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It was appropriate that the promotion of vasectomy as a birth control technique should be undertaken at the Marie Stopes Clinic whilst under the management of the Eugenics Society which had for so long concerned itself with voluntary male sterilisation and with the attempt to rid it of its contradictory associations with castration and rejuvenation. It was correspondingly unfortunate that the last reluctant heroine of the twentieth century birth control movement should have to endure near martyrdom for her efforts to encourage that then emergent procedure at the Clinic.
Dr Caroline Deys obtained her MB BS (London) in 1962 and held hospital appointments as house physician and house surgeon at the Middlesex Hospital and in Glasgow and as a Registrar in Salisbury. During her tenure of this latter post she had been trained as a Family Planning Association doctor by Dr Dorothy Morgan - a pioneer of domiciliary birth control services.(1) In 1966 she married and went to live in Cambridge where she was a founder member of the Cambridge Advisory Centre for young people, providing contraceptive advice to the unmarried. She also did family planning work in Thetford and set up the first domiciliary family planning service in the city of Cambridge as well as an IUD clinic at a local hospital. In 1969 she moved to London where her husband had recently been appointed Medical Secretary of the International Planned Parenthood Federation. It was during a tour of India, Pakistan and Bangladesh with him in the winter of 1969 that she learned and perfected the technique of vasectomy.
Returning from India in February 1970, Dr Deys began work at the Marie Stopes Clinic where Dr Nils Regan had been offering vasectomies to carefully selected patients for about a year. She was employed for two three-hour sessions a week with a mandate to develop a free vasectomy service.
This was a role for which Dr Deys was uniquely qualified by training, experience and temperament. It enabled her to employ both her domiciliary counselling skills and her surgical expertise in the provision of a form of contraception for which there was an immediate and sustained demand. In the first of her two weekly sessions she interviewed potential patients in their home, usually in the presence of their wives, explaining in detail the nature and implications of the proposed procedure. During the second session she carried out the operation at the Marie Stopes Clinic and arranged to see the patient again during a subsequent domiciliary visit, in the meantime leaving him her telephone number in the event of a complication or the need for reassurance. The routine worked well. During the first two years following her appointment Dr Deys performed 700 vasectomies. Since she scheduled her weekly clinic session to permit her to carry out six to eight operations this represented a heavy case load.
The Marie Stopes Clinic and Dr Deys had demonstrated the existence of a need for this new and innovative form of birth control; they had also shown how easily and efficiently that need could be met. At this time the early returns on the operation of the 1967 Abortion Act (which had come into effect in April 1968) revealed the inadequacy of contemporary contraceptive practice whilst the oral contraceptive, which had then been in use in England for just over a decade, was beginning to attract the first serious doubts about its long-term safety.(2) Vasectomy, in these circumstances, appeared to offer an attractive alternative form of family limitation.
It was coitus-independent, it placed the responsibility with the husband where many thought that responsibility rightly belonged, it was safe, simple and cheap and, as Dr Deys was fond of saying, "it could not be left behind when the couple went on holiday, or discovered and eaten by the children."
In 1971 Dr Deys published the first of a number of articles she was to write for the professional journals about her work at the Marie Stopes Clinic. Believing that vasectomy could be routinely performed by general practitioners in their surgeries, she also agreed to teach the technique to doctors on a series of courses planned by the Vasectomy Advancement Society. And, during 1971 she had discussions with Dr Wilfrid Harding, the eminent and innovating Medical Officer of Health for Camden, who wished to establish a vasectomy service within his borough. It was through these peripheral events that Dr Deys’ work at the Marie Stopes Clinic became known to the press, being first mentioned in a report in that tribal notice board of the bien pensant, The Hampstead and Highgate Express in March 1972.
Following the appearance of that report Helen Speed, a freelance journalist, telephoned Dr Deys seeking an interview in connection with an article which she was writing and which she hoped to sell to the Sunday People. The interview took place at the Marie Stopes Clinic and the article appeared on 2 April under the headline: "THEIR SEX LIFE IN HER HANDS". A sub-heading read: "A doctor notches up 700 male ops" and an accompanying photograph purported to show Dr Deys with her four year old daughter, Sally.
In a subsequent assessment of the Sunday People article, the distinguished medical correspondent of the New Statesman, himself a doctor, was to comment: "The headline was possibly not quite the sort of thing you’d find at the top of a Lancet article, but the story was a straightforward account of the way this woman was being accepted as their surgeon by a steady stream of men who have decided that their breeding days are over. Its effect was to show how easily the thing could be done and how many ordinary men had become the doctor’s satisfied customers."(3) This was a reasoned judgement by a journalist and doctor. For, although Dr Deys had pointed out the high acceptability of vasectomy, especially amongst those in the lower socio-economic groups who were well-known to have difficulties with more sophisticated forms of contraception, the article also stressed those caveats which ethics and responsible medicine, then and now, would demand in any discussion of vasectomy: the need for the written consent both of the man’s general practitioner and of his wife, the desirability of using additional contraception for three months following the operation and the need, in any particular instance, to regard the procedure as irreversible.
The publication of the Sunday People article nevertheless provoked a strange sequence of events which was to cause immense distress to Dr Deys, consternation amongst her medical colleagues and the intensification of demands for the reform of the government and regulation of the medical profession.
On 18 May, seven weeks after the article appeared, Dr Deys received formal notification from the General Medical Council that it was considering a complaint against her which raised a question "whether as a registered medical practitioner you have committed serious professional misconduct". The complaint, accompanying the GMC’s letter, was in the form of a statutory declaration by Dr Philip H Addison who alleged that it was "self-evident" that Dr Deys had supplied the material for the Sunday People article and that in consequence "Dr Deys has acquiesced in the publication of matter commending and drawing attention to her professional skill, knowledge and services, primarily or to a substantial extent for the purpose of promoting her own personal advantage."
Quite apart from the substance of the charge this was a curious and, to say the least, unusual situation. Dr Philip H Addison was the Secretary of the Medical Defence Union and was, he claimed in his statutory declaration, acting on the instructions of his Council which had received a complaint from one of its members. The Medical Defence Union is one of the two "trade unions" to which every working doctor belongs and whose primary function is to defend doctors against charges brought by the GMC and others. Needless to say Dr Deys was a member of the rival Medical Protection Society whose lawyers in fact were to take over the conduct of her defence. Dr Deys was faced with a situation in which a single and anonymous complaint had already been pronounced upon by one professional body (which could merely have passed it on without comment to the GMC) and dignified by the full backing of its Council. Moreover, the swearing of a statutory declaration by Dr Addison appeared to add spurious legal authority to what, after all, was merely one man’s grievance. The President of the GMC could more easily have disregarded that original letter (or given Dr Deys a mild caution) than the statutory declaration carrying the full weight of the MDU’s governing body. Instead he decided to set in motion the awesome disciplinary machinery of the GMC. "In accordance with the provisions of Rule 5 of the Procedure Rules", the Registrar warned Dr Deys, "the President may direct the Registrar to refer the complaint to the Penal Cases Committee of the Council and in this event it will be the duty of the Committee to consider the complaint and any explanation furnished by you and to determine whether the case shall be referred to the Disciplinary Committee for inquiry into the charge against you."(4) Nor could there be any mistaking the gravity of the charge. "Serious professional misconduct" represents the grounds on which doctors are struck from the Register.
In her written reply to the GMC’s charges Dr Deys conceded that she had "acquiesced" in the publication of the Sunday People article though she had not initiated the article nor had she been consulted about either the main headline or the sub-heading, of which she disapproved. Parts, but not the whole, of the article had been read to her over the phone and these she had approved. She did not remember making some of the statements attributed to her and she had refused to be photographed by the newspaper’s photographer. The photograph which was published was taken from the newspaper’s files and was reproduced without her knowledge or consent. It was two years’ old and Sally, who was referred to in the article as a four-year old was portrayed at obviously half that age.
Dr Deys stated that her motive in assisting with the publication of an article, which was going to be written, with or without her help, was solely "to try to get away from the middle class image of vasectomy and to show that it is an operation that is easily and cheaply available to ordinary people in all walks of life as a method of family planning, and that it can be carried out informally and is nothing to be afraid of." She felt, she said, "that an article in a popular newspaper would be useful publicity for vasectomy in a manner appropriate for the readership of such a newspaper." These arguments were totally consistent with everything Dr Deys had previously said and written about this birth control method of which she was such a visible advocate. Her denial of any attempt to obtain personal professional advantage through the publication of the newspaper article was also corroborated by the known details of a career very clearly dedicated to a social purpose.
"My motive", she wrote to the GMC, "was not to publicise myself or my own professional skill, knowledge or services, or the services provided by the Marie Stopes Clinic ... I am not engaged in private practice. Even if it [ie the article] were to result in a large number of potential patients approaching the Marie Stopes Clinic I would derive no financial benefit, because I am paid for two sessions per week irrespective of the number of patients attending and family commitments prevent my undertaking any additional sessions." So far as her standing within the profession was involved Dr Deys pointed out that since most doctors who knew her already considered what she was doing was unorthodox, the article was more likely to diminish than enhance her reputation amongst her peers.
She concluded her letter to the GMC by expressing her regret that the article should be thought to have offended against professional ethics but reiterating her denial that she had been motivated by considerations of professional or financial advantage.
This was a second point at which the GMC could have called a halt to the case. The Penal Cases Committee considers only written evidence - in this case the deposition by Dr Addison and Dr Deys’ letter of rebuttal. The latter, as we have seen, had dealt in a factual - and therefore verifiable - manner with the complaints raised; it had convincingly refuted the charge of seeking financial advantage and it had ended with a humble apology for any inadvertent breach of ethics. If there had been any lingering doubt about Dr Deys’ innocence the Committee could have asked for further written clarification. It did not. It referred the case to the ultimate judicial tribunal - the GMC’s Disciplinary Committee.
The inquiry was set for 20 November but Dr Deys, her solicitors, Counsel and witnesses were kept waiting for two days, whilst other cases were heard, before being brought to the GMC’s Council Chamber - the baroque setting for what, were the possible consequences for the defendant not so serious, might pass as the burlesque of a mediaeval trial. In the heavily panelled hall, galleried at each end, Aesculapian busts gazed down into the court where the solicitors and barristers at their benches faced the President on his raised dais flanked by the members of Council. The defendant was placed in the dock.
To Be Concluded
References:
1.D Morgan, "Acceptance by problem parents in Southampton of a domiciliary birth control service" in Biological Aspects of Social Problems (ed Meade and Parkes) Oliver and Boyd, 1965. (Dr Morgan’s work was financed by the Eugenics Society and the Marie Stopes Memorial Foundation).
2.WHW Inman, M P Vessey, B Westerholm, and A Engelund, "Thromboembolic disease and steroidal content of oral contraceptives". British Medical Journal, ii, 1970 p 203.
3.Donald Gould, "Dr Caroline’s Crime", New Statesman, 17 November 1972, pp 714-715.
4.Letter from Assistant Registrar, General Medical Council to Dr Deys, 18 May 1972.