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WASHINGTON LETTER Nov-4-2005 (940 words) Backgrounder. xxxn

Does a fetus feel pain? Hearing tries to sort out differing views

By Nancy Frazier O'Brien
Catholic News Service

WASHINGTON (CNS) -- In a House hearing room recently, much of the discussion focused on the meanings of the words "feels" and "pain."

Is pain "a subjective sensory and emotional experience that requires the presence of consciousness," as a recent article in the Journal of American Medical Association defined it? Or does pain instead depend on certain physiological and behavioral responses to stimuli? Or does it have to do primarily with brain development?

Answers to those questions could make all the difference to women considering an abortion -- and to their unborn children -- if a measure pending in the House becomes law.

The Unborn Child Pain Awareness Act of 2005, introduced in January by Rep. Chris Smith, R-N.J., got its first hearing Nov. 1 before the Subcommittee on the Constitution of the House Judiciary Committee.

The legislation would require medical professionals to inform women seeking abortions -- if their unborn child has reached "a probable stage of development of 20 weeks after fertilization" -- that there is "substantial evidence that the (abortion) will cause the unborn child pain, and that the mother has the option of having pain-reducing drugs administered directly to the child."

Sen. Sam Brownback, R-Kan., has introduced a similar measure in the Senate.

"The topic of pain of the unborn, including whether, how early and to what extent an unborn child feels pain, ignites heated debate," said Rep. Steve Chabot, R-Ohio, subcommittee chairman and a co-sponsor of the bill. "Yet 77 percent of the individuals surveyed in an April 2004 Zogby International poll favor a law requiring that women who are 20 weeks or more along in their pregnancy be given information about pain of the unborn before having an abortion."

Dr. Kanwaljeet S. "Sunny" Anand, professor of pediatrics, anesthesiology, pharmacology, neurobiology and developmental sciences at the University of Arkansas for Medical Sciences in Little Rock, said the topic of fetal pain "deserves a scientific appraisal that is independent from the highly controversial and partisan issues surrounding abortion, women's rights or philosophical projections about the beginning of human life."

Anand disputed the findings of a review of earlier studies published in August in the Journal of the American Medical Association, which concluded that fetal perception of pain is unlikely until 29 to 30 weeks after fertilization.

"The conclusions ... regarding fetal pain are flawed because they ignore a large body of research related to pain processing in the brain, present a faulty scientific rationale and use inconsistent methodology for their systematic review," he said. "Based on the available scientific evidence, we cannot dismiss the high likelihood of fetal pain perception before the third trimester of human gestation."

Teresa Stanton Collett, a law professor at the University of St. Thomas School of Law in Minneapolis, said the conclusions of the August JAMA article also were contrary to that of the British Medical Association, which said in 1999 that "due consideration must be given to appropriate measures for minimizing the risk of pain" to the fetus, both in abortions and in therapeutic interventions.

"If there is a single issue in the abortion debate where common ground could be found, one would hope it might be on the issue of ensuring that women who obtain abortions at 20 weeks or later be informed of the possibility of fetal pain and their options to relieve that pain," Collett added.

To a certain degree, that consensus already exists. When the bill was introduced in January, Nancy Keenan, president of NARAL Pro-Choice America, said her organization did not oppose the legislation.

"Pro-choice Americans have always believed that women deserve access to all the information relevant to their reproductive health decisions," Keenan said. "For some women, that includes information related to fetal anesthesia options."

But Arthur L. Caplan, chairman of the department of medical ethics at the University of Pennsylvania School of Medicine, strongly objected to the proposed law, calling it "an unwise interference with the practice of medicine by Congress" that could have "enormous ramifications for the future practice of medicine."

Caplan said that because the medical profession has not reached a consensus about when a fetus is capable of pain, "legislation mandating that a health provider or physician represent something as a fact which is not known to be true or agreed upon by the majority of medical and scientific experts as valid would not only be poor public policy, it would set a terrible precedent for other topics where Congress might choose to mandate disclosure about 'facts' for political or even ethical reasons which have no foundation in science or medicine."

Offering the most hands-on testimony at the hearing was Dr. Jean A. Wright, executive director of Children's Hospital and Women's Institute at Memorial Health University Medical Center in Savannah, Ga., who traced the history of pediatric anesthesia since the early 1980s, when "little or no pain management" was offered to premature infants undergoing major surgery.

Today, however, "our understanding of the presence of pain and the need to clinically treat this pain in the premature infants leads us to understand the presence of pain and the need to treat pain in the unborn fetus of the same gestational age," Wright said.

"Our conscience as clinicians requires us to apply the same standards of informed consent that we would to any other patient in the same or similar situation," she said. "We no longer can ignore the fact that maternal anesthesia treats the mother's pain perception during these procedures, but leaves the unborn with no pain protection."


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