recently published in the prestigious Journal of the American Medical
Association (August 24, vol. 294, p.947) has caused quite a stir. The authors
claim that the fetus’ neurological pathways in its brain that allow “the
conscious perception of pain” do not function until after 28 weeks. To say that
there has been an explosion of criticism is quite an understatement. Reactions
to it have centered on basically three issues.
One is that preemie infants born prior to 29 weeks, and as early as 22-23 weeks,
do show ample evidence of feeling pain as they react to painful stimuli,
withdraw from it and cry. A second major comment has been that the article
offers no new research but merely goes over certain previous findings. Third,
much has been made of the inferred bias of the authors, one of whom is the
medical director of the abortion facility at San Francisco General Hospital. It
has been reported that this hospital commits 600 abortions a year, done in the
5th and 6th months of pregnancy. The other author previously worked for NARAL.
These are valid comments, and in and of themselves go a long way to destroy the
scientific credibility of the article. However, it is obvious that a more
in-depth analysis would be helpful.
Having read the article carefully, I was immediately struck by the fact that if
you can change a definition to fit your needs, then it is easy to prove your
point. Changing the commonly accepted definition of pain is the heart of the
matter. Note above that the article speaks of “conscious perception” of pain.
Further, they defined pain as “a sensory and emotional experience that requires
the presence of consciousness to permit recognition of stimulus as unpleasant.”
Their definition of pain is simply wrong.
If we define pain as being cerebral, if we define it as only existing when there
is consciousness and memory, if we define all other responses to noxious stimuli
as mere reflexes that really don’t hurt, then the article has certain merit. But
herein lies the basic falsehood of their analysis. As a matter of fact, you do
not need consciousness to react to a painful stimulus. Furthermore, you don’t
even need cerebral hemispheres. Several examples will illustrate this.
If you put your finger on a hot stove, you will pull it back immediately. Your
finger will be off of that hot burner prior to when your brain consciously
registers pain. That is a reflex, yes, but the fact that it is a reflex does not
mean that it didn’t hurt, for your finger certainly hurt and later developed a
Anencephalic babies are born without the higher parts of their brain. All they
have is a brain stem. Therefore, they certainly do not have consciousness. Some
of them live several days or longer. During this brief neonatal period, if you
stick them with a needle, or their diapers are wet, they will cry. Do they feel
pain? I doubt if any mother, father or attending physician would claim that this
is not pain, for it obviously is.
Let’s look at another example as early as 8 – 10 weeks of fetal age
intrauterine. If you stick this developing baby in the palm of her hand with a
needle, she will withdraw her hand. She will also open her mouth. We can compare
this to a newborn infant who is stuck with a pin while being changed in a cloth
diaper. Said baby will withdraw his little butt and complain loudly. All three
of these reactions are the same.
What then is the neural mechanism of this? A peripheral or surface pain stimulus
is carried by way of a sensory nerve to a portion of the brain stem called the
thalamus. The thalamus resembles a switchboard. It directs the pain message down
a motor nerve. This motor nerve goes to the fetus’s palm or the diapered baby’s
little butt and activates a muscular recoil, the same as pulling your finger
from the hot burner.
Until somewhat recent years, there was a certain amount of conventional wisdom
in the medical field that very premature babies could not feel pain. Because of
this, a born preemie would be operated on without any anesthetic. That has
largely been disproved in recent years by a series of articles, which report
that not only does a premature baby (or fetus) feel pain, but also that this
tiny person feels far more generalized and severe pain than an adult.
The reason for this is the myelin sheath. A myelin sheath is basically an
insulation. It can be compared to the covering over an electric wire. That wire
receives an electric charge at one end and delivers it out the other end without
that electric charge escaping enroute because of the insulated covering. Grown
children and adults have their peripheral nerves sheathed in myelin so that the
stimulus at one end carries to the thalamus without impacting the tissues it
passes through on the way. This localizes the pain to where the noxious stimulus
is applied. It is now known that an older fetus and premature babies do not have
this protective myelin sheath or do not have it completed. Because of this, a
pain stimulus at one end is not just felt at the tip where this stimulus is
applied, but probably is felt all along the course of that exposed nerve fiber.
This being true, that tiny infant then feels far more agonizing pain than the
older child or adult subject to the same painful stimulus.
Let’s quote a few authorities. Dr. Jean Wright at Emory University said,
“Infants at 23 weeks show very highly specific and well coordinated physiologic
and behavioral responses to pain similar to older infants.” Blechschmidt has
stated, “At 7 weeks of fetal age they twitch or turn their head away from a
stimulus in the same defense maneuver seen at all stages of life.” Matviuw has
said, “By 13 weeks, the fetal organic response to pain is more than a reflex. It
is an integrated physiological attempt to avert the noxious stimulus.” (See
Abortion Questions and Answers by the author, 1991, pages 65-69.)
But isn’t it true the unborn baby cannot tell us that he or she feels pain? Good
question. But there is an answer. Pain can be detected when nociceptors (pain
receptors) discharge electrical impulses to the spinal cord and brain. They fire
impulses outward telling the muscles in the body to react, as I noted above.
These can be measured. Further, changes in heart rate and fetal movements, as
well as movement of the newborn preemie, also suggest a response to painful
Most recently, the United States District Court for the southern district of New
York received extensive testimony from experts on both sides regarding fetal
pain during partial-birth abortion. The testimony of one doctor, Kanwaljeet
Anand, (which was not challenged) described that fetuses undergo severe pain
during abortion procedures.
One of those who defended the controversial JAMA article was Dr. David Grimes,
who until recently was chief of the department of OB-GYN at the same San
Francisco General hospital as one of the authors. We might note that Grimes,
along with Dr. Cates, for many years did second and third-trimester abortions in
Atlanta. Cates authored an article suggesting that the financial charge for a
late-term abortion be calibrated on the length of the fetal foot. Grimes, since
that time, has been a notorious defender of unrestricted abortions.
In closing, I note that the Unborn Child Pain Awareness Act (S51, HR356,)
requires that the mother be told a late-term abortion will cause pain and that
the fetal infant be given an anesthetic. The obvious purpose of the authors of
the JAMA paper was to damage the prospects of passage of this bill. Considering
the above, we hope their attempt will be counterproductive and that the bills