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the Body Politic
Vol. 7, No. 3 - March 1997, Page 8
Copyright © 1997 by the Body Politic Inc.
Fetal Pain: What We (Don't) Know, and Why We Need to Know It
by Victoria Tepe
Anti-abortion activists and protestors have long insisted that the "unborn baby" feels pain during the process of abortion. Pro-choice activists and advocates usually respond that this is incorrect, uninformed, insincere or downright irrelevant. After all, would the anti-abortion protestor change his mind about abortion -- about its morality, its legal status, or its meaning -- if scientists and physicians were able to agree, conclusively, that the fetus feels nothing? No, of course not. The one and only concern of the anti- abortion activist is that nothing in any stage of life development be removed from a woman's uterus until such time as it can be delivered as a viable infant.
The anti-abortion movement did not invent pain. They didn't invent feeling it, they didn't invent causing it, and they didn't invent caring about it.
And so it is that in the context of the larger political and social debate about abortion, supporters of abortion rights generally avoid the question of fetal pain. We suspect, naturally, that if we agree to discuss this issue, we might find ourselves trapped in an implied shift of public attention away from the rights of women, and toward the question of so-called "fetal rights." The woman who wants or needs to terminate an unwanted or dangerous pregnancy needs us not to respond defensively to those who politicize abortion. She needs us not to accept terms of debate that would trivialize her needs as inherently secondary to those of her developing fetus.
But here we are, very much on the defensive, knee-deep in matters relating to the procedure known all-too-commonly now as "partial-birth abortion" (known more correctly as the D&X, or intact D&E, method of abortion). Despite the frequent use of drawings that illustrate the procedure, the debate surrounding it isn't about what abortion looks like. It's about the supposition that the D&X procedure causes the fetus to feel pain. Absent the supposition of pain, the D&X abortion procedure could not be characterized as relatively more "grotesque" or "inhumane" than any other form of abortion. These are the characterizations that invoke the assumption of fetal pain, and this is the issue that inspires public discomfort.
We haven't seen the end of the D&X debate. The 105th Congress will attempt once again to ban the procedure, as many state legislatures are already trying to do. But the issue won't be won or lost by the passage or failure of new laws, or even by the fate of such laws once they are put to judicial and constitutional scrutiny. This struggle will be won or lost, in final measure, by its effect on public opinion about abortion generally. The anti-abortion movement has used and will continue to use D&X abortion to make the persistent, grueling, and potentially effective demand that we learn to identify abortion with pain.
Nobody likes pain. The sticky thing about pain is, sometimes it's not a bad thing. Sometimes, it might be the only thing left to inspire empathy between people, nations, or species. Pain is a universal language, and it matters to everyone. It matters a lot, and it's been around for a very long time. The anti-abortion movement did not invent pain. They didn't invent feeling it, they didn't invent causing it, and they didn't invent caring about it.
We should remember, too, that the issue of fetal pain isn't only about abortion. Much of the scientific research that is done to address the question of fetal pain is done to improve the practice of prenatal surgeries, blood transfusions, and other procedures. Whether we like it or not, the debate about abortion does raise questions that relate to fetal development, fetal capacity and fetal viability. However problematic these issues might seem to activists on both sides of the debate, they are nonetheless accepted as relevant and important to ordinary citizens, legislators, and judges. Fetal pain is a question that must be dealt with as part of our conversation with the American people, and with elected officials who are in a position to author legislation that every woman will have to live with, or die without. Ultimately, too, this is about our conversation with ourselves.
It's not so scary as it might sound. Pain is just one of many human (and non-human) capacities. The human fetus may or may not possess any one or more capacities at any particular point throughout its development. We don't have to demonstrate that abortion is painless in order to defend its constitutionality. But we'd be smart to care, one way or the other.
There is still no real consensus on when the human fetus acquires the capacity to experience pain, or for that matter, how best to define this capacity or show that it exists. It is careless to presume that fetuses feel pain whenever all the necessary "hardware" is in place. Anatomy merely makes possible that which is essentially physiological. To make matters even less simple, no one knows exactly how various regions of the brain work together to support the experience of pain, much less which parts of the brain are essential to support the state of awareness we call "consciousness."
There is some evidence that an active frontal cortex is necessary to support a conscious experience of pain, and that transmission of pain signals to the frontal cortex may begin around 29 weeks. The evidence may be convincing, but fails to account for the fact that it's possible for some stroke victims to feel and experience pain despite serious damage to the frontal brain.
Studies involving fetal blood transfusions after 19 weeks have demonstrated hormonal and chemical changes that often occur as a response to pain or physiological stress -- but these same responses can occur in children and adults who report that they feel no pain at all. Exaggerated reflexive responses in premature infants might mean they are very sensitive to pain -- or might instead suggest the presence of a primitive system whose purpose is to protect an organism otherwise unable to feel, avoid, or respond to pain. Some studies suggest that premature infants might experience pain, but that their experience may occur more slowly than in full-term infants, children, and adults. Biochemical responses may be delayed, perhaps due to slower electrophysiological transmission of information to the brain. Or not.
It is not uncommon for women who seek abortion care to ask, "will the baby feel anything?" If she's brave enough to ask this question, it seems only right that we should learn all we can to answer it as honestly as we're able.
Scientists who perform pain research have reached very different conclusions, based on their differing methodologies and concerns. Some scientists believe that the human fetus may be capable of experiencing pain as early as 13 weeks, while others believe that the conscious experience of pain may depend upon the development of other cognitive abilities after birth.
Dizzy yet? Well, for all of the apparent confusion, we may be able to reach a few, sensible if conservative conclusions. First, there is a fair amount of evidence that the fibers necessary to transmit pain and sensory information from subcortical to higher brain centers begin to develop around 17-19 weeks, and may be fully developed as early as 26 weeks. We do not know that this means the fetus is "conscious," or that it is capable of experiencing pain. We can agree, however, that the necessary hardware is in place to make such an experience possible sometime between 20 and 30 weeks gestation. Second, fetuses between 17-20 weeks appear capable of producing a variety of behavioral and physiological responses to noxious events. These responses may or may not be acceptable as proof of a painful experience, but can be understood as evidence that the fetus may have grown beyond its earlier, more primitive ability to respond only by simple reflex.
What are the implications? For starters, it is fair to argue that the human fetus is incapable of "feeling" pain during an abortion prior to 20 weeks, and that the same is probably -- but not certainly -- true for abortions between 20 and 26 weeks. Sometime between 26 and 29 weeks, it is likely that a normal human fetus is capable of experiencing pain during abortion. However -- and this is important -- this might depend in a big way on how the abortion is performed. Evidence of delayed pain transmission might suggest that speedier methods are more humane. In any case, we should remember that abortions during the third trimester are frequently performed to terminate pregnancies that involve severe fetal abnormalities. These may involve fetuses already in extreme physical distress, or fetuses whose brains and nervous systems are already severely compromised.
It is not uncommon for women who seek abortion care to ask, "will the baby feel anything?" If she's brave enough to ask this question, it seems only right that we should learn all we can to answer it as honestly as we're able. Her concern is appropriate, sensible, and understandable, and we ought not dismiss it as irrelevant. If we take seriously the obligation to acknowledge her question as important, we might learn new things. We might be better equipped to judge and influence the development of state-mandated "informed consent" materials, or discover the need to improve abortion care, service, or methodology.
That's fine and good, for in the long run, we should be willing to acknowledge, understand and address the implications of what we defend as right. And when we do, we are better trusted to focus attention back where it belongs, on the issue of whose right it is to decide whether or not to continue an unwanted, unplanned, or dangerous pregnancy.
References:Do fetuses feel pain? British Medical Journal, 313, pp. 795-798.
Into the mind unborn. New Scientist, 19 October 1996, pp. 40-45.
Clark, D.A. (1994). Stress without distress: the intrauterine perspective. The Lancet, 344, pp.73-74
Craig, Kenneth D., Whitfield, Michael F., et al. (1993). Pain in the preterm neonate: behavioural and physiological indices. Pain, 52, pp. 287-299.
Giannakoulopoulos, X., Sepulveda, W., et al. (1994). Fetal plasma cortisol and B-endorphin response to intrauterine needling. The Lancet, 344, pp. 77-81.
Morowitz, Harold J. & Trefil, James S. (1992). The Facts of Life: Science and the Abortion Controversy. NY: Oxford University Press.
Victoria Tepe, Ph.D., is an experimental psychologist and neurophysiologist, author and advocate for women's reproductive health and rights.
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