Antiabortionists hijack fetal pain argument

BMJ 1996; 313 doi: (Published 27 July 1996) Cite this as: BMJ 1996;313:188

Claims by antiabortionists that fetuses can feel pain at 10 weeks' gestation have been criticised by specialists. Last week the all party parliamentary pro-life group produced a review of previously published data relating to anatomical structures involved in awareness of pain. In Fetal Sentience 15 scientists from Britain, Ireland, and Australia claim that the fetus can feel pain from the tenth week of gestation, much earlier than previously thought.

The cerebral cortex is not the only area of the brain that is responsible for consciousness (thought to be a prerequisite for feeling pain), says the report. It cites three cases— anencephalic infants, a patient with the persistent vegetative state, and a student with hydrocephalus—who have non-existent, damaged, or very small upper brains but who are still capable of feeling pain. In these individuals the thalamus may assume some cortical functions. But no one is sure yet when parts of the brain in a fetus become mature enough to register pain.

Although many specialists accept that the issue of fetal pain must be explored further, they say that the use of such an emotive subject to campaign against abortion with insufficient scientific evidence is a misinterpretation of the facts.

Mr John Friend, senior vice president of the Royal College of Obstetricians and Gynaecologists, said: “To suggest that a 10 week fetus can feel pain in the same way as you or I would seem unreasonable. We need to look at the facts as they are and not jump to conclusions.”

The only research into fetal pain is from Queen Charlotte's Hospital in London and is highly controversial. Researchers found that levels of the stress hormone cortisol in fetuses rose sharply as a needle was inserted into the womb.

“Just because a sample of blood shows an increase in stress hormone does not mean that a fetus is feeling pain,” commented Mr Friend. “It may indicate that they feel stressed, but whether that translates into pain as we know it is a different matter.” The evidence to date will not alter the ethos of termination, he added.

Professor Kypros Nicolaides, professor of fetal medicine and director of the Harris Birthright Research Centre for Foetal Medicine at King's College Hospital in London, is adamant that the question of fetal pain is irrelevant to abortion. Fetal experts have already resolved the issue of fetal pain for themselves. Through a consensus they agree that no termination is carried out beyond 20 weeks' gestation without first ensuring that the fetus is dead by giving it an injection.

Mr Nicolaides said that earlier terminations are performed under general anaesthetic, and the fetus will receive anaesthetic through the placenta, so that if there was a chance the fetus could feel pain it would already have been anaesthetised.

Commenting on the research to date he added: “All the procedures involving the measurement of cortisol have been confined to fetuses older than 20 weeks, at which we ensure the fetus is dead before a termination. The scientific basis for claiming fetal pain is so far dubious and very controversial. The main issues have been taken up by antiabortionists to make us out as murderers.”

In the case of very early terminations, which are not always performed under general anaesthetic, measures to ensure that the fetus does not suffer will have to be taken if it is proved that fetuses can feel pain, added Mr Friend: “We as doctors are not keen to do anything that causes suffering.”—ZOSIA KMIETOWICZ, freelance journalist, London

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