Intended for healthcare professionals

Analysis And Comment Controversy

Can fetuses feel pain?

BMJ 2006; 332 doi: (Published 13 April 2006) Cite this as: BMJ 2006;332:909
  1. Stuart W G Derbyshire, senior lecturer (
  1. 1 University of Birmingham, School of Psychology, Edgbaston, Birmingham B15 2TT
  • Accepted 6 March 2006

Legal or clinical mandates to prevent pain in fetuses are based on limited evidence and may put women seeking abortion at unnecessary risk. This paper outlines neurodevelopment in fetuses in the context of pain experience

The US federal government is considering legislation that will require doctors to inform women seeking abortions that “there is substantial evidence that the process of being killed in an abortion will cause the unborn child pain.”w1 The bill mandates that a fetus of more than 22 weeks' gestational age should receive pain reducing drugs before an abortion. Doctors who fail to comply can be fined $100 000 (£57 700; €84 000) and can lose their licence and Medicaid funding.

In the United Kingdom provocative images of the fetus generated by four dimensional ultrasonography have fuelled a reassessment of fetal capabilities along with suggestions that the fetus can respond both emotionally and cognitively. Subsequent political and media discussion in the United Kingdom has debated changing abortion laws and procedures to mitigate against fetal pain.w2 w3

This paper discusses whether there is sufficient evidence to support a concept of fetal pain through an examination of fetal neurobiology and the relation to experience. Important neurobiological developments occur at 7, 18 and 26 weeks' gestation and are the proposed periods for when a fetus can feel pain. Although the developmental changes during these periods are remarkable they do not tell us whether the fetus can experience pain. The subjective experience of pain cannot be inferred from anatomical developments because these developments do not account for subjectivity and the conscious contents of pain.

The neurobiology of the fetus: anatomical pathways

Not with standing limitations, it is useful to view the pain system as an alarm system. Viewed in this way, a noxious stimulus is an event that activates free nerve endings in the skin, similar …

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