All you pretty much need to know about the reality of fetal pain in one story
By Dave Andrusko
Over the past decade NRL News and NRL News Today have collectively carried dozens and dozens and DOZENS of articles about the topic of the capacity of the unborn child to feel pain. So when colleagues tell you on your return to work of a must-read article, the first temptation might be to expect too little rather than too much. But after reading Eric Schulzke’s “The disputed science of fetal pain,” I can see why they say the article is balanced—a rarity—and comprehensive—even rarer.
Schulzke cleverly works backwards. He starts with newborns who were born premature. Their parents are absolutely convinced their twin sons experienced pain at birth. “The pain markers went well beyond facial cues,” Schulzke writes. “Even routine blood draws or IV insertions could cause measurable reactions.”
And in stark contrast to what prevailed not so long ago, “Anesthesia is now routine for both neonatal and fetal surgery, but a generation ago newborns were thought to not perceive pain, and they routinely underwent surgery without anesthesia.” That would be considered barbaric today.
He interviewed Dr. Ray Paschall about fetal surgery and the use of anesthesia. Dr. Paschall has performed around 260 surgeries on babies before birth and “was part of a team that developed fetal surgery for myelomeningocele, a type of spina bifida, where the spine fails to close correctly, leaving it exposed to corrosive amniotic fluid.”
Schulzke notes that “Pre-birth intervention has been found to significantly improve outcomes. The target age for these surgeries, Paschall said, is between 21 and 25 weeks of gestational age, which happens to be precisely the age targeted in fetal pain abortion legislation.” He “firmly believes” they feel pain.
You can read this fascinating account in its entirety so let me summarize some of what the story accomplishes.
It takes on the principle arguments against the idea that the unborn child can feel pain beginning at 20 weeks fetal age (equivalent to “22 weeks of pregnancy”). For starters, Paschall is deeply skeptical of those who argue that “the unborn fetus is immersed in a mix of fluids that chemically induce sleep, meaning that even if the brain wiring were in place, the fetus will still be oblivious.”
We have discussed this absurd contention at much greater length elsewhere. (See “Royal College of Ob-GYN ‘Fetal Awareness’ Report Does Nothing to Rebut Conclusion Unborn Can Experience Pain at 20 Weeks.”)
He also helpfully juxtaposes the work of Dr. Kawaljeet Anand, who affirms the reality of fetal pain, and a 2005 co-authored article published in Journal of the American Medical Association. Anand’s research is head and shoulders more persuasive, beginning with a landmark 1987 article in the New England Journal of Medicine in which “Anand proved that newborns not only perceived pain,” Schulzke writes, “but that they were literally dying from it.”
Schulzke adds, “In one of his studies, mortality dropped from 25 to 10 percent just through using anesthesia. By the turn of the 21st century, thanks largely to Anand, newborn anesthesia was standard.”
Anand then moved on to the question of pain experienced before birth. Not only did he find that it was a reality, Anand “argued that a fetus or premature newborn may actually feel pain more intensely than an older newborn,” Schulzke writes. “He asserted in 2007 congressional testimony on fetal pain legislation that ‘a fetus at 20 to 32 weeks of gestation would experience a much more intense pain than older infants or children or adults’ because certain pain mechanisms are in play much earlier, while ‘fibers which dampen and modulate the experience of pain’ are delayed until between 32-34 weeks.”
The reader is exposed to an important shift in the debate over fetal pain. The centrality of the cortex to pain has been challenged, indeed, one could argue, debunked by research that demonstrated children born without a higher brain structures (‘decorticate’ patients) are capable of experiencing pain and also other conscious behaviors.
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In many ways, the most instructive portion of the story is that Schulzke explains the fork in the road over the debate about fetal pain. He quotes Maureen Condic, a neurobiologist at the University of Utah Medical School, who has testified before Congress on the question.
“’One camp gives a fundamentally psychological definition of pain perception,’ she said. ‘They say that to experience pain you must have conscious awareness. That, they argue, requires life experience to put sensations in context.’
“On the other side are those who, like Condic, see pain mainly as a biological reaction to trauma, one easily centered in the thalamus long before (and long after) the cortex is involved.”
Equally important Schulzke delves into the issue of where the deniers like Professor Stuart Derbyshire will eventually wind up. Derbyshire wrote in a widely-cited 2006 British Medical Journal piece that
“If pain also depends on content derived from outside the brain, then fetal pain cannot be possible, regardless of neural development.”
Schulzke draws the inevitable conclusion: “Not even a complete link between the cortex and thalamus would thus satisfy Derbyshire, who insists that pain requires experience only gained with time. Even a full-term newborn fails that test.” (my emphasis)
A terrific overview that addresses a ton of issues in a thorough but understandable way. Take ten minutes out and read “The disputed science of fetal pain.”