NATIONAL RIGHT TO LIFE:
GULLIBLE TREATMENT OF TRUMPED UP "STUDY" ON FETAL
PAIN ISSUE SHOULD EMBARRASS J.A.M.A.
AND SOME JOURNALISTS
This memo offers a number of points of
information regarding the article "Fetal Pain: A Systematic
Multidisciplinary Review of the Evidence," published in the
August 24 edition of the Journal of the American Medical
Association (JAMA). Any of the material below, if not
otherwise attributed, can be attributed to NRLC Legislative
Director Douglas Johnson (Legfederal@aol.com),
who prepared this memorandum.
BASIC OBJECTIONS
1. The JAMA article was produced by
pro-abortion activists. There is no new laboratory research
reported in the article -- it is merely a commentary on a
selection of existing medical literature. The authors
purport to show that there is no good evidence that human
fetuses feel pain before 29 weeks (during the seventh
month). The authors' conclusion (which was predetermined by
their political agenda -- see below) is disputed by experts
with far more extensive credentials in pain research than
any of the authors. These independent authorities say that
there is substantial evidence from multiple lines of
research that unborn humans can perceive pain during the
fifth and sixth months (i.e., by 20 weeks gestational age),
and perhaps somewhat earlier.
2. For example,
Dr. Kanwaljeet S. Anand, a
pain researcher who holds tenured chairs in pediatrics,
anesthesiology, pharmacology, and neurobiology at the
University of Arkansas, said in a document accepted as
expert by a federal court, "It is my opinion that the human
fetus possesses the ability to experience pain from 20 weeks
of gestation, if not earlier, and the pain perceived by a
fetus is possibly more intense than that perceived by term
newborns or older children." Read Dr. Anand's complete
statement entered in federal court, summarizing the
scientific evidence,
here. In a
USA Today article (August 25), Dr. Anand predicted that
JAMA's publication of the article would "inflame a lot of
scientists who are . . . far more knowledgeable in this area
than the authors appear to be."
3.
A similar review published in September 1999 in the
British Journal of Obstetrics and
Gynaecology
(the
leading ob-gyn journal in the UK) concluded: "Given the
anatomical evidence, it is possible that the fetus can
feel pain from 20 weeks and is caused distress by
interventions from as early as 15 or 16 weeks."
(Article available in PDF format
here.)
4. The JAMA authors arrive at their
"conclusion" through a highly tendentious methodology
that could, for the most part, also be used to
argue that there is no proof that animals really feel
pain and no proof that premature newborn humans really
feel pain (although the authors do not address those
subjects). There are innumerable state and federal laws
intended to reduce the suffering of animals, even though
it is impossible to "prove" that their "experience" of
pain is subjectively the same as that of the lawmakers
who have enacted these regulations.
THE EVIDENCE FROM PREMATURELY BORN
INFANTS
5. Infants born as early as 23 or 24
weeks now commonly survive long term in
neonatal intensive care units. Neonatologists confirm
that they react negatively to painful stimuli -- for
example, by grimacing, withdrawing, and whimpering.
When they must receive surgical procedures, they are
given drugs to prevent pain. Yet, the JAMA authors
assert that there is no credible evidence of fetal pain
until 29 weeks -- which is five or six weeks later. If
these babies feel pain in the incubator, then they also
feel pain in the womb. If the newborn at 23 weeks
demonstrates aversion to pain and needs protection
from pain, the same is true of the 24-week (or 25-week,
26-week, 27-week, or 28-week) unborn child.
6. As Dr. Paul Ranalli,
a neurologist at the University of Toronto, commented on the
paper: "Across the nation, Neonatal Intensive Care Units
(NICUs) are full of bravely struggling preemies . . .
The only difference between a child in the womb at this
stage, or one born and cared for in an incubator, is how
they receive oxygen -- either through the umbilical cord
or through the lungs. There is no difference in their
nervous systems. Their article sets back humane
pediatric medicine 20 years, back to a time when doctors
still believed babies could not feel pain." In
testimony before a congressional committee in 1996, Dr.
Jean A. Wright, then a pediatric pain specialist at
Emory University, said: "Preterm infants who are born
and delivered at 23 weeks of gestation show very highly
specific and well-coordinated physiologic and behavioral
responses to pain which is just like older infants."
(Even the paper notes in passing, "Normal EEG patterns
have been characterized for neonates as young as 24
weeks' postconceptual age.")
THE VIOLENCE OF ABORTION METHODS USED
7. The gross trauma inflicted on the
unborn human by abortion methods used in the fifth and
sixth months far exceed anything that would be done to a
premature newborn at the same stage of development. The
most common abortion method, the so-called "D&E,"
involves tearing arms and legs off of the unanesthetized
unborn child, then crushing the skull. (Click
here to see a series of professional medical school
illustrations of this method.) Thousands of times
annually, the partial-birth abortion method is used,
which involves mostly delivering the living premature
infant, feet first, and then puncturing the skull with
scissors or a pointed metal tube (to see medically
accurate illustrations of this method, click
here). To review material presented to Congress by
leading anesthesiologists and other medical experts with
varying positions on legal abortion, click
here.
THE ORIGINS OF THE PAPER
8. The so-called "study" was produced by
pro-abortion activists and a well-known practitioner of late
abortions -- but, with a few notable exceptions, that
readily available information was omitted or greatly
minimized by mainstream media outlets that initially covered
story on August 23 and 24, including ABC World News Tonight,
the Associated Press, and the New York Times.
9. The lead author of the article, Susan J.
Lee, who is now a medical student, was previously employed
as a lawyer by NARAL, the pro-abortion political advocacy
organization (Knight
Ridder, August 24).
10. One of Lee's four co-authors, Dr.
Eleanor A. Drey, is the director of the largest abortion
clinic in San Francisco (San
Francisco Chronicle, March 31, 2004, and
Knight Ridder, August 24, 2005). According to Dr. Drey,
the abortion facility that she runs performs about 600
abortions a year between the 20th and 23rd weeks of
pregnancy (i.e., in the fifth and sixth months). (San
Francisco Chronicle, March 31, 2004) Drey is a
prominent critic of the Partial-Birth Abortion Ban Act, and
a self-described activist. (In
a laudatory profile in the newsletter of Physicians for
Reproductive Choice and Health, September 2004, it was noted
that "much of Dr. Drey's research centers on repeat and
second-trimester procedures . . .," and quotes Drey as
saying, "I am very lucky because I get to train residents
and medical students, and I really do feel that it's a type
of activism.") Drey is also on the staff of
the Center for Reproductive Health Research and Policy (CRHRP)
at the University of California, San Francisco -- a
pro-abortion propaganda and training center. Much of this
information was available through even a very cursory Google
search, and some of it was provided to journalists who
contacted NRLC about the embargoed JAMA paper on August
22-23, but few saw fit to mention these connections in
their initial reports.
11. However, one reporter (Knight Ridder's
Marie McCullough) did contact JAMA editor-in-chief Catherine
D. DeAngelis regarding the ties of Lee and Drey. McCullough
reported that DeAngelis "said she was unaware of this, and
acknowledged it might create an appearance of bias that
could hurt the journal's credibility. 'This is the first
I've heard about it,' she said. 'We ask them to reveal any
conflict of interest. I would have published' the disclosure
if it had been made." (Knight
Ridder, August 24, 2005) A day later, DeAngelis told
USA Today that the affiliations of Drey and Lee "aren't
relevant," but again said that the ties should have been
disclosed. If she really thought the affiliations were not
relevant, why would she say that they should have been
disclosed? If a review of the same issue by
doctors employed by pro-life advocacy groups had been
submitted or published, would those affiliations have been
ignored by journalists?
12. Dr. David Grimes, a vice-president of
Family Health International, has been relied on by CNN, the
New York Times, and some other media as a purported expert
to defend the paper. Dr. Grimes has made pro-abortion
advocacy a central element of his career for decades.
(During the time he worked for the CDC in the 1980s, his
off-hours work at a local late-abortion facility sparked
protests from some pro-life activists.
In 1987, a year after he left the
CDC,
Grimes testified
that he had already performed more than 10,000
abortions, 10 to 20 percent of those after the first
trimester.)
In addition,
Grimes was previously the chief of the Department of
Obstetrics, Gynecology and Reproductive Sciences at the San
Francisco General Hospital -- the very same institution
where author Drey directs the abortion clinic.
THE FINDINGS OF A FEDERAL COURT
13. In 2004, the U.S. District Court for the
Southern District of New York received extensive testimony
regarding fetal pain from experts on both sides, including
doctors who perform many late abortions, as part of a legal
challenge to the
Partial-Birth Abortion Ban Act. Although the subsequent
opinion struck down the ban as inconsistent with a 2000 U.S.
Supreme Court ruling (this is being appealed), the
court made certain formal "findings of fact," among
these: "The Court finds that the testimony at trial and
before Congress establishes that D&X [partial-birth
abortion] is a gruesome, brutal, barbaric, and uncivilized
medical procedure. Dr. Anand's testimony, which went
unrebutted by Plaintiffs, is credible evidence that D&X
abortions subject fetuses to severe pain. Notwithstanding
this evidence, some of Plaintiffs' experts testified that
fetal pain does not concern them, and that some do not
convey to their patients that their fetuses may undergo
severe pain during a D&X." (This illustrates that
abortionists will not raise the question of pain, at any
stage of pregnancy, unless they are required to do so.)
UNBORN CHILD PAIN AWARENESS ACT (S. 51, H.R.
356)
14. The obvious purpose of the authors of
the JAMA paper was to damage the prospects for the Unborn
Child Pain Awareness Act (S. 51, H.R. 356). This bill would
require that abortion providers give women seeking abortions
after 20 weeks after fertilization (22 weeks gestation)
certain basic information on the substantial evidence that
their unborn children may experience pain while being
aborted, and advise them regarding any available methods to
reduce or eliminate such pain. The bill explicitly states
that the abortion provider may offer his or her own opinions
and advice regarding the question, including discussion of
any risks to the mother of methods of reducing the pain of
the unborn child. The authors, in their final paragraph,
explicitly oppose any requirement that abortionists raise
the pain issue in any fashion, at least during the fifth and
sixth months.
15. It is noteworthy, however, that in
January, 2005, NARAL President Nancy Keenan issued a
statement that NARAL "does not intend to oppose" the bill,
because "pro-choice Americans have always believed that
women deserve access to all the information relevant to
their reproductive health decisions." (A complete
reproduction of the NARAL statement is available
here.)
16. Spokepersons for some groups of abortion
providers say that they object to the Unborn Child Pain
Awareness Act because it would require that abortionists
recite a "script" advising women who are seeking abortions
after 22 weeks gestational age (20 weeks from
fertilization) that there is "substantial evidence" that
abortion will inflict pain (the bill also explicitly says
that the abortionist may also offer whatever opinions he or
she wishes regarding the issue and the risks of any optional
pain relieving methods). But in truth, abortion providers,
like the authors of the paper, object not just to a "script"
but to any requirement whatever that women be provided with
any information on the subject. They have also objected to
laws enacted in Arkansas and Georgia that require only the
provision of printed information prepared by the state
health agencies, and to a Minnesota law that merely requires
that the abortionist tell the woman "whether or not an
anesthetic or analgesic would eliminate or alleviate organic
pain to the unborn child caused by the particular method of
abortion to be employed and the particular medical
benefits and risks associated with the particular anesthetic
or analgesic." Apparently, the abortionists are taking the
paternalistic stance that women are incapable of evaluating
such information and giving it whatever weight they think it
deserves.
ADMINISTERING ANESTHESIA OR ANALGESICS
17. The authors of the JAMA paper say
that "no established protocols exist for administering
anesthesia or analgesia directly to the fetus for
minimally invasive fetal procedures or abortions." (p.
952) Yet, some abortions are performed by administering
toxins into the amniotic sac (or even directly into the
fetal heart) with a needle, precisely guided by
ultrasound. Moreover, in cases of women carrying
multiple unborn humans, abortionists sometimes engage in
"selective reduction," in which some of the fetuses are
killed by stabbing them directly in their hearts with a
needle guided by ultrasound. One suspects, therefore,
that any current lack of methods of safely administering
pain-reducing drugs to a fetus in utero relate more the
fact that abortionists just don't care about fetal pain
and have not developed such methods, rather than to any
insurmountable technical obstacles. In any case, under
the Unborn Child Pain Awareness Act, a woman considering
an abortion after 20 weeks gestational age would be
given information on the current state of the art,
including the abortionist's own assessment of any risks,
to evaluate as she sees fit.
18. Paul Ranalli,
a neurologist at
the University of Toronto, reports, "Experts from Britain
and France have proposed safe and effective fetal anesthesia
protocols. (Ranalli cites the 1997 Working Party Report on
Fetal Pain by the UK's Royal College of Obstetrics and
Gynecology and "La douleur du foetus," Mahieu-Caputo D,
Dommergues M et al, Presse Med 2000; 29:663-9, recommending Sulfentanyl
1 ug/kg and Pentothal 10 ug/kg.) Ranalli also writes
that the JAMA paper itself "includes experimental animal
evidence that suggests an effective intra-amniotic needle
injection could spare the fetus pain, without the need to
give the mother any additional anesthetic" (citing material
on JAMA p. 952, column 1).
NUMBERS OF ABORTION AT ISSUE
19. According to the JAMA paper, relying
on
a CDC report, about 1.4 percent of the abortions
performed in the U.S. are performed at or after 21 weeks
gestational age. If so, that would be over 18,000
abortions annually nationwide -- hardly inconsequential
to anyone concerned with inflicting pain on a sentient
young human. (Note: That figure omits abortions
performed at 20 weeks gestational age.) It is worth
noting that the CDC reports are very incomplete.
Indeed,
the report itself makes it clear that the CDC
received no abortion reports from California -- so none
of the 600 abortions performed annually at 20-23 weeks
in Dr. Drey's abortion clinic are reflected in the CDC
figures.To return to the
Pain of the Unborn Index, click
here.
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