Fetal pain and the politicisation of science

Attempting to resolve the question of abortion through debates about fetal pain is damaging for both science and politics, argues Dr Stuart Derbyshire.

Over a decade ago a friend called me and alerted me to a forthcoming article in the Lancet arguing that a fetus might feel pain in utero. (1) She asked what I thought, and I replied the idea seemed, at best, to be a little strange. Subsequently I wrote a letter of response arguing, in essence, that pain is too complex a sensation and emotion to be experienced by a fetus. (2)

In the months that followed I was invited to give evidence before the Rawlinson Committee, a pro-life parliamentary grouping headed by Lord Rawlinson and including Sir David Alton, and to speak at a conference in Queen Charlotte’s Hospital and at a further conference at the Novartis Foundation. The conference at Queen Charlotte’s was cancelled because of concerns about negative publicity and the mix of science and politics. Although the conference at the Novartis Foundation went ahead, the organisers cancelled their planned press conference.

The question of whether the fetus feels pain is an interesting academic question that tests much of what we believe about pain but it is also much more than that. The question was quickly bound up into abortion politics and has become a central argument for those who oppose abortion. I think this is highly problematic because fetal pain cannot resolve the question of whether abortion is right or wrong.

Science, morality and politics

If it is accepted that the fetus does not feel pain that will not mean that it is acceptable to dismiss the life of the fetus out of hand. There will remain very good reasons to defend fetal life and to protect the welfare of the fetus. Similarly, if it is accepted that the fetus can feel pain that will not mean that it is acceptable to force pregnant women to become mothers against their will. There will remain very good reasons to defend the rights of women to control their own fertility and protect their bodily sovereignty.

In October 2007, the House of Commons Science and Technology Committee (STC) published a report gathering the most recent science regarding viability, fetal development and fetal pain. (3) I gave evidence to the committee and I believe the report is very good. It is pleasing that Parliament had a document with the science right, but it is important to understand that abortion is not a scientific issue, and science cannot dictate when an abortion should be allowed and when it should not. Abortion is a moral and political issue that should be resolved by moral and political debate. In other words it should be resolved democratically and to do otherwise is bad for democracy.

Allowing the question of fetal pain, and other scientific issues, to dominate the question of abortion can have negative consequences for the political understanding of abortion. The reverse is also true: politicising fetal pain can have negative consequences for the scientific understanding of fetal pain.

Immediately before the Science and Technology Committee published its report, Channel 4 aired an episode of its documentary series Dispatches examining late-term abortion. I featured in the programme and have commented on it elsewhere. (4) In brief, the programme argued for restricting abortion after 12 weeks because the fetus then starts to look, behave and feel like a baby. The programme featured Professor Stuart Campbell, who interpreted his 4D ultrasound images as proof of emotional experience in second trimester fetuses, and Professor KJS Anand, who claimed to have new evidence proving that a fetus of around 16 weeks’ gestation could feel pain.

Following the programme, opponents of abortion began to argue that the Science and Technology Committee had suppressed the work of Anand. They cited a recently published review of fetal pain by Lowery, Anand and others, which was not mentioned by the committee, as evidence of suppression. (5)

In fact, the Committee considered the review in question but found it to be of little help or relevance. Briefly, the review agrees that a connection from the skin to the higher centres of the brain is not complete before 29 weeks’ gestation. Most neuroscientists believe that this connection is necessary for an experience of pain. Lowery and colleagues, however, argue that pain is possible dependent upon lower brain regions or transitory fetal brain structures.

Technical debates

The possibility of pain arising from structures beneath the cortex is highly controversial. Some sort of experience from the lower regions has been discussed, (6) but most neuroscientists believe the cortex is intimately involved in mental experience. If we take the idea that mental experience is related to brain structures at all seriously then the idea of pain experience being unaffected when vast regions of the brain are missing is quite a reach.

Similarly it is reasonable to argue that the transitory brain structures that appear during fetal development perform a different function from the relatively fixed structures that appear later. Generally speaking it is believed that these transitory structures perform important maturational functions that allow the brain to develop appropriately. The idea that the transitory structures perform functions, ncluding causing pain experience, is not very plausible. A structure that appears, provides for pain experience, and then disappears, in an environment where pain is of no obvious value and could be actively detrimental to survival, is a very odd proposal that needs extraordinary supporting evidence.

Lowery and colleagues also claim that noxious insult to the fetus could have long-term negative developmental consequences for the fetus, neonate and infant. That is true but obviously irrelevant in the case of abortion.

Finally, Lowery and colleagues sloppily suggest that the fetus responds to pain. Pain is the response; pain is not being responded to. It is the presence or absence of pain that needs to be explained and a review of fetal pain should not confuse the stimulus and the response.

Lowery and colleagues confuse themselves over stimulus and response because they are confused about what pain is. Although they state that pain is a conscious experience, and not just a biological reaction, they are unable to account for pain subjectivity so pain appears in places it doesn’t belong such as in the stimulus, or in specialised nerve fibres, or in lower brain loops and so forth. But pain cannot be boiled down to ‘pain stimuli’ or ‘pain fibres’ without boiling out pain, because only socially conscious beings can feel. Stimuli and fibres don’t feel anything.

By now you might have noticed that many of the arguments over fetal pain are quite technical and far removed from political arguments. You would be correct. It is normal for scientists to argue over technicalities and it is usual for broader debate and experimentation to gradually resolve those arguments. If this were a normal scientific dispute then myself, Anand and other interested scientists would publish papers and commentaries on each other’s work and would meet to discuss our different approaches at scientific conferences.

The problem of politicisation

The only chance I have had to debate openly my differences with Anand, however, was via an invitation from Nadine Dorries to speak at a meeting in Westminster. (7) I declined in part because I was going to be on the platform with Anand and Stuart Campbell and in part because the meeting was essentially a pro-life rally. I didn’t see the possibility of having a balanced scientific discussion and the question of fetal pain has only minimal relevance to the question of abortion.

The debate over fetal pain is interesting and provocative but it cannot resolve the question of whether abortion is right or wrong. That is something that I think myself, and professors Anand and Campbell might agree with. Unfortunately, for more than a decade, I have been largely arguing with Anand and Campbell through trial lawyers, journalists and ministerial committee meetings. Some of that is unavoidable and unproblematic but the concern is that both sides can become entrenched in a political rather than a scientific argument.

I am not suggesting that scientists refuse to engage the political debate; the issue has become politicised and that fact has to be dealt with. It is important that scientists bring their scientific knowledge to bear upon the politics as far as can be reasonably achieved and that is why the STC report is valuable and useful. (3)

I don’t, however, see the value in suggesting that abortion can be resolved with a decision about fetal pain or with technically spectacular 4D images. Failing to challenge the idea that the moral question of abortion can be resolved with science betrays an opportunist approach to politics and science that is narrow and self-serving.

There is a case for maintaining a scientific debate beyond the heat of a political argument and the need to reassure other scientists that there is a genuine scientific debate and not just a political fight. I have argued elsewhere that we should encourage debate about fetal pain to continue without reference to abortion as far as possible. (8) But when politicians, such as Nadine Dorries, drag science into a political arena then scientists should explain how the science does, or does not, resolve the political question to hand. Playing on the assumption that science can resolve moral questions takes opportunism to the point of cowardice.

Stuart WG Derbyshire is a senior lecturer in psychology at the University of Birmingham. His major research interest is understanding how the brain processes pain, and he has written extensively on abortion, especially in regards to the issue of fetal pain.

References

1) Giannakoulopoulos X, Sepulveda W, Kourtis P, et al. ‘Fetal plasma cortisol and -endorphin response to intrauterine needling.’ Lancet 1994;344:77-81
2) Derbyshire SWG. ‘Fetal stress responses.’ Lancet 1994; 344: 615.
3) House of Commons Science and Technology Committee. ‘Scientific Developments Relating to the Abortion Act 1967’. 29 October 2007. Available here.
4) Derbysire, Stuart. ‘Abortion: What you didn’t need to see’. spiked, 22 October 2007.
5) Lowery CL, Hardman MP, Manning N, Hall RW, Anand KJS. ‘Neurodevelopmental changes of fetal pain.’ Seminars in Perinatology 2007;31:275-82.
6) Merker B. ‘Consciousness without a cerebral cortex: A challenge for neuroscience and medicine.’ Behavioral and Brain Sciences 2007;30:63-134.
7) Nadine Dorries’ blog.
‘The Perils of Hero Worship’. Liberal Conspiracy website.
8) Derbyshire SWG. ‘Fetal Pain: What the evidence can and cannot tell us.’ American Pain Society Bulletin. 2006;16:1-5.