The real issue in the fetal pain debate

By Wendy Smith
Registered Nurse

The human brain is an extremely complex human organ. Neurons are the specialized cells that transmit nerve impulses. In order to pass the impulse from one neuron to another, neurons have dendrites which extend out from the cell body. Dendrites receive the impulse and carry it to the cell body. Neurons also have arms that extend out from the cell body called axons, which transmit the impulses away from the neurons to other neurons or tissues. They communicate with one another over junctions called “synapses.” It has been estimated that 86 billion neurons, along with innumerable synapses, dendrites, axons and support cells make up the human brain.¹ These processes are far too complex to review in detail as volumes of journal articles and texts have been written in an attempt to describe the intricacies and complexities of the nervous system.

From the moment of conception, the genetic blueprint contained within the DNA is set in motion and development proceeds rapidly. Early evidence of human brain and spinal cord development have been noted as early as the third week post-conception. The neural groove is first seen at approximately day 20-21 post conception. Then by the sixth week, reflex responses to touch have been noted.²  “In the first trimester, fetal movements grow rapidly in frequency and complexity.  In around 7 weeks of pregnancy only gross movements are visible; at the end of the first trimester the fetus presents complex movements of the head, limbs and fingers.”³ Much of the neuronal development occurs between 8 and 18 weeks.⁴     

In the abortion debate, fetal pain is controversial and complicated.  When does the developing fetus actually feel and/or respond to pain? How do we know when actions are responsive rather than reflexive? How do we measure response: by movement/withdrawal from a noxious stimulant, or can we measure endocrine/hormonal responses to stress?

Is it even possible to answer these questions definitively since pain is subjective and is described as “an emotional and psychological experience that requires conscious recognition of a noxious stimulus?”⁵ Are these even the right questions to ask?

What do we know so far?

Though we have seen tremendous advances in neuroimaging (e.g. 4D ultrasound, electroencephalography, magnetoencephalography, functional magnetic resonance imaging, etc.), most of the studies involving fetal pain involve the second trimester as earlier prenatal data involving interconnectivity of the nervous system are not available.¹   According to a 2005 report in the Journal of the American Medical Association “…tests of cortical function suggest that conscious perception of pain does not begin before the third trimester.”⁵ In March of 2010, the Royal College of Obstetricians and Gynecologists (RCOG) from the UK issued a report in which they concluded: “The lack of cortical connections before 24 weeks, therefore, implies that pain is not possible until after 24 weeks.  Even after 24 weeks, there is continuing development and elaboration of intra-cortical networks.”⁶

Yet, human fetal endocrine responses to stress have been demonstrated from as early as 18 weeks gestation.⁴

Based on a review of literature and evidence thus far, we can at least infer that the fetus may experience pain between 18-24 weeks gestation. That said, science may prove this to be a false hypothesis in the future as more knowledge is gained and when there is more evidence to support pain earlier or later in fetal development.

Not to minimize the importance of this debate, but is the question of fetal pain a rabbit trail?

Brain development is a life-long process. The point is not so much whether the fetus feels pain; a newborn is aware of self; or if a teenager can describe their emotions or even think rationally. The main point is that the fetus is a human. The stages of development of the neurologic system are part of normal human growth and development. This is a process that occurs in every human being from conception on into adulthood.

From conception, the DNA in that first cell orchestrates this innate process. The DNA is unique to the individual; it is their signature. It is this same DNA that guides differentiation from the first pluripotent stem cell into all of the complex, intricately interwoven and highly interdependent body systems.

DNA can be obtained from a cigarette butt at a crime scene and not only confirms that the criminal was human, but it can also identify the criminal by name through a DNA data base. It is their own signature.

Were you to be killed in a massive explosion, tissue fragments would not only recognize you as human, but would also identify your DNA signature by name, enabling your next-of-kin to be notified.

DNA can be obtained from saliva and sent off to be analyzed by genetics/genealogist and not only confirm your life, but also trace your ancestors going back generations.

DNA obtained from fragments, “products of conception,” fetal tissue, can confirm humanity and parentage.

Only one question needs to be asked — “is the fetus a human being?”  If it is, then abortion is the taking of a human life. This is a simple question. Whether it is the first cell at conception, a morula, a blastocyst, an embryo, a fetus, or a baby 8 inches and a few minutes from birth — abortion at any moment is ending the process of normal human growth and development. With current technology, it is possible to capture images from conception to birth.⁸ The human genome has been mapped, opening our understanding to DNA. To deny the humanity is to deny science. Abortion ends a human life defined by the DNA signature, as well as the innate complex patterns of growth and development of this life.

1. Keunen, K., Counsell, SJ, Benders, MJ.    The emergence of functional architecture during early brain development.  ScienceDirect.  January 2017.  doi: 10.1016/j.neruoimage.2017.01.047 http://www.sciencedirect.com/science/article/pii/S105381191730054X Accessed 1/25/17.
2. Moore, KL., Persuad, TVN., Tochia, MG. The Developing Human:  Clinically Oriented Embryology, 10^th  Elsevier, Inc.  2016.
3. Lebit, FD & Vladareanu, R. The Role of 4D Ultrasound in the Assessment of Fetal Behavior.  Maedica (Buchar).  2011 Apr:6(2):120-127 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3239390/
   Accessed 2/10/17
4. Brusseau, R. Developmental Perspectives: is the Fetus Conscious? http://www.slideshare.net/SDRTL/developmental-perspectives-is-the-fetus-conscious
5. Lee, SJ et al. Fetal Pain:  A Systematic Multidisciplinary Review of the Evidence.  JAMA, August 24/31, 2005—Vol 294, No. 8 http://serendip.brynmawr.edu/local/scisoc/brownbag/brownbag0506/fetalpain.pdf
6. RCOG Working Group. Fetal Awareness: Review of Research and Recommendations for Practice. March 2010. Royal College of Obstetricians and Gynaecologists.
7. https://www.rcog.org.uk/globalassets/documents/guidelines/rcogfetalawarenesswpr0610.pdf Accessed 2/10/17.
8. Tsiaras, A. Conception to birth – Visualized.  2010 https://www.ted.com/talks/alexander_tsiaras_conception_to_birth_visualizedSee also: Charlotte Lozier Institute.  Fact Sheet:  Science of Fetal Pain. https://lozierinstitute.org/fact-sheet-science-of-fetal-pain/