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Children Past 22
weeks Gestational Age Very Sensitive to Painful
Stimulus, Doctor Testifies Part Two of Three Editor’s note. The following are excerpts from Dr. Michael Cotter’s February 16 testimony to the Kansas House Federal & State Affairs Committee. Dr. Cotter was speaking in favor of HB 2218. Chairman Brunk and members of the Committee, My name is Dr. Michael Cotter. I have been asked to provide expert medical testimony regarding the subject of fetal pain in unborn human beings older than 22 weeks gestational age. … I can testify that children past 22 weeks gestational age experience clear physical signs of discomfort and are very sensitive to painful stimulus. At somewhere around 18 to 24 months of age, most children develop the ability to communicate that they are experiencing pain with words. Prior to that, pain is typically identified by observing certain physical signs, a list of which includes, but is not necessarily limited to: crying, thrashing, painful appearing facial expressions or grimacing, changes in vital signs (heart rate, respiratory rate and blood pressure) and physical withdrawal from painful stimulus (for example, pulling a body part away from a needle when the skin is poked). I can testify that in my experience, children past 22 weeks gestation, without exception, experience these physical findings which even a non-medical professional would be able to identify as pain. [Dr. Cotter offered a series of examples]. It can be argued that premature infants in fact experience more pain than their older counterparts. The more premature a newborn is, the less “state control” they have. State control can be understood as a child’s ability to shut out stimuli. The cause of this is a lack of neurologic “coordination” in a young infant’s nervous system. …That lack of state control is even more pronounced in preterm infants. …Painful stimuli in my experience cause more intense responses than non-painful stimuli. It is worth noting that many (if not all) Newborn Intensive Care Units utilize some type of scoring system to quantify the pain experienced by preterm newborns. … [T]he earlier the gestational age (23 weeks for example), the higher score they receive. These are all industry accepted, standardized, and objective measures that are used by neonatal health care providers to rate a preterm infant’s pain. Human beings past 22 weeks gestational age have a similar response to painful stimulus whether they are born or not yet born. Babies are not born with an “on / off switch” that is pushed to activate their central and peripheral nervous system after they are delivered. The only difference is that the response to these noxious stimuli are not as easily observable when the fetus is in utero. Recent medical advances in fetal surgery now allow for surgery to be performed on a fetus while still in its mother’s womb. Our current knowledge of fetal development and the development of the fetal nervous system has prompted anesthesiologists to provide anesthesia to fetuses during these procedures. While I feel competent to testify as to the evidence of pain felt by 23 week gestational age newborns based on my direct clinical experience, I lack the basic science expertise to testify as to the exact minimum age of gestation where a fetus can feel pain. Nevertheless, it is reasonable, from my understanding of general Embryology to assume that pain is perceived well before 22 weeks of gestation. Requisite elements of the fetal nervous system are in place well before then. Furthermore, the process of organ system development in a fetus is a gradual process. The perception of pain is probably best thought of as a gradually increasing capability, much like the gradual turning on of a light with a dimmer. In my clinical experience, all I can say is that the light appears clearly on at 22-23 weeks. … Please send your comments to daveandrusko@gmail.com. If you like, join those who are following me on Twitter at http://twitter.com/daveha. |