Article Gauges Fetal Ability to Sense Pain

This past week, the Journal of the American Medical Association published an article contending that a fetus is not able to feel pain until the third trimester. Some are fiercely challenging the conclusions of the article.

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A review of research published in the Journal of the American Medical Association has generated great debate both in the medical and health policy communities. The article concludes that a fetus does not feel pain until the third trimester. NPR's Patricia Neighmond reports.

PATRICIA NEIGHMOND reporting:

Reaction to the study has been fierce. Critics say it's written by pro-abortion activists. Researchers respond their work has nothing to do with abortion politics; it's about science. The journal's editor in chief, Dr. Catherine DeAngelis, says she stands by the article. What shocks her is the number of vindictive e-mails she's received.

Dr. CATHERINE DeANGELIS (Editor in Chief, Journal of the American Medical Association): I mean, people who say things like, `I spit on your soul,' `May you burn in hell,' when they don't know me, they obviously didn't read the article. I mean, they go on and on making all kinds of claims and hateful statements. I mean, it makes me wonder, do these people think that life ends at birth? I just can't believe it.

NEIGHMOND: The e-mails take issue with the article's conclusion that a fetus is not capable of feeling pain until the 29th week of gestation, about seven months. Neuroscientist Peter Ralston is one of the study's five authors from the University of California-San Francisco. He says the protective coating on nerves, which is critical for them to work to deliver signals to the brain, is not even functioning until the 24th week of gestation. The brain itself matures even later.

Mr. PETER RALSTON (University of California-San Francisco): The electroencephalogram, which is the way we always measure activity in the human cortex, in the fetus begin--and just begin--to look like the pattern one sees at birth at about 29 to 30 weeks. That's the earliest time the cortex is getting wired enough to deal with the information arriving to it, pain or vision or hearing or anything.

NEIGHMOND: Not all medical specialists agree. Pediatrician Kanwaljeet Anand specializes in fetal pain at the University of Arkansas for Medical Sciences. He says that pain perception is more complex, and he points to premature babies as young as 23 weeks. They experience pain, he says, while living in incubators, for example, when their heel is pricked with a needle to get a blood sample.

Dr. KANWALJEET ANAND (University of Arkansas for Medical Sciences): They will cry. Even though they are on a ventilator, you can see that they have the respiratory movements and vocal chord changes associated with crying. They will have a facial expression, which is highly specific for pain. They will have changes in their heart rate, blood pressure, hormone levels, all kinds of things, which are exactly the same things that occur in an adult who is undergoing a similar painful stimulus.

NEIGHMOND: Pretty much everyone who's studied the issue agrees fetuses don't feel pain in the first trimester when 90 percent of abortions occur. The debate occurs because dozens of states and the US Congress are considering laws that would require doctors to inform women who are considering abortion that the fetus may feel pain in the second trimester at 20 weeks. Doctors would then be required to offer women anesthesia for the fetus during the abortion. David Grimes is an obstetrician and former abortion expert at the Centers for Disease Control and Prevention.

Dr. DAVID GRIMES (Obstetrician): What we're seeing are attempts to dissuade or harass women and providers. The attempt to legislate abortion out of existence is not new; it's just a continuation of the same process.

NEIGHMOND: A treacherous process, says Grimes, who says lawmakers aren't equipped to make medical decisions.

Dr. GRIMES: For example, in the state of Mississippi, doctors are required by state law to advise women contemplating an abortion that doing so will increase their risk of breast cancer. That's not the truth, and it's not the assessment of the World Health Organization or the National Cancer Institute, but that's what the legislators in Jackson have said.

NEIGHMOND: Douglas Johnson is legislative director for the National Right to Life Committee. He supports the federal proposal called the Unborn Child Pain Awareness Act, which he says is simply an effort to give women options.

Mr. DOUGLAS JOHNSON (Legislative Director, National Right to Life Committee): Using the standards that these authors applied, one could never prove that animals of any kind ever feel pain. And yet we have a host of federal and state laws designed properly to try to avoid unnecessary pain to animals. We have federal laws, for example, that specify very specifically what methods must be used to kill livestock for food. Even though you can't prove that a pig suffers, it is an inference based on their behavior and other evidence. And the same is true of newborns.

NEIGHMOND: David Grimes says using terms like `newborn' or `unborn child' to describe a fetus is in itself inflammatory and intended to intimidate women who might choose abortion. As for the debate about pain, it will likely never be resolved. People can't recall fetal experiences, and consciousness is nearly impossible to prove. Patricia Neighmond, NPR News.

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