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federal legislation, introduced by Senator Sam Brownback, Republican of Kansas, in 2004 and again this year as the "Unborn Child Pain Awareness Act," says there is "substantial evidence" of "substantial pain to an unborn child" during abortions performed after 20 weeks. The bill includes a script doctors must read to women, offering to deliver anesthesia directly to the fetus and stating, "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."
Study Finds 29-Week Fetuses Probably Feel No Pain and Need No Abortion Anesthesia
By DENISE GRADY, New York Times
Published: August 24, 2005
Taking on one of the most highly charged questions in the abortion debate, a team of doctors has concluded that fetuses probably cannot feel pain in the first six months of gestation and therefore do not need anesthesia during abortions.
Their report, being published today in The Journal of the American Medical Association, is based on a review of several hundred scientific papers, and it says that nerve connections in the brain are unlikely to have developed enough for the fetus to feel pain before 29 weeks.
The finding poses a direct challenge to proposed federal and state laws that would compel doctors to tell women having abortions at 20 weeks or later that their fetuses can feel pain and to offer them anesthesia specifically for the fetus.
About 1.3 million abortions a year are performed in the United States, 1.4 percent of them at 21 weeks or later.
Bills requiring that women be warned about fetal pain have been introduced in the House and Senate and in 19 states, and recently passed in Georgia, Arkansas and Minnesota. The bills are supported by many anti-abortion groups. But advocates for abortion rights say the real purpose of the measures is to discourage women from seeking abortions. It is too soon to tell what effect the new laws are having in abortion clinics.
The finding was considered persuasive by many scientists but is unlikely to settle the controversy. Most scientists agree that fetuses probably do not feel pain in the first trimester, but there remains wide disagreement over when, in later pregnancy, the fetal brain is sufficiently developed for pain to register. Some think that, with the current state of knowledge, it is impossible to know for sure. In Britain, the Royal College of Obstetricians and Gynecologists has said that fetuses probably do not feel pain before 26 weeks, which is into the third trimester.
"This is an unknowable question," said Dr. David A. Grimes, a former head of abortion surveillance at the Centers for Disease Control and Prevention who now delivers babies and also performs abortions in Chapel Hill, N.C. "All we can do in medicine is to infer." Nonetheless, he said, the new article makes a compelling case for lack of pain perception in fetuses before 29 weeks.
The federal legislation, introduced by Senator Sam Brownback, Republican of Kansas, in 2004 and again this year as the "Unborn Child Pain Awareness Act," says there is "substantial evidence" of "substantial pain to an unborn child" during abortions performed after 20 weeks. The bill includes a script doctors must read to women, offering to deliver anesthesia directly to the fetus and stating, "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."
Mr. Brownback said he hoped Congress would act on the bill sometime next year. "It is one of the top priorities of the pro-life movement to address this issue," he said.
But Dr. Mark A. Rosen, an author of the journal article and chief of obstetric anesthesia at the University of California, San Francisco, said such measures were misguided.
"From the available biological evidence, it seems very unlikely that a fetus experiences what we think of as pain before 29 weeks of gestation," Dr. Rosen said in a telephone interview. Giving anesthesia to the fetus could be difficult and would needlessly expose the pregnant woman to additional risks, he said, adding, "Policy decisions should be based on evidence, scientific evidence, not our emotional beliefs."
The federal legislation is based in part on observations that 20-week-old fetuses pull away if they are poked or prodded, in much that the same way children and adults react to pain.
But Dr. Rosen said that response in the fetus did not mean it felt pain, but was instead more likely to be a reflex, like the leg jerk that occurs in adults when doctors tap them on the knee with a rubber hammer.
After studying the medical literature, Dr. Rosen and his co-authors concluded that critical wiring in the brain, between the cerebral cortex and a lower region, the thalamus, was not complete until about 29 weeks. Without that connection, they said, a fetus cannot feel pain.
Not all physicians agree. Dr. K. S. Anand, a pediatrician at the University of Arkansas for Medical Sciences, said, "There is circumstantial evidence to suggest that pain occurs in the fetus."
For example, he said, tiny premature babies, as young as 23 or 24 weeks, cry when their heels are stuck for blood tests and quickly become conditioned to cry whenever anyone comes near their feet. "In the first trimester there is very likely no pain perception," Dr. Anand said. "By the second trimester, all bets are off and I would argue that in the absence of absolute proof we should give the fetus the benefit of the doubt if we are going to call ourselves compassionate and humane physicians."
Dr. Anand said he did not oppose abortion, but had testified at hearings called by legislators seeking to ban late-term abortions that fetuses feel pain.
The authors of the paper said that even crying or grimacing in a very premature infant did not necessarily signify pain because such infants often cry at even the lightest touch. Dr. Eleanor A. Drey, one of Dr. Rosen's co-authors, said that as an obstetrician who performed abortions and the medical director of an abortion clinic, she would find it troubling to be compelled to bring up the subject of fetal pain with her patients. "I would be forced to drag them through potentially a lot of misinformation," Dr. Drey said. "Our systematic review has shown it's extremely unlikely that pain exists at a point when abortions are done. I'm going to have to talk about something I know will cause the patient distress, something that by our best assessment of the scientific data is not relevant."
But Dr. Rosen acknowledged that it was impossible to say with 100 percent certainty that there was never pain before 29 weeks.
Mr. Brownback said the new report did not raise questions about whether a fetus felt pain, only about when. "The child in the womb does experience pain," he said. "We knew there was a debate about at what age the child experiences pain."
He said he would listen to debate and consider changing the fetal age specified in his legislation. But, he said, "We're clearly going to stick with the bill."
Study Finds 29-Week Fetuses Probably Feel No Pain and Need No Abortion Anesthesia
By DENISE GRADY, New York Times
Published: August 24, 2005
Taking on one of the most highly charged questions in the abortion debate, a team of doctors has concluded that fetuses probably cannot feel pain in the first six months of gestation and therefore do not need anesthesia during abortions.
Their report, being published today in The Journal of the American Medical Association, is based on a review of several hundred scientific papers, and it says that nerve connections in the brain are unlikely to have developed enough for the fetus to feel pain before 29 weeks.
The finding poses a direct challenge to proposed federal and state laws that would compel doctors to tell women having abortions at 20 weeks or later that their fetuses can feel pain and to offer them anesthesia specifically for the fetus.
About 1.3 million abortions a year are performed in the United States, 1.4 percent of them at 21 weeks or later.
Bills requiring that women be warned about fetal pain have been introduced in the House and Senate and in 19 states, and recently passed in Georgia, Arkansas and Minnesota. The bills are supported by many anti-abortion groups. But advocates for abortion rights say the real purpose of the measures is to discourage women from seeking abortions. It is too soon to tell what effect the new laws are having in abortion clinics.
The finding was considered persuasive by many scientists but is unlikely to settle the controversy. Most scientists agree that fetuses probably do not feel pain in the first trimester, but there remains wide disagreement over when, in later pregnancy, the fetal brain is sufficiently developed for pain to register. Some think that, with the current state of knowledge, it is impossible to know for sure. In Britain, the Royal College of Obstetricians and Gynecologists has said that fetuses probably do not feel pain before 26 weeks, which is into the third trimester.
"This is an unknowable question," said Dr. David A. Grimes, a former head of abortion surveillance at the Centers for Disease Control and Prevention who now delivers babies and also performs abortions in Chapel Hill, N.C. "All we can do in medicine is to infer." Nonetheless, he said, the new article makes a compelling case for lack of pain perception in fetuses before 29 weeks.
The federal legislation, introduced by Senator Sam Brownback, Republican of Kansas, in 2004 and again this year as the "Unborn Child Pain Awareness Act," says there is "substantial evidence" of "substantial pain to an unborn child" during abortions performed after 20 weeks. The bill includes a script doctors must read to women, offering to deliver anesthesia directly to the fetus and stating, "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."
Mr. Brownback said he hoped Congress would act on the bill sometime next year. "It is one of the top priorities of the pro-life movement to address this issue," he said.
But Dr. Mark A. Rosen, an author of the journal article and chief of obstetric anesthesia at the University of California, San Francisco, said such measures were misguided.
"From the available biological evidence, it seems very unlikely that a fetus experiences what we think of as pain before 29 weeks of gestation," Dr. Rosen said in a telephone interview. Giving anesthesia to the fetus could be difficult and would needlessly expose the pregnant woman to additional risks, he said, adding, "Policy decisions should be based on evidence, scientific evidence, not our emotional beliefs."
The federal legislation is based in part on observations that 20-week-old fetuses pull away if they are poked or prodded, in much that the same way children and adults react to pain.
But Dr. Rosen said that response in the fetus did not mean it felt pain, but was instead more likely to be a reflex, like the leg jerk that occurs in adults when doctors tap them on the knee with a rubber hammer.
After studying the medical literature, Dr. Rosen and his co-authors concluded that critical wiring in the brain, between the cerebral cortex and a lower region, the thalamus, was not complete until about 29 weeks. Without that connection, they said, a fetus cannot feel pain.
Not all physicians agree. Dr. K. S. Anand, a pediatrician at the University of Arkansas for Medical Sciences, said, "There is circumstantial evidence to suggest that pain occurs in the fetus."
For example, he said, tiny premature babies, as young as 23 or 24 weeks, cry when their heels are stuck for blood tests and quickly become conditioned to cry whenever anyone comes near their feet. "In the first trimester there is very likely no pain perception," Dr. Anand said. "By the second trimester, all bets are off and I would argue that in the absence of absolute proof we should give the fetus the benefit of the doubt if we are going to call ourselves compassionate and humane physicians."
Dr. Anand said he did not oppose abortion, but had testified at hearings called by legislators seeking to ban late-term abortions that fetuses feel pain.
The authors of the paper said that even crying or grimacing in a very premature infant did not necessarily signify pain because such infants often cry at even the lightest touch. Dr. Eleanor A. Drey, one of Dr. Rosen's co-authors, said that as an obstetrician who performed abortions and the medical director of an abortion clinic, she would find it troubling to be compelled to bring up the subject of fetal pain with her patients. "I would be forced to drag them through potentially a lot of misinformation," Dr. Drey said. "Our systematic review has shown it's extremely unlikely that pain exists at a point when abortions are done. I'm going to have to talk about something I know will cause the patient distress, something that by our best assessment of the scientific data is not relevant."
But Dr. Rosen acknowledged that it was impossible to say with 100 percent certainty that there was never pain before 29 weeks.
Mr. Brownback said the new report did not raise questions about whether a fetus felt pain, only about when. "The child in the womb does experience pain," he said. "We knew there was a debate about at what age the child experiences pain."
He said he would listen to debate and consider changing the fetal age specified in his legislation. But, he said, "We're clearly going to stick with the bill."
