Abortion Debate Turns to Age at Which Fetuses Can Feel Pain

Mary Beth Nierengarten

Disclosures

May 28, 2015

In This Article

Pain-Capable Unborn Child Protection Act

Called the Pain-Capable Unborn Child Protection Act (H.R. 36), the bill bans abortion of fetuses 20 weeks after fertilization (equal to 22 weeks after the last menstrual period (LMP)) except when the mother's life or health is in danger or when pregnancy is the result of rape. The bill strives to enact at the federal level what is already occurring at the state level; 12 states have passed bills banning abortions at 22 weeks from last menstrual period (Figure).[1]

Figure.

State abortion restrictions.

Among the research most cited in support of evidence of fetal pain at 20 weeks, or even earlier, is that done by Kanwaljeet Anand, MBBS, a professor of pediatrics, anesthesiology, and neurobiology at the University of Tennessee Health Science Center. In an expert report requested by the US Department of Justice to assist the Court in its assessment of the Partial-Birth Abortion Ban Act of 2003, Dr Anand said he believes that fetal pain occurs at 20 weeks of gestation, if not earlier. During his testimony, Dr Anand said his research shows the development prior to 20 weeks of subsensory cortical and thalamic structures that allow for conscious pain perception.[2,3]

Support for the evidence of fetal pain at 20 weeks also comes from surgeons who note anecdotally that fetuses withdraw from pain during surgery, says David Stevens, MD, CEO of the Christian Medical & Dental Associations (CMDA) in Bristol, Tennessee, who, along with members of CMDA, is in favor of the bill. He also points to data showing that fetal surgeons routinely use sedation and pain medications to reduce fetal movement and prevent a hormonal stress response.[4]

Speaking on behalf of ACOG at the May 13 press conference, Dr Lawrence said science has repeatedly discounted claims of fetal pain at 20 weeks. His conclusion is based on a 2005 meta-analysis that found that functional pain perception requires neural connections into the cortex that are not functionally developed until 26 weeks of gestation or later, and, therefore, that fetal pain probably does not exist prior to the third trimester. The evidence suggests that the responses that a fetus may have to stimuli prior to this time are probably more similar to a reflex, such as when a leg is tapped with a rubber mallet, and are not an indication of a conscious perception of pain.[5]

Dr Lawrence noted during the press conference that women who undergo a second-trimester abortion, especially after 20 weeks, are by far in the minority (only about 1.2% of abortions are performed after this time[6]). He also stressed that fetal anomalies are the major reason why women have second-trimester abortions. As a physician who counsels such women, he stressed the need for empathetic care in these situations, "not persecution and restrictions."

Other medical associations contacted by Medscape said they have not taken a position on the current bill. A representative from the American Medical Association (AMA) said ACOG is the authority on the medical and scientific issues tied to the bill and is in the best position to offer comments. However, after a similar bill was proposed in 2013 that banned abortions at 20 weeks after fertilization, a number of organizations joined with ACOG in arguing against the ban.[7]

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