Fetal-pain study omits an abortion-rights link Scientists weigh in on planned legislation.


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Posted on Wed, Aug. 24, 2005

Fetal-pain study omits an abortion-rights link
Scientists weigh in on planned legislation.

By Marie McCullough
Philadelphia Inquirer Staff Writer

Is a fetus capable of feeling pain, and if so, should fetal pain be treated during an abortion?

In today’s Journal of the American Medical Association, five researchers from the University of California, San Francisco, review nearly 2,000 studies on the hotly debated questions. They conclude that legislative proposals to allow fetal pain relief during abortion are not justified by scientific evidence.

But their seven-page article has a weakness: It does not mention that one author is an abortion clinic director, while the lead author – Susan J. Lee, a medical student – once worked for NARAL Pro-Choice America.

JAMA editor-in-chief Catherine D. 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.

UCSF obstetrician-gynecologist Eleanor A. Drey, medical director of the abortion clinic at San Francisco General Hospital, said: “We thought it was critical to include an expert in abortion among the authors. I think my presence… should not serve to politicize a scholarly report.”

Figuring out when fetuses – and even newborns – are in pain is not easy because the sensation involves both physical and mental processes.

“Until about 1987, the medical community thought newborns do not feel pain,” said anesthesiologist Sanjay Gupta, director of the Atlantic Pain and Wellness Institute at Lankenau Hospital. “We were doing circumcisions and even heart surgeries without anesthesia.”

The UCSF authors – including a neuroscientist, a pediatrician, and an anesthesiologist – conclude that the fetus cannot perceive pain until 29 or 30 weeks of pregnancy. That’s when pain-signaling nerve pathways from the spinal cord to the brain are fully wired.

Other experts – many of them antiabortion activists – believe the fetus may feel pain as early as 13 weeks, when pain receptors are connected to a part of the brain that relays impulses, but not to the part responsible for processing sensory information.

Since no one can remember being a fetus or get into the mind of a fetus, any judgment about fetal pain “will have to be inferred from evidence other than subjective experience,” Emory University bioethicist Michael Benetar wrote in a 2001 article that concluded fetuses could feel pain at about 28 weeks’ gestation.

Circumstantial evidence – such as fetal stress hormone levels, or standard tests of brain-wave activity – is not conclusive. The UCSF authors point out that a fetus will reflexively pull away from a surgical instrument – but so will an infant born without a brain or a person in a persistent vegetative state.

Legislation proposed in Congress, the Unborn Child Pain Awareness Act, would require physicians to tell women seeking abortions 20 or more weeks after fertilization that the fetus may feel pain, and that the women may opt for fetal pain treatment.

About 1.4 percent, or 18,000, of the 1.3 million U.S. abortions performed annually are done this late in pregnancy. (Most states ban abortion when the fetus can survive outside the womb, about 24 weeks’ gestation.)

Not all abortion-rights activists object to the proposed law. NARAL Pro-Choice America “does not intend to oppose” it, president Nancy Keenan said in a January statement, because “pro-choice Americans have always believed that women deserve access to all the information relevant to their reproductive health decisions.”

But the UCSF researchers conclude that even if the fetus can feel pain, offering anesthesia or analgesia is not justified because current techniques “provide unknown fetal benefit and may increase risks for the women.”

UCSF neuroscientist Henry J. Peter Ralston 3d said he hoped the review would help legislators who were “trying to figure out whether we are causing pain at 12 or 13 weeks.”

“The evidence might at least sway their vote,” he said.

Not likely, said Douglas Johnson, legislative director of National Right to Life in Washington. “If Congress wanted to know if lambs feel pain,” he said, “it wouldn’t ask the veal industry for an analysis of the scientific evidence.”

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Contact staff writer Marie McCullough at 215-854-2720 or [email protected]

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