Intended for healthcare professionals

Rapid response to:

Analysis And Comment Controversy

Can fetuses feel pain?

BMJ 2006; 332 doi: (Published 13 April 2006) Cite this as: BMJ 2006;332:909

Rapid Response:

Can fetuses feel pain?

Editor - Derbyshire attempts to argue a case against the ability of
fetuses to feel pain (1). His summary of the current understanding of the
development of the neurobiology of pain sensation in the fetus is cogently
encapsulated in “…good evidence exists that the biological system
necessary for pain is intact and functional from 26 weeks”. He then adopts
a definition of pain from the International Association for the Study of
Pain, as “an unpleasant sensory and emotional experience associated with
actual or potential tissue damage…” but concludes from this that pain is
“a conscious experience” rather than “merely the response to noxious
stimuli”, allowing him to make the sweeping statement that “it is not
possible for a fetus to experience pain”.

This is a specious argument. There are many examples of the ability
of babies of this gestation to feel pain. In the first few moments after
birth, even with extremely premature neonates (23-26weeks), a noxious
stimulus (e.g. phlebotomy) can cause bradycardia, desaturations and
hypertension as a stress response. A neonatologist would seek to relive
this distress with analgesia, and a parent would seek to soothe. Also as
Derbyshire himself notes, fetal procedures (such as in-utero chest drain
placement) are increasingly being carried out with analgesia (2). The
problem lies with his definition of “pain” and the subsequent development
of his argument. If a pregnant woman is asking whether the fetus feels
“pain”, a conscious rationalisation is not necessarily implied. The Oxford
English Dictionary instead describes pain as “a strongly unpleasant bodily
sensation such as is produced by illness, injury or other harmful physical
contact.”(3) There is thus a gap between the definition he has adopted and
his patients’ understanding of pain, resulting in ill-informed counselling
or worse (as he encourages in his conclusion); “avoiding a discussion of
fetal pain with women”. His argument that “fetuses cannot feel pain” needs
correcting at the earliest opportunity.

1) Derbyshire SWG: Can fetuses feel pain. BMJ 2006; 332:909-12
2) Davis CF, Sabharwal AJ: Management of congenital diaphragmatic hernia
Arch Dis Child Fetal Neonatal Ed 1998;79:F1-F3 ( July )
3)The Concise Oxford Dictionary of Current English (ed. D Thompson) 9th
Edition (1995). Clarendon Press. p432.

Competing interests:
None declared

Competing interests: No competing interests

19 April 2006
Mark Tighe
Paediatric Specialist Registrar
Southampton General Hospital, Tremona Road, Southampton, SO16 6YD.