Letters

Do fetuses feel pain?

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7088.1201 (Published 19 April 1997) Cite this as: BMJ 1997;314:1201

Surgical terminations of pregnancy take place under general anaesthesia

  1. Wendy Savage, Press officer, Doctors for a Woman's Choice on Abortiona
  1. a 19 Vincent Terrace, London N1 8HN
  2. b Department of Physiology, St Thomas's Hospital, London SE1 7EH
  3. c University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA 15213, USA

    Editor-Peter McCullagh1 and P J Saunders2 link the theoretical possibility that the fetus may feel pain (albeit much earlier than most embryologists and physiologists consider likely) with the procedure of legal abortion. Doctors for a Woman's Choice on Abortion consider this to be unhelpful to women and to the scientific debate.

    In Britain virtually all surgical terminations of pregnancy take place under general anaesthesia, which will affect the fetus. The question of whether the fetus experiences pain is not an issue as far as abortion is concerned, although those experts in fetomaternal medicine who are operating on the more mature fetus in utero need to consider whether women should have general anaesthesia for these procedures.

    References

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    Definition of pain needs clarification

    1. Patrick D Wall, Professorb
    1. a 19 Vincent Terrace, London N1 8HN
    2. b Department of Physiology, St Thomas's Hospital, London SE1 7EH
    3. c University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA 15213, USA

      Editor-Peter McCullagh1 compounds the confusion of Vivette Glover and Nicholas Fisk over whether fetuses feel pain.2 They show that a 25 week fetus responds to injury with an endocrine response. McCullagh now adds that response to trigeminal stimulation begins after several weeks. The confusion comes from the authors' eccentric definition of pain as simply a response to injury. This cannot be an adequate definition since adults under general anaesthesia respond to injury with movement and endocrine changes and yet have no sensation. A paraplegic person responds to caudal stimuli but has no sensation.

      Any definition of pain in someone who cannot speak has to include a prolonged–even permanent–change of response. A neonate operated on with inadequate analgesia suffers prolonged abnormalities. A battered baby is recognised by his or her abnormal development. Where is the authors' evidence that a fetus shows any prolonged shift of response? A normal term baby after vaginal delivery shows clear signs of tissue damage, especially if forceps have been applied. A normal term baby delivered by elective caesarean section seems unscathed. Where is the evidence that the baby delivered vaginally has suffered from its injuries when compared with the baby delivered by caesarean section?

      References

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      Analgesic and anaesthetic procedures are being introduced because of shoddy sentimental argument

      1. Stuart WG Derbyshire, Research fellowc
      1. a 19 Vincent Terrace, London N1 8HN
      2. b Department of Physiology, St Thomas's Hospital, London SE1 7EH
      3. c University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA 15213, USA

        Editor-Can the fetus feel pain? The authors of three of the four contributions to this article decided no.1 Even the more cautious response suggested only a grey area during the second trimester. Now the authors of two letters argue for placing the development of fetal pain at somewhere around 6-12 weeks after conception.2 3 Is their dissent logical and scientific?

        Peter McCullagh and P J Saunders both argue that without interrogation we cannot know for sure what the fetus feels.2 3 All science is uncertain; that is why it demands thought. An investigation of fetal experience should answer four questions: (1) How is the experience characterised or defined? (2) What is its underlying neurophysiology? (3) Is that neurophysiology present in the fetus? (4) Can we tie the characterisation to the fetus in a logical manner (or escape the “epistemological layby” as McCullagh puts it)?

        McCullagh suggests taking the working definition of pain from “the community at large.” Sadly, he does not explain further; presumably we should just know what pain is. I suspect that what McCullagh means is that any aversive behavioural response from any creature indicates pain. Such a definition is useless: pain is defined, tautologically, as the response to painful stimulation. The definition does, however, handily reduce the neurological complexity necessary for the processing of pain. Both McCullagh and Saunders suggest that the thalamus, independent of the cortex, may be sufficient for pain. A letter provides inadequate space to clear up this issue, but suggesting that a response by a sophisticated nervous system is unnecessary for pain is, at best, highly controversial. While the thalamus begins to mature early on in the fetus, further development needed to create the sophisticated nervous system comes much later.

        Finally, only assertion is used to escape the epistemological layby. It is asserted as common sense that clinical practice be changed to avoid fetal pain. Disturbingly, gynaecologists around the world are being encouraged to introduce analgesic, anaesthetic, and maybe even surgical procedures into their practice not because of clinical trials proving their efficacy but because of shoddy sentimental argument. At a recent meeting on fetal pain one of those attending rightly denounced such proposals as “emotion based medicine.”

        References

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