He blinded me with science

Posted by Joshua Holland at 11:28 AM on January 25, 2006.

Several of us "blogged for choice" on Sunday, the anniversary of Roe v. Wade. A commenter on a recent post, who I have no doubt is sincere in his or her beliefs, wrote this (and left a similar comment on another post):

My opposition [to abortion] has nothing to do with law, it has to do with the often-protracted suffering of those being aborted. Some procedures, such as saline poisoning, cause the baby to suffer for hours as he is being burned to death by the solution… it may take the baby many hours of intense suffering before he dies.

Not surprisingly, there's a blizzard of misinformation out there on the subject of "fetal pain." On this site, belonging to a "crisis pregnancy center," they say an eight-week old fetus is a "tiny human [who is] perfectly developed, with long, tapering fingers, feet and toes."

This site, by an anti-choice group, backs up its assertion that at eight weeks a fetus has the capacity to experience pain with some pretty convincing sounding science:

By this age the neuro-anatomic structures are present. What is needed is (1) a sensory nerve to feel the pain and send a message to (2) the thalamus, a part of the base of the brain, and (3) motor nerves that send a message to that area. These are present at 8 weeks. The pain impulse goes to the thalamus. It sends a signal down the motor nerves to pull away from the hurt.

They offer as further evidence, under the heading "Give me more proof," this: "In 1984 President Reagan said: "When the lives of the unborn are snuffed out, they often feel pain, pain that is long and agonizing," followed by a letter supporting Reagan from "an auspicious group of professors."

After perusing the abortion sites, pro and con, I figured I'd shine some serious scientific light on the subject. The short version is: this is all disinformation according to the best available science.

To cut through the crap, I went outside of the debate, to peer-reviewed scientific journals, specifically a review article in the Journal of the American Medical Association and another in Pain, a journal for clinicians in the business of pain management. The author of the latter went so far as to note that he wasn't trying to weigh in on abortion, but to give clinicians a handle on how to treat pregnant women.

Before I get to the science, though, some reality-based data on the crucial issue of when women terminate a pregnancy. According to the Allan Guttmacher Institute - whose data is used by both sides - 98.6 percent of abortions take place at or before 20 weeks. Almost nine out of ten happen before 12 weeks. That's key. The majority of the remaining 1.4 percent are due to complications that threaten the pregnant woman.

With that in mind, let's look at the science, which I'll annotate (feel free to skip the gobbledy-gook if you trust me to translate it accurately). According to Pain:

Fitzgerald (1987, 1994), who has reviewed the biological development of the fetus and examined the possibility of fetal pain at each stage of development. At 7.5 weeks' gestation, reflex responses to somatic stimuli begin, and touching the perioral region results in a contralateral bending of the head. The palms of the hands become sensitive to stroking at 10.5 weeks, and the rest of the body and hindlimbs become sensitive at approximately 13.5 weeks. Shortly after the development of sensitivity, repeated skin stimulation results in hyperexcitability and a generalized movement of all limbs. This hyperexcitability has been interpreted as evidence for the presence of a functional pain system, reflecting an immature but intact pain response with early hypersensitivity to stimulation (Barr, 1994). This view is not widely accepted, however, and is rejected by Fitzgerald herself. Prior to 26 weeks, the thalamocortical fibers have not yet penetrated the cortical plate, and it seems unlikely the cortical structures considered necessary for pain are responding to noxious stimulation (Mrzljak, Uylings, Kostovic, & van Eden, 1988).

Translation: as early as 7.5 weeks, there are autonomic responses that are consistent with a reaction to pain. This "has been interpreted" (I wonder by whom) as evidence of prenatal pain. But the researchers who did the study reject that view, and it is "not widely accepted."

Giannakoulopoulos et al. (1994) from the Queen Charlottes Hospital in London, England, successfully demonstrated intrauterine needling to obtain blood samples from fetuses at 20 to 34 weeks' gestation results in a hormonal stress response. They demonstrated that needling the innervated intraabdominal portion of the umbilical vein, rather than the placental cord (which is not innervated) resulted in increased cortisol and b-endorphin concentrations in fetal plasma.

Translation: research has shown that between 20-34 weeks of gestation (remember: 1.4% of abortions), there's an endocrine response that is consistent with the stress reaction observed in fully formed people.

But…

The undisputed discovery that the neonate and fetus launch a hormonal and neural response to invasive practice cannot be considered proof there is an experience of pain. An experience implies sensations have been interpreted in a conscious manner…

Although all of these phenomena are associated with the notion of "pain," none of them adequately describe or explain the phenomenological experience of "pain." These phenomena may exist independently of conscious experience…

Pain experience is now widely seen as a consequence of an amalgam of cognition, sensation, and affective processes, commonly described under the rubric of the biopsychosocial model of pain. Pain is no longer regarded as merely a physical sensation of noxious stimulus and disease, but is seen as a conscious experience that may be modulated by mental, emotional, and sensory mechanisms with sensory and emotional components. The biopsychosocial concept emphasizes the multidimensional nature of illness, injury, and pain, rather than emphasizing pain as a purely physical fact of illness or injury.

If this 'multidimensionality' is the basis of conscious pain experience, it seems unlikely we can attribute this experience to the neonate or unborn fetus, which is naive to the cognitive, affective, and evaluative experiences necessary for pain awareness. This is accepted in the current definition of pain, which is further expanded to state, "Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life." Pain does not, so to speak, spring forth from the depths of the person's mind prior to any experience, but is gradually formed as a consequence of general conscious development.

Interestingly, even those authors who support a concept of fetal pain tend to back away when confronted with the need to explain pain phenomenology. Giannakoulopoulos et al (1994), for example, distanced themselves from any implied fetal pain experience with the statement, "a hormonal response cannot be equated with the perception of pain." Lloyd-Thomas and Fitzgerald (1996) have suggested if feeling and pain are properly understood, the fetus cannot be said to feel pain.

A further reason to doubt the viability of fetal pain post-26 weeks' gestation is the development of the fetal cortex. Although the thalamocortical fibers penetrate the cortical plate at approximately 26 weeks' gestation, the cortical regions that have been identified as important in processing the various components of pain (Derbyshire, 2000) do not become fully responsive until after birth (Chugani & Phelps, 1986).

Translation: pain, as we understand it, is a combination of stimulus, cognition and experience. Even the researchers who have done the studies the forced childbirth movement likes to cite back off of the notion that a developing fetus can experience "pain." And there are neurological structures associated with pain, as we know it, that don't fully develop until after birth. Again, the evidence is based on studies looking at fetuses after 20 weeks, after 98.6% of abortions occur.

The Journal of the American Medical Association concurs:

Pain perception requires conscious recognition or awareness of a noxious stimulus. Neither withdrawal reflexes nor hormonal stress responses to invasive procedures prove the existence of fetal pain, because they can be elicited by nonpainful stimuli and occur without conscious cortical processing. Fetal awareness of noxious stimuli requires functional thalamocortical connections. Thalamocortical fibers begin appearing between 23 to 30 weeks' gestational age, while electroencephalography suggests the capacity for functional pain perception in preterm neonates probably does not exist before 29 or 30 weeks…

Evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester.

Of course, this doesn't prove anything; the point is there's no scientific evidence to support the claim that a fetus or embryo experiences pain. And the larger point is that those who make those claims do so based on ideology, not science.

They are, as I've said before, hucksters dedicated to muddying the waters of intelligent debate with rhetoric meant only to stoke their followers’ righteous rage.

And this particular piece of intellectually dishonest rhetoric is being used to stigmatize women seeking to terminate a pregnancy. Last year Minnesota Citizens Concerned for Life pushed a “fetal pain law” that requires doctors to give higher doses of anesthesia to women seeking abortions after 20 weeks (there were 67 such abortions out of 14,000 performed in minnesota), a practice that the American College of Obstetricians and Gynecologists says puts women at greater medical risk.

Update: The Department of Health and Human Services sent a bill to the House yesterday modeled on Minnesota's bill.

Joshua Holland is a staff writer at Alternet and a regular contributor to The Gadflyer.