The Emerging Reality of Fetal Pain in Late Abortion

by Paul Ranalli, MD

The disturbing concept that an unborn child feels pain while being destroyed has once again entered the public conscience in England, when a pro-choice fetal researcher suggested that anesthesia should be given to comfort the fetus from pain from abortions as early as 17 weeks gestation.

Dr. Vivette Glover, a researcher at the Queen Charlotte's and Chelsea Hospital in London, told the British Broadcasting Corporation that, while it is unlikely the fetus can feel anything before 13 weeks, "after 26 weeks it is quite probable. But between 17 and 26 [weeks] it is increasingly possible that it starts to feel something and that abortions done in that period ought to use anaesthesia".

Her comments triggered another round of controversy in England, one of the few places in the world where the subject has been honestly addressed. Although the medical and science establishment had largely ignored mounting evidence of the early development of fetal pain perception for the better part of a decade, it was Britain's Royal College of Obstetricians and Gynecologists that stuck a Working Party to study the issue three years ago. Their report, issued in October 1997, startled the world by recommending that the evidence for fetal pain perception in the late second trimester was convincing enough that the doomed fetus should be sedated with its own specific anaesthesia in all abortions performed from 24 weeks onward. The RCOG panel actually concluded that pain perception was not possible before 26 weeks, but they backed up their anaesthesia recommendation to 24 weeks because of the uncertainty of estimating gestational age. They also suggested an alternative to anaesthesia: stabbing the fetus through the heart and injecting potassium chloride, a technique they delicately stated, "that stops the heart rapidly". This had the double benefit, for the abortionist, of ensuring the delivery of a dead baby, since many abortions around 24-26 weeks are likely to result in a viable birth.

Dr. Glover's statement was especially controversial for the RCOG, as it followed an apparent internal argument within the doctor's group about how to deal with the findings of the 1997 report it commissioned. Media reports earlier this summer that the group would officially endorse a policy of fetal anaesthesia during late-term abortion were quickly denied, too quickly in the eyes of some observers. Dr. Glover's public statement appears to have blown the lid off attempts to contain the controversy. Leaders in the field took issue with her statement, although their denials were carefully couched. Dr. Gillian Penney, of the Aberdeen [Scotland] Maternity Hospital, and Chairman of the Royal College's induced abortion guideline group, claimed that, until 26 weeks, "the fetus would not be capable of experiencing what we would perceive as pain" [emphasis added]. Professor Peter Hepper, of the fetal behaviour research center at Queen's University in Belfast, Northern Ireland, said there was not enough evidence to say that the unborn child experienced pain before 26 weeks, but he allowed that it was "better to be safe than sorry".

The authority Dr. Glover brings to the debate makes it difficult for the RCOG, and the general public, to ignore her concerns. The RCOG Working Party referenced one of the key fetal pain research projects she published in 1994 with Dr. Nicholas Fisk and colleagues. Their research revealed that, in response to a painful procedure, fetuses as early as 19 weeks release large amounts of pain and stress hormones into the surrounding amniotic fluid, the same hormonal surge that occurs in adults. An earlier study by German researcher Dr. Joachim Partch detected similar hormones from the amniotic fluid as early as 16 weeks into the pregnancy. Although some have criticized the notion that such a finding implies that the fetus is experiencing pain, there is, in fact, no direct objective method of assessing pain in any subject, adult or fetus, human or animal. Conclusions about the experience of pain must be based on what is considered to be reasonable from the available evidence, a point that is made in another British report, called the Commission of Inquiry into Fetal Sentience. Those who can self-report, like conscious adults, may cry out, give elaborate descriptions of their pain, or rate its intensity, either verbally, or on an analogue scale, such as the 1-to-10 scale (think of any headache commercial on TV). For those who are unable to articulate their pain, such as infants, unconscious adults, or unborn children, the perception of pain must be deduced, indirectly, by observing other biological responses, such as a physical withdrawal of limbs from painful stimulus, a change in vital signs (blood pressure and pulse rate go up), or a release of stress hormones (cortisol, beta-endorphin). By every measure, the fetus from 16-19 weeks reacts to a painful stimulus in a manner consistent with (not conclusive of, an unprovable proposition) the perception of pain. Support for Dr. Glover's position came from Canadian researcher Dr. Ken Craig, of the University of British Columbia, who said "at 24-25 weeks post-conception, a fetus displays all of the physiological and behavioural reactions you observe in children and adults." "My experience is that they do experience pain", Dr. Craig, who has spent over 15 years studying pain in premature babies, told the Vancouver Province [Aug. 30]. "I say we should give the babies the benefit of the doubt."

Dr. Glover also touched on the political nature of the abortion controversy. When asked what she thought about her scientific conclusions lending support to those who oppose abortion, she stated: "I am pro-choice, but one should not muddle the two."

The direction of this debate will not surprise some readers, as research into fetal pain has been discussed for several years. An independent analysis of the original research reviewed by the 1997 RCOG panel concluded that the panel had misinterpreted the data in concluding that pain signals do not reach the highest levels of brain cortex until 26 weeks. Careful anatomical studies reveal that the ascending pain fibers reach the cortex by 20 weeks, then they "sit" briefly, for days to a few weeks, before making their final push upward to establish their ultimate connections ("synapses") with the surface gray matter neurons that register a conscious awareness of pain. Thus, with some room for individual variability, the brain of an unborn child will begin to register pain impulses just after 20 weeks, with ever-increasing amounts of pain reception reaching millions of surface cortical neurons between 20-24 weeks.

In fact, as we have learned from other work, the late second-trimester fetus, like the similar-aged premature newborn, likely develops the capacity to be more sensitive to pain than a full-term baby, or even an adult. This is because, the inhibitory, pain-modifying network lags in embryologic development behind the establishment of the pain system. Neurons from the higher reaches of the brain send fibers down to synapse with the thalamus (a key pain-relay station deep in the brain), and the spinal cord, where incoming pain signals from the trunk and limbs are directed upward to the brain. These neurons secrete brain chemicals (serotonin, norepinephrine, dopamine) which inhibit pain in adults. Yet, while the pain system is up and running by 20-24 weeks gestation, this pain-modifying system does not begin to make its appearance until later in pregnancy, and continues development until full term and beyond. Thus there is a key period of mis-match, from 20 weeks onward, in which raw pain impulses from the body may roar through unchecked by the modifying inhibitory mechanism that helps to blunt pain in adults, leaving the unborn child at this stage vulnerable to a degree of pain that is truly unimaginable. Dr. Glover has now raised concerns that this dreadful period of potential vulnerability to pain may extend as far back as 17 weeks gestation.

The implications for the abortion debate are stark. Even using the conservative fetal pain date of 20 weeks, as many as 14,000 U.S. abortions every year may cause horrific pain as well as death. If some pain is perceived at 17 weeks, the 42,000 abortions may be implicated annually, including hundreds, perhaps thousands, of partial-birth abortions. A clinical description of this procedure has already been sickening enough to fracture the ranks of abortion opponents, even without considering that the nearly-born child may feel massive pain before death. Now the concept of fetal pain in late abortion, long derided by mainstream commentators as a pro-life construct, is being discussed as a scientific reality by pro-choice researchers and the community of abortion doctors themselves.

In lieu of being able to contain the controversial subject, the British medical establishment has announced a conference to discuss the issue at the prestigious Royal Institute in November. It will be chaired by Dr. Vivette Glover.

Dr. Ranalli is a neurologist at the University of Toronto.  In 1995 he testified on fetal pain before the House Judiciary Committee for the state of Ohio. This article was written for NRL News, September 2000 and is published here with permission.