Fetal pain

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Fetal pain, its existence, and its implications are debated politically and academically, particularly in regards to the abortion debate.

Overview

Whether a fetus has the ability to feel pain and to suffer is part of the abortion debate.White, R. Frank. "Are We Overlooking Fetal Pain and Suffering During Abortion?", American Society of Anesthesiologists Newsletter (October 2001). Retrieved 2007-03-10. David, Barry & and Goldberg, Barth. "Recovering Damages for Fetal Pain and Suffering", Illinois Bar Journal (December 2002). Retrieved 2007-03-10. Determining the stage of pregnancy at which a fetus is able to feel pain or suffering could have a significant effect on the abortion debate as well as abortion laws and practices. For example, legislation has been proposed requiring abortion providers to tell a woman that the fetus may feel pain during the abortion procedure, and requiring her to accept or decline anesthesia for the fetus.Weisman, Jonathan. "House to Consider Abortion Anesthesia Bill", Washington Post 2006-12-05. Retrieved 2007-02-06. In a straw poll conducted by the British Newspaper the Daily Telegraph, a group of neurobiologists believe that a fetus may be able to feel pain sometime during the pregnancy, perhaps beginning at 20 weeks after conception, although the question of exactly when pain might be possible is disputed.Derbyshire, David, [http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2003/03/10/nfoet10.xml&sSheet=/news/2003/03/10/ixhome.html Foetuses 'may be conscious long before abortion limit'], Telegraph (UK) 2003-09-03: "a Daily Telegraph straw poll found many neurologists were concerned that foetuses could feel pain in the womb before 24 weeks after conception." A 2005 American study, conducted by neurobiologists and pediatricians concluded that "...fetal perception of pain is unlikely before the third trimester. Little or no evidence addresses the effectiveness of direct fetal anesthetic or analgesic techniques.""Fetal Pain: A Systematic Multidisciplinary Review of the Evidence" JAMA. 2005;294:947-954. Susan J. Lee, JD; Henry J. Peter Ralston, MD; Eleanor A. Drey, MD, EdM; John Colin Partridge, MD, MPH; Mark A. Rosen, MD With the encouragement of President Ronald Reagan, in 1984 a small group of physicians argued that the ability of a fetus to feel pain appears as early as seven weeks after conception.Robinson, B.A. (2006). Can a fetus feel pain?. Ontario Consultants for Religious Tolerance. Retrieved December 14, 2005. Most medical researchers agree pain cannot be felt until the third trimester of pregnancy or until after birth."Study: Fetus feels no pain until third trimester" MSNBCThere may be an "emerging consensus among developmental neurobiologists that the establishment of thalamocortical connections" (at about 26 weeks) is a critical event with regard to fetal perception of pain. Nevertheless, because pain can involve sensory, emotional and cognitive factors, it is "impossible to know" when painful experiences may become possible, even if it is known when thalamocortical connections are established.

Summary of overview

Early in development, from about 12-18 weeks gestation, there is a complete link from the periphery to the thalamus in the brain, and the fetus shows clear evidence of defensive reactions against tissue damage including hormonal and hemodynamic responses. After about 26 weeks gestation there is a complete link from the thalamus to the cortex of the brain. Cortical responses in premature babies of about 25 weeks gestation have been recorded during the usual heel lance procedure performed shortly after birth (for blood sampling). In summary, there is good evidence that from about 26 weeks gestation the fetal brain can be considered a functional unit capable of processing noxious sensory input, and pain before that point may also be possible.

Medical studies and reviews

2000 and beyond

United Kingdom

In 2001, a working group of the Medical Research Council (UK) in the United Kingdom suggested that doctors should consider the use of analgesia and sedation for fetuses over 24 weeks of age undergoing surgery.Medical Research Council, Fetal Pain - Research Review (2001-08-24). Retrieved 2007-03-10. Dr. Eve Johnstone, the chair of that working group, told The Daily Telegraph that a fetus was aware of pain by 24 weeks, maybe as early as 20 weeks,Highfield, Roger. "Very premature babies may need pain relieving drugs," The Telegraph (2001-08-27). Retrieved 2007-03-10. because "connections from the thalamus to the cortex begin to form at about 20 weeks gestation."Medical Research Council, Fetal Pain - Research Review (2001-08-24). Retrieved 2007-03-10. Dr. Susan Dudley of the National Abortion Federation in the U.S. responded: "The obvious and most important thing to say is most abortions take place before 20 weeks."Beaucar, Kelley. Fetal Study Adds Fuel to Late-Term Abortion Debate, Fox News (2001-08-31). Retrieved 2007-03-10.In 2006, a clinical review published in the British Medical Journal concluded that pain is dependent upon cognitive and emotional developments that occur after birth:

United States

In 2005, Mellor and colleagues reviewed several lines of evidence that suggested a fetus does not awake during its time in the womb. If the fetus is asleep throughout gestation then the possibility of fetal pain is greatly minimised. Mellor D.J., Diesch T.J., Gunn A.J., & Bennet L. (2005). The importance of ‘awareness’ for understanding fetal pain. Brain Research Reviews, 49(3), 455-71. Retrieved December 23, 2006.Later in 2005, a meta-analysis (or "review") of existing experiments published in the Journal of the American Medical Association (JAMA) concluded that the limited available evidence indicates fetal perception of pain is unlikely before the third trimester, and that electroencephalography suggests the capacity for functional pain perception in premature infants probably does not exist before 29 or 30 weeks; this study asserted that withdrawal reflexes and changes in heart rates and hormone levels in response to invasive procedures are reflexes that do not indicate fetal pain.Lee, Susan J., Ralston, Henry J. Peter, Drey, Eleanor A., Partridge, John Colin, & Rosen, Mark A. (2005). Fetal Pain: A Systematic Multidisciplinary Review of the Evidence. Journal of the American Medical Association, 294 (8), 947-954. Retrieved 2007-02-26. "Evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester....electroecephalography suggests the capacity for functional pain perception in preterm neonates does not exist before 29 or 30 weeks." A news report about this JAMA study can be found here: "[http://news.bbc.co.uk/1/hi/health/4180592.stm Foetuses 'no pain up to 29 weeks']," BBC News (2005-08-24). Retrieved 2007-03-14. This meta-study was criticised by pro-life groups who were skeptical because of the prior involvement of several authors of the report. One directs an abortion clinic at San Francisco Hospital, while the lead author undertook legal work with NARAL Pro-Choice America for six months.Bazar, Emily. 2 authors of fetal-pain paper accused of bias, USA Today (2005-08-24). Retrieved 2007-03-10.Catherine DeAngelis, M.D., editor of the JAMA and a Roman Catholic who opposes abortion, defended the review. According to Medical News Today:
M.D. said she will publish properly submitted comments on the review in an upcoming JAMA issue but added that there is "nothing wrong" with the review. DeAngelis said the review was based on data from dozens of medical articles by other researchers, adding, "If there weren't four other authors and this wasn't a peer-reviewed journal, I'd worry ... but I don't" (AP/Long Island Newsday, 8/25). [http://www.medicalnewstoday.com/articles/29826.php "JAMA Editor Defends Publishing Fetal Pain Review Despite Criticism for Not Disclosing Authors' Abortion-Related Work"] MedicalNewsToday.com
The meta-study published in JAMA was criticized by Dr. K.J.S. Anand, an abortion rights advocate, who believes the threshold for pain is 20 weeks.Derbyshire, Stuart W.G. July/August, 2003. Fetal "Pain"—A Look at the Evidence. American Pain Society Bulletin. Vol. 13, No. 4. [http://www.ampainsoc.org/pub/bulletin/jul03/article1.htm]Anand, K.J.S., and P.R. Hickey. November 19, 1987. Pain and Its Effects in the Human Neonate and Fetus. New England Journal of Medicine. Vol. 317, No. 21, pp. 1321-1329 [http://www.cirp.org/library/pain/anand/] However, contrary to other researchers, Anand discounts the importance of subjective conscious perception in the experience of pain.Derbyshire, Stuart W.G. July/August, 2003. Fetal "Pain"—A Look at the Evidence. American Pain Society Bulletin. Vol. 13, No. 4. [http://www.ampainsoc.org/pub/bulletin/jul03/article1.htm] Anand writes:

1990's

Also in 1997, a "Working Party" appointed by the Royal College of Obstetricians and Gynaecologists, a medical group in the United Kingdom, stated that "very early in pregnancy fetuses will react to stimuli, but that reaction does not in itself provide any evidence that the fetus experiences those stimuli."Fetal Awareness Report of a Working Party RCOG Press. October 1997. The Working Party further stated that, "Little sensory input" reaches the brain of the developing foetus before 26 weeks, and "therefore reactions to noxious stimuli cannot be interpreted as feeling or perceiving pain."[http://news.bbc.co.uk/1/hi/health/900848.stm 'Abortion causes foetal pain'] BBC.co.uk. 29 August, 2000. Accessed 2007-03-09. A British government report said in 2007 (shortly before the RCOG report) that signals from the thalamus begin to reach the cortex between "22-34 weeks" after conception. See Parliamentary Office of Science and Technology,Fetal Awareness (February 1997). Retrieved 2007-03-15.

1980's

In 1984, anesthesiologist Vincent J. Collins wrote: "because the requisite neurological structures are present at that time and because they are functioning, as evidenced by the aversive response of the human fetus, it may be concluded with reasonable medical certainty that the fetus can sense pain at least by 13 ½ weeks."Collins, Vincent et al."Fetal Pain and Abortion: the Medical Evidence", Studies in Law and Medicine, No 18 (1984). Dr. Collins was one of several scientists who wrote an open letter to President Reagan, asserting that, "The ability to feel pain and respond to it is clearly not a phenomenon that develops de novo at birth....by the close of the first trimester the fetus is a sentient, moving being."Schmidt, Richard et al., "Open Letter to President Reagan" (1984-01-31). Retrieved 2007-03-14.

Abortion Debate

United Kingdom

In 1996, physiologist Peter McCullagh spoke on behalf of a pro-life group to the British Parlament. He said, "At what stage of human prenatal development are those anatomical structures subserving the appreciation of pain present and functional? The balance of evidence at the present time indicates that these structures are present and functional before the tenth week of intrauterine life."

United States

In 1995, Dr. Robert J. White, director of the Division of Neurosurgery and Brain Research Laboratory at Case Western Reserve University School of Medicine and a member of the Vatican's Pontifical Academy of Sciences, gave testimony before the House Constitution Subcommittee of the Congress of the United States. He stated that, at 20 weeks' gestation, the fetus "is fully capable of experiencing pain...Without question, all of this is a dreadfully painful experience for any infant subjected to such a surgical procedure."White, Robert. Testimony to U.S. House Judiciary Committee, Subcommittee on the Constitution (1995-06-15). Quoted in this congressional report. Retrieved 2007-03-10.In November of 2005, Dr. Jean Wright testified to Congress that data "shows 16 weeks and even earlier, many of these infants feel pain and have negative outcomes from it."Wright, Jean. Testimony to U.S. Congress, Subcommittee on the Constitution, Civil Rights, and Civil Liberties. "Oversight Hearing on Pain of the Unborn." (2005-11-01). Dr. Wright is Professor and Chair of Pediatrics, Mercer School of Medicine. Retrieved 2007-03-10.

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