Pain study set to 'inflame' abortion debate

A review of medical evidence has found that foetuses do not feel pain until the final months of pregnancy – a powerful challenge to abortion opponents who hope that discussions about foetal pain will make women think twice.

Critics angrily disputed the findings and claimed the report was biased.

“They have literally stuck their hands into a hornets’ nest,” said Dr Kanwaljeet Anand, a foetal pain researcher at the University of Arkansas for Medical Sciences, who believes foetuses as young as 20 weeks old feel pain.

“This is going to inflame a lot of scientists who are very, very concerned and are far more knowledgeable in this area than the authors appear to be. This is not the last word – definitely not.”

The review by researchers at the University of California, San Francisco comes as advocates are pushing for foetal pain laws in America aimed at curtailing abortion.

Proposed federal legislation would require doctors to provide foetal pain information to women seeking abortions when foetuses are at least 20 weeks old, and to offer women foetal anaesthesia at that stage of the pregnancy. A handful of states have enacted similar measures.

But the report, appearing in Wednesday’s Journal of the American Medical Association, says that offering foetal pain relief during abortions in the fifth or sixth months of pregnancy is misguided and might result in unacceptable health risks to women.

Dr Nancy Chescheir, chairman of obstetrics and gynaecology at Vanderbilt University and a board director at the Society of Maternal-Foetal Medicine, said the article “will help to develop some consensus” on when foetuses feel pain. “To date, there hasn’t been any,” she said.

The researchers reviewed dozens of studies and medical reports and said the data indicates that foetuses are likely to be incapable of feeling pain until around the seventh month of pregnancy, when they are about 28 weeks old.

While brain structures involved in feeling pain begin forming much earlier, research indicates they likely do not function until the pregnancy’s final stages, said the report’s senior author, UCSF obstetric anaesthesiologist Dr Mark Rosen.

Based on the evidence, discussions of foetal pain for abortions performed before the end of the second trimester should not be mandatory, the researchers said.

The authors include the administrator of a UCSF abortion clinic, but the researchers dispute the claim that the report is biased.

Dr Catherine DeAngelis, JAMA’s editor-in-chief, said the decision to publish the review was not politically motivated.

JAMA does not publish “politically-motivated science. We publish data-based, evidence-based science,” DeAngelis said.

The measure pending in Congress would affect about 18,000 US abortions a year performed in the fifth month of pregnancy or later, said Douglas Johnson, legislative director of the National Right to Life Committee. He said the review was slanted.

But Rosen said the researchers “tried to review the literature in an unbiased fashion. This was a multidisciplinary effort by experts on anaesthesia, neuroanatomy, obstetrics and neonatal development”.

Rosen also said that administering anaesthesia or painkillers to the fofoetusesetus could pose health risks to the mother.

When doctors operate on fetuses to correct defects before birth, general anaesthesia is given to the mother primarily to immobilise the foetus and to make the uterus relax, Rosen said.

Anaesthesia during foetal surgery increases the mother’s risks for breathing problems and bleeding from a relaxed uterus, the researchers said.

Rosen said those risks are medically acceptable when the goal is to save the foetus but there is not enough evidence to show any benefit from foetus-directed anaesthesia during an abortion.

Administering anaesthesia directly to the foetus is also sometimes done but generally to reduce the release of potentially harmful foetal stress hormones, Rosen said. There is little research on its effects, the authors said.

Anand, the researcher from Arkansas, said the authors excluded or minimised evidence suggesting foetal pain sensation begins in the second trimester and wrongly assume that foetuses’ brains sense pain in the same way as adult brains.

While Anand has testified as an expert witness for the government in court cases opposing some late-term abortions, he said he is not anti-abortion and that his views are based on years of foetal pain research.