatherman involved, and much of the outcry has been directed against the public-health officials for their " gross breach believes that the basic need from childhood is to prevent of. medical secrecy " in passing the list of names to the gingivitis, and, where gingivitis and its sequelae have has The local medical public prosecutor. organisation developed, to see that the causes are removed and the advised its members to suspend all notifications of supporting structures rendered healthy. The patient abortion until the legality of the recent police action has should be made to understand that the supporting been investigated, and an information has been laid structures of the teeth require as much attention as the against the health officials concerned for breach of medical surfaces of the teeth themselves, and to this end the term and official secrecy. This step has been endorsed by the toothbrush should be changed to mouthbrush. He medical chamber of the Land, which demands new favours the use of a mouthwash of full-strength hydrogen legislation to provide legal safeguards against such peroxide (10 volumes), or ’Milton’ (1part to 4 parts breaches of medical secrecy, if the present rules- should be water), or sodium chloride and sodium bicarbonate found insufficient. After this sharp reaction of public (1/2 teaspoonful of each in half a glass of warm water). and medical opinion in Western Germany such attempts The teeth and mouth are brushed first thing in the to circumvent medical secrecy are not likely to be morning and last thing at night with salt powder, ora repeated, the more so since German law clearly says powder of urea and ammonium ; though what really that in no circumstances can such a breach be ordered matters is not what is on the brush but how and when even for the purpose of pursuing punishable conduct. the brush is used. The brush of choice, according to In this country the duties of medical practitioners in Mr. Leatherman, is one of natural bristle, of medium relation to cases of criminal abortion which have come to consistence, 6-8 rows long, the bristles being all of the their knowledge in the course of treatment were the subsame length ; and more than one brush is necessary, for ject of a resolution passed by the Royal College of 1. Brit, dent. J. 1950, 89, 119. 2. Ibid, p. 125. Physicians in- 1916. After emphasising " the moral "