As the constitution of the House to-day is somewhat different from what it was when the House rose last night, I may perhaps be permitted to remind Senators that the section which is objected to is one which has the effect of giving power to the Minister to compel a midwife to call in a local dispensary doctor, if available, and that it was supported by the Parliamentary Secretary on the grounds that it was desirable for purposes of discipline. On the Second Reading, it did occur to me that, although that was a perfectly valid reason, yet it might run counter to the demands of humanity and the needs of the patient. It was a matter, however, about which it was obviously necessary to get some light and guidance from those who are more professionally competent to deal with those two conflicting arguments and, therefore, I took occasion, in the interval, to consult persons who were Masters or ex-Masters of great Dublin midwifery hospitals—the Rotunda, the Coombe, and Holles Street—and also with well-known gynæcologists attached to other hospitals, and I was unable to find any one of those specialists who was in favour of this section. One of them was not anxious to decide between the view of the Parliamentary Secretary and his own view as a doctor, but generally the specialist gynæcologists were strongly against the passing into law of this section, and they assured me that the opinion of the medical profession, as a whole, was exceedingly adverse to it.
The reasons for that opinion are simple and, although we are not doctors, I think they are within the knowledge of most of us in this House. For instance, in child-birth, certain emergencies may arise at any time. You may have to deal with a sudden hæmorrhage at any stage of the birth, either before it or after it. You may have to deal with other sudden and dangerous emergencies, such as eclampsia or fits, and when you are faced with those emergencies the question of the mother's life may depend on promptness in attendance and skill. Now, drafted as it is, the section imperatively requires that the midwife must call in the dispensary doctor, if available, and no standard is laid down as to the availability of the doctor. Senators will be aware that in country districts dispensary doctors, very often, are not on the telephone, and they will be also aware that by reason of the shape or contour of a particular county, and the irregularity of the districts over which a dispensary doctor presides, a woman may have her labour come upon her when there is no dispensary doctor within many miles of her place. Apparently, however, this section would make it incumbent upon the midwife to send a message, by bicycle, by foot, or on horseback, to the nearest dispensary doctor, no matter how far away he might be, in order to find out whether or not his services are available. He might be available, but he might be too late. He might not be available, and it would be only when the midwife could ascertain that he was not available, that she could call in another doctor. At the same time, there might be a doctor two or three miles away, perhaps in a nearby town which did not constitute part of the dispensary district, who could be summoned by telephone to save the woman's life.
I am advised that that is more than a possibility; it is a thing which is likely to occur, and I suggest that the mere statement of that as a possibility should be sufficient to induce this House either to reject altogether or, at least, to insist upon some strong modification of the section as it stands. But there are other considerations. There may not be an emergency involving danger of the mother's death if it is not dealt with immediately and skilfully, but there may be long and difficult labour in which it is desirable, not only from the point of view of humanity, but also from the point of view of the health of the mother and the child, that skilled, and the most skilled, help should be available at the first opportunity. I think that not merely the saving of life but the saving of suffering is a consideration which should be allowed to overweigh mere considerations of discipline.
The Parliamentary Secretary will, no doubt, develop at greater length the necessity for this discipline upon which he has already touched. But I do rather earnestly urge on this House to insist that the treatment of the patient is, and must be, the primary consideration. We know that, even among those who are not gynæcological specialists, there are doctors in most districts who tend to pay more attention to midwifery cases than other doctors because they are more expert and more interested in that branch of the profession. They are more skilled and they are likely to be able to deliver a woman sooner and with less suffering and, speaking for myself, I do feel that it is a wrong thing that the midwife should be compelled to call in a dispensary doctor, even if he is available, when it may be known to her, and known to everybody in the neighbourhood, that, through no fault of his, he is not as skilled an operator as other doctors equally available. I ask the House to give greater weight to those considerations than to a rather formalistic conception of discipline. Discipline is a good thing; it is sometimes a necessary thing, but it is not everything.
