Wednesday, August 24, 2005

The "Fetal Pain" Fallacy

According to a JAMA review study [d]octors should not be required to discuss fetal pain with women seeking abortions because fetuses likely can't feel pain until late in pregnancy.

No matter. Sen. Sam Brownback, R-Kan, sponsor of proposed federal fetal pain legislation, says the JAMA report seems to fly in the face of common experience and common sense. Well then, off with the scientists' heads, metaphorically speaking, of course. I don't know about you, but I find it quite disturbing that people of Sen. Brownback caliber get to decide what our medical care should be.

If it's true that we deserve the leaders we get, what does that say about us?

On a less philosophical note, here's a good discussion of fetal pain, as well as some background on Dr. Kanwaljeet Anand, the MD quoted in the AP article:

Nevertheless, the [partial-birth abortion ban] trials will have a lasting consequence because of multiple damaging testimonies from Dr Kanwaljeet (Sunny) Anand on the issue of fetal pain. The potential for fetal pain was already becoming a common part of the argument against abortion but it is now guaranteed to form a more central role. Fetal pain

Dr Kanwaljeet Anand made a series of seminal discoveries during the late 1980s that led to a dramatic change in the treatment of neonates undergoing surgical and other types of care. Anand demonstrated that the major hormonal response to invasive practice could be significantly reduced when strong opioids, pain-killers, were added to the anesthetic regimen (7). Accompanying these reductions in the hormonal 'stress response' to injury were dramatic improvements in clinical outcome. Babies prepped for surgery with opioids required less post-surgical ventilatory support and had reduced circulatory or metabolic complications (8).

Anand and his colleagues advanced these impressive findings in a subsequent report indicating that neonates receiving deep anaesthesia during surgery had improved post-operative morbidity, they survived more frequently, compared with those neonates who received lighter anaesthesia (8). An accompanying editorial called on physicians to 'Do the Right Thing', concluding that 'it is our responsibility to treat pain in neonates and infants as effectively as we do in other patients' (9). In an earlier review for the New England Journal of Medicine, however, Anand was more measured, stating that: 'None of the data cited [in this review] tell us whether neonatal nociceptive activity and associated responses are experienced subjectively by the neonate as pain similar to that experienced by older children and adults' (10).

Since that time, Anand has moved further and further towards the view that neonates and late-term fetuses do not merely respond to noxious events but experience pain subjectively.

...

...Anand... [made] the following claim during the course of the trial in New York: 'I can state my opinion to a degree of medical certainty that all fetuses beyond 20 weeks of gestational age will experience severe pain by the partial-birth abortion procedure.'

But the statement is pure hyperbole and nonsense, for many reasons (12).

...

In short, fetal pain is a moral blunder based on the false equivalence between observer and observed that misses the whole point and process of development.

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