Experts Set the Record Straight on Abortion Pain
BY Jonathan Imbody

In an often testy congressional hearing November 1, science squared off against abortion ideology as experts testified that babies within the womb may feel pain as early as 20 weeks into their development.

Much of the expert testimony supported the principles in the Unborn Child Pain Awareness Act (H.R. 356 and S. 51), introduced by Rep. Chris Smith (R-NJ) and Senator Sam Brownback (R-Ks.), to "ensure that women seeking an abortion are fully informed regarding the pain experienced by their unborn child."
Pro-life Congressman Steve Chabot (R-Ohio), the chairman of House Judiciary Constitution Subcommittee, opened the hearing by quoting President Ronald Reagan: "Medical science doctors confirm that when the lives of the unborn are snuffed out, they often feel pain, pain that is long and agonizing."
Rep. Chabot noted that the bill "would apply to the approximately 15,00020,000 abortions that are performed each year in the United States on unborn children who are 20 weeks or more past fertilization."

Some pro-abortion groups such as NARAL have remained uncharacteristically quiet on the bill, presumably because their opposition would focus public attention on the baby's pain during an abortion, and because the bill aims at providing women with information to insure their fully informed consent to an abortion. However, the Religious Coalition for Reproductive Choice (a coalition of a number of religious bodies, including the United Methodist Church, United Church of Christ, Episcopal Church, and Presbyterian Church USA), distributed a statement at the hearing opposing the bill.

The Unborn Child Pain Awareness Act would require abortionists to fully inform mothers, who are considering an abortion on an "unborn child who has reached a probable stage of development of 20 weeks after fertilization," regarding the pain her child will likely feel.

A written statement to be read by abortionists or their agents states, "The Congress of the United States has determined that at this stage of development, an unborn child has the physical structures necessary to experience pain." The statement informs the mother that she has "the option of choosing to have anesthesia or other pain-reducing drug or drugs administered directly to the pain-capable unborn child if you so desire."

Expert witnesses at Tuesday's hearing of the House Constitution Subcommittee included Jean A. Wright, M.D., MBA, professor and chair of pediatrics at the Mercer School of Medicine and executive director of the Children's Hospital & Women's Institute, Memorial Health University Medical Center in Savannah, Georgia.

Dr. Wright testified that the "development of the perception of pain begins at the sixth week of life. By 20 weeks, and perhaps even earlier, all the essential components of anatomy, physiology, and neurobiology exist to transmit painful sensations from the skin to the spinal cord and to the brain."
Dr. Wright also noted that scientists know a great deal more than in 1973, when the Supreme Court opened the door to abortion on demand based on what many consider faulty legal reasoning and misleading medical evidence.

"Viability for the premature infant has long since passed the 28-week gestational age definition that existed when Roe v. Wade was decided," Dr. Wright explained. "For some infants, viability has been pushed back to 2324 weeks. And so many of our neonatal units now have infants of 23 weeks and older gestational ages. Today with the survival of 23- and 24-week infants, we no longer speculate as to whether they feel pain. We understand it, try to avoid it, and treat it when appropriate."

Dr. Wright then demonstrated the implications of new scientific knowledge for mothers.  "As a mother myself, every procedure I face with my own child is preceded by her first question, 'Mommy, will this hurt?' It is my natural maternal response is to try to avoid all forms of pain and suffering for my child. As a parent, I want to know about the possibility of pain, and my child (if old enough) wants to know it as well.

She continued, "But for the child unable to speak ... the parent stands in the gap gathering clinically relevant information, and exercising prevention and protection against harmful or painful situations. It is our question to ask, 'Will my child feel pain?'"

Parents are entitled to this information for their children, Dr. Wright maintained. "They need it explained in a clear and meaningful way that they as laypeople can understand. This standard exists for children born; now we raise the standard and ask that it exist for those unborn. 'Will this surgery or procedure on my premature baby cause pain? What will be done to alleviate the pain and suffering?' We should answer those questions as clearly for procedures concerning the unborn as the born."

Other witnesses included the world-renowned fetal pain expert Dr. K. J. S. Anand, professor of pediatrics, anesthesiology, pharmacology, neurobiology, and developmental sciences at the University of Arkansas for Medical Sciences College of Medicine. Dr. Anand serves as director of the Pain Neurobiology Laboratory at the Arkansas Children's Hospital Research Institute.

Dr. Anand's testimony strongly contradicted a controversial article written by abortion advocates and published in the August 24 Journal of American Medical Association (JAMA). That article's authors purported to show that there is no good evidence that human fetuses feel pain before 29 weeks.

The paper was the focus of considerable controversy after its publication, in part because of revelations that the lead author, Susan J. Lee, had been employed as a lawyer for the National Abortion and Reproductive Rights Action League, and that one of the co-authors, Dr. Eleanor A. Drey, directs the largest abortion clinic in San Francisco. (See www.nrlc.org/abortion/Fetal_Pain/NRLCrebuttalJAMA.html.)

The JAMA article reported on a "meta-analysis," or survey, of published articles. A proper meta-analysis requires researchers to follow stringent data analysis guidelines that take into account the limitations of drawing a single conclusion from vastly differing studies. If researchers violate these safeguards, their conclusions are akin to dumping all the pills in a pharmacy into a blender, putting the powder into capsules, and labeling them cold medicine.
In the case of the JAMA article, an improperly conducted meta-analysis appears to have provided abortion advocates with a "quick and dirty," superficially credible way to blunt growing public awareness of the pain inflicted on developing babies subjected to an abortion.

Dr. Anand critiqued the study's methodology. He noted that the conclusions of the JAMA article authors "regarding fetal pain are flawed, because they ignore a large body of research related to pain processing in the brain, present a faulty scientific rationale and use inconsistent methodology for their systematic review."

Dr. Anand exposed basic scientific flaws in the authors' assertions, noting that they "incorrectly assume that pain perception during fetal or neonatal development must engage the same structures involved in pain processing as those used by human adults. Lack of development of these areas is then used to support the argument that fetuses do not feel pain until late gestation."

Many years of "careful, painstaking research" shows that "the fetus or neonate is not a 'little adult,' that the structures and mechanisms used for pain processing during fetal or neonatal life are unique and completely different from those used by adults, and that many of these structures/mechanisms are not maintained beyond specific periods of early development," Dr. Anand explained.

Dr. Wright offered a clear explanation of the potential for pain in a developing baby.   "Any procedure done on an unborn fetus after 20 weeks of gestation," Dr. Wright testified, "has all the prerequisite anatomy, physiology, hormones, neurotransmitters, and electrical current to close the loop and create the conditions needed to perceive pain. In a fashion similar to explaining the electrical wiring to a new house, we would explain that the circuit is complete from skin to brain and back. The hormones and EEGs and ultrasounds record the pain response, and our therapies with narcotics demonstrate our ability to adequately block them."

Dr. Wright explained how a practicing doctor with years of experience would address the pain issue.

"'Can the unborn fetus feel pain at this stage of development,' we would be asked.

"'Is there something that can be given to alleviate the pain?'

"And we would answer, 'Yes,' to both."

Teresa Stanton Collett, a professor of law at the University of St. Thomas School of Law in Minneapolis, Minnesota, also testified at the hearing. Prof. Collett noted that public debate over fetal pain "intensified when the world caught a glimpse of life within the womb through the picture of Samuel Armas' tiny hand apparently grasping the finger of his perinatal surgeon who was repairing Samuel's spine when he was only twenty-one weeks in gestation." (See www.nrlc.org/news/2000/NRL03/fetal.html.)

Prof. Collett also pointed out that even apart from universal medical agreement on pain perception in developing babies, the British Medical Association "recommends that, when carrying out any surgical procedures (whether an abortion or a therapeutic intervention) on the fetus in utero, due consideration must be given to appropriate measures for minimizing the risk of pain."

Prof. Collett also noted that the Royal College of Obstetricians and Gynecologists of Great Britain "recommended that practitioners who undertake procedures directly on the fetus, or who undertake termination of a pregnancy at 24 weeks or later, should consider the requirements of fetal analgesia or sedation prior to the procedure."

Even some abortionists realize that mothers typically feel concern for their unborn children's pain.

Prof. Collett noted that during a trial on partial-birth abortion, "Dr. Katharine Sheehan, medical director for Planned Parenthood of San Diego and a witness for the plaintiffs, testified that her clinic offered to administer digoxin to induce fetal [death] prior to every abortion related to pregnancies that had progressed to 22 weeks of gestation or more. Every one of her patients had accepted the offer."

Prof. Collett concluded, "If there is a single issue in the abortion debate where common ground could be found, one would hope it might be on the issue of insuring that women who obtain abortions at 20 weeks or later be informed of the possibility of fetal pain and their options to relieve that pain."

Dr. Arthur L. Caplan, a well-known medical ethicist at the University of Pennsylvania School of Medicine, questioned "whether there is as a matter of empirical fact consensus about when a fetus is capable of feeling pain." Contrary to the approach of the British Medical Association, Dr. Caplan opined that insisting on informed consent for women should require an absolute consensus--presumably including the hearty agreement of abortionists and their advocates--that an unborn baby can feel pain after 20 weeks gestation.

Dr. Caplan summed up his concerns about the legislation by warning, "In order to achieve political ends, even well-intended ends, it is exceedingly dangerous, as history shows, to try and bend science to serve political goals."

(In an MSNBC commentary last year, however, Dr. Caplan took a decidedly different stance on "bending science to serve political goals." He spoke to the charge "that proponents of embryonic stem-cell research have over-hyped it. This is partly true, but every form of scientific research in 21st-century America gets over-hyped. In facing a president who is trying to ban research vital to finding new treatments and cures, is it any wonder that patients and their advocacy groups engage in a bit of hype?"1)

Pro-abortion Reps. Jerrold Nadler (D-NY) and Bobby Scott (D-Va.) attacked the bill's requirement that abortionists or their representatives read a script acknowledging the possibility that the baby may feel pain during the abortion. Neither addressed the question of how, apart from an unequivocal mandate, to guarantee that abortionists would voluntarily supply mothers with any factual information about fetal pain.

Rep. Nadler peppered Dr. Wright as to whether all doctors agreed with the findings of early pain perception in developing babies, interrupting her as she attempted to answer. Dr. Wright persisted in pointing out that in the hospital she manages and in virtually all hospitals in the country, no doctor questions the necessity of addressing pain issues in prematurely born 23-week-old infants. She asked why the standard would be any different for the same baby still in the womb.

Dr. Wright observed that if lawmakers would simply visit a neonatal ward and view the pain reactions of premature babies born at 23 weeks, "We wouldn't need to have this hearing."

Toward the end of the hearing, pro-life Rep. Trent Franks (R-Az.) moved past the details of script requirements and pain perception physiology to address his distress about a culture that debates whether or not to acknowledge the pain a baby feels while being killed.

Rep. Franks observed, "I am concerned about where our humanity is going." At the end of our time here on earth, he noted, "We have to ask ourselves what we have done for those around us."

For additional information, see the NRLC web site section on "The Pain of the Unborn" at http://www.nrlc.org/abortion/Fetal_Pain/index.html.
For information on how you can help pass the Unborn Child Pain Awareness Act, visit the NRLC Legislative Action Center at http://www.capwiz.com/nrlc/.
Jonathan Imbody serves as senior policy analyst for the Christian Medical Association (www.cmawashington.org).

Note
1. Arthur Caplan, "Stem-cell research a pawn in election politics. Bush's policy makes a mockery of moral issues involved," posted online by MSNBC, October 5, 2004, http://www.msnbc.msn.com/id/6142664/.