Fetal Pain

In the latest issue of JAMA is an article about fetal pain which makes the case that abortion providers should not have to inform women about the possibility of procedural pain in the fetus, and purports to back up the assertion with science. Go read what Medpundit has to say about this. She has summed it up better than I can although I would offer a few observations and questions.

The authors’ major premise is that pain is a psychological construct. Indeed, the premise sets the evidentiary standard for the rest of the paper, because, in the authors’ own words, it “presupposes” the neuroanatomic connections they believe must be proven to make the case for fetal pain. Conveniently enough, the presupposition makes tissue injury irrelevant. (What if physicians start telling patients their pain is psychogenic)?

JCAHCO had some things to say about this in its pain management initiative of a few years ago. 1) Patients have a right to assessment and management of pain (implicitly surrogates have the right to be informed about pain). 2) Observation of vital signs, crying and reflex withdrawal (which have been observed in premature infants of less than 29 weeks gestation, and which the JAMA authors seem to dismiss as non-evidence of fetal pain) are legitimate pain assessment tools in preverbal individuals.

The authors admit that the evidence does not establish at what point in fetal development the thalamo-cortical pain pathways become functional.

The first sentence of the abstract establishes the politics driving this “science.” Perhaps the authors’ conflict of interest disclosure should have included their political affiliations. The issue of interface between scientific publication and politics has surfaced previously in JAMA and caused trouble for an editor.