Thursday, February 14, 2008

Can a Fetus Feel Pain? [Serge]

Surprisingly, one of the best articles that I have ever read concerning the topic of fetal pain is found here in the New York Times. It is certainly long, but well worth the read if you are at all interested in the topic.

As for my view - and considering my career I may be considered well versed on the topic, it may surprise some. The answer to the question of does a fetus feel pain is... I don't know. And neither does anyone else. Pain is a subjective experience that does not always even need a stimulus for someone to experience. My patients under sedation can have an elevated blood pressure despite the fact that I know they are not experiencing pain. At the same time, a patient can have the sensation of pain without any reason. Pain is very complicated, and because none of us is able to remember our fetal experiences - we cannot for certain state that a fetus has the ability to feel pain. This in important to understand whenever anyone on either side claims they know the truth to this question. It also needs to be appreciated that our understanding and treatment of pain has changed greatly in recent years and it is a topic we continue to learn more about.

Yet, we can look at objective truths in order to attempt to determine the chance that a fetus can feel pain. These facts are not in dispute, and many of them are confirmed in the article above:

1. Doctors have historically underestimated the ability of young humans to feel pain. This is true from circumcision to pediatric dentistry, in which many patients still remember having their dentist hurting them because we thought primary teeth had less developed nerve supply and thus wouldn't be painful when drilled into.

2. In NICUs, humans as young as 21-22 weeks gestation withdraw and cry when poked with a needle. I have seen this personally in a 28 week gestation child, and it sure as heck looks like the kid is reacting in pain.

3. During fetal surgery, the fetus in utero withdraws from the surgeon's scalpel. This has caused a change in how we perform anesthesia as well as the use of local anesthesia for the wound during surgical interventions.

4. A human fetus in utero shows a hormonal response that is similar to the hormonal response that infants show when they are in pain. This hormonal response causes a significant change in the vital signs and evidence shows that a human which experiences this hormonal change may have detrimental effects from it in the future.

5. Controlling pain via local or general anesthesia decreases the above hormonal response in both human beings outside of the womb and those inside of the womb.

6. Born human beings that do not possess a cerebral cortex seem to be able to feel pain.

In conclusion, can we say with certainty that a fetus can feel pain? No. Neither can anyone state that they know that a fetus cannot feel pain. However, considering the evidence above, and considering our past errors in the past, we should assume and treat accordingly every human organism that we subject to a painful surgical stimuli as if they can feel pain. Those who state otherwise bear the burden of proof to show why we should not.

3 comments:

  1. Rich,

    Pain is indeed a mystery in many ways - for example, consider phantom limb pain, cluster headaches, trigeminal neuralgia - all kind of "odd" types of pain typically without [current] traumatic injury...

    Despite the absence of injury, pain is truly felt by individuals who suffer from these afflictions. The absence of trauma doesn't mean pain isn't felt. Likewise, the presence of stress in reaction to painful stimuli doesn't mean pain isn't felt either.

    I would speculate that some sort of diagnostic imaging or testing would allow us to better understand this issue. Maybe a PET scan could help determine if a fetus feels pain..

    Finally, here is my uninformed opinion on this issue.

    Given the points you mention above, I suspect that maybe this issue is much simpler than everybody is making it out to be - if it looks like a fetus is in pain, if stress is present, then the fetus is feeling pain. The only question that is left unanswered, in my mind, is what is the intensity of the pain being felt?

    I think too much is made out of the possibility of some kind of disassociation with the pain and the possibility of primitive reactions. I think this debate has been over-intellectualized – it’s turning out to be like the debate over the question “how do we know we exist?”

    Just my two cents - I could be entirely wrong here...

    Thanks for this posting...

    Ruben

    ReplyDelete
  2. For me, the matter is not very complicated at all. As a nurse, I have seen E.R. trauma patients in terrible agony, including one of my small children who was struck and nearly killed by a speeding car. If unborn persons have a nervous system like born persons do, I think it is safe to assume that having one's body parts removed one a time while awake would be excrutiatingly painful. End of story. Lori Vance, lpn.

    ReplyDelete
  3. Serge - thanks for the interesting article and observations.

    I get the distinct impression that when it comes to pain - it's much like the philosophical question - if a tree falls in the forest and no one is there to hear it does it make a noise?

    Reframed in pro-choice assumptions: If a tissue is in pain, but a scientist/psychologist is not there to observe it, and call that tissue a human being, then is it pain at all?

    Whatever the case may be regarding fetal pain - the substance view of the unborn as human beings doesn't stand or fall on the pain issue, and as you point, ignorance is not an excuse when it comes to treating human beings, of whatever sensory state or stage of development.

    ReplyDelete

All comments are moderated. We reject all comments containing obscenity. We reserve the right to reject any and all comments that are considered inappropriate or off-topic without explanation.

News on the Matter

Loading...