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:

The problem of pain

Stuart Derbyshire argues that fetuses, even of full gestation,
cannot feel pain at a conscious level; therefore although analgesia may
have clinical benefits to surviving fetuses and neonates, it is
unnecessary for fetuses being aborted.

His argument is informed and erudite; he clearly has a keen
appreciation for the difficulties in determining the presence or absence
of an essentially subjective phenomenon, and he wisely divorces his
argument from the ethics of abortion itself. Nevertheless I feel I must
question a couple of the statements from which he draws his conclusion.

Firstly, he uses the IASP definition of pain and its premise that
"Each individual learns the application of the word [pain] through
experiences related to injury in early life." to argue that the fetus,
having not been exposed to such experiences, cannot have acquired the
processes of consciousness necessary to experience pain. This strikes me
as a circular argument: "In order to experience pain, the individual must
first learn what pain is; and in order to learn what pain is, he must
first experience it."

The IASP definition is a good one in the dictionary sense; however, I
submit that it is of little use either clinically, biologically or
philosophically. It is a tired but true argument to say that using it, I
cannot prove even that you experience pain (you might be lying), let alone
a fetus, or an animal. If we are to avoid difficulties of solipsism, we
can only rely on objective criteria such as behavioural or neuro-endocrine
changes to posit the existence or absence of pain. If a creature shows all
the physical and biological features of being in pain, we should assume
that it is in pain, precisely because we can never know directly what its
conscious state is.

I would also challenge his statement that "If pain also depends on
content derived from outside the brain, then fetal pain cannot be
possible, regardless of neural development." For a proponent as
knowledgable as Dr Derbyshire, he seems to be making a remarkably naive
statement here. The fetus has access to a great deal of content outside of
its brain: quite apart the sensations of its own body, there is a
perception of light and dark, a wide range of sounds, touch and pressure
stimuli to the mother's abdomen, changes in balance, and possibly changes
in amniotic fluid taste.

His argument then falls back on the necessity of representational
memory to the perception of pain, which he (probably correctly) claims
depends on frontal lobe development in postnatal infancy. Memory may
indeed be necessary for the interpretation of pain, but this misses the
point. Even if the infant or fetus does not recognise pain for what it is,
the experience is still (as far as we can recognise) unpleasant for them;
few people would disagree that a newborn crying from hunger or pain is
suffering, regardless of whether it recognises the nature of that
suffering. It is this suffering, however nebulously it may be experienced,
that must be weighed in the clinical decision whether to provide fetal
analgesia for abortion or not.

Competing interests:
None declared

Competing interests: No competing interests

22 April 2006
James Austin
Consultant Anaesthetist
Wagga Wagga, Australia