Respecting Women's Rights and Fetal Value: Reflections on the Question of Fetal Anesthesia

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Earlier this year, Senator Sam Brownback, a Republican from Kansas, introduced the Unborn Child Pain Awareness Act (S.51).

The introduction of legislation by those opposed to legal abortion that would require doctors to not only inform women that fetuses post-20 weeks might feel pain and to offer women the option of anesthesia for the fetus, but also to do so in ways that were profoundly insensitive to women, made us aware of the medical discussion that was going on about this issue. However, before we could decide what position we might have on any specific piece of legislation, we needed to better understand the science and develop an ethical position on the matter.

Having done that to the extent possible (data on this matter is limited and more suggestive than definitive), we have come to the following conclusions:

1. The question of whether or not fetuses can feel pain in what is best described as a "gray zone" (20-26 weeks) is not "junk science," but a legitimate area of scientific inquiry with medical specialists, who have no axe to grind regarding abortion, working to figure this out. The impetus comes primarily from those engaged in fetal surgery as well as in the field of pain studies and fetal development. At present, there are those who believe it is possible that fetuses about 20 weeks' gestation might feel pain and those who believe it is not possible. Much of the speculation depends on how one defines pain, definitions that are themselves speculative.

We have concluded that it is possible but not probable that fetuses in the range of 20-26 weeks experience pain, and that even that possibility should lead us to act with caution and aim to diminish or eliminate possible fetal pain during abortion.

2. In spite of serious attempts to find out if fetal anesthesia represented any significant risk to women's health, we have been unable to get concrete responses to this question from experts. It has been indicated that the low number of cases in which fetal anesthesia has been administered makes it difficult to answer this question. Speculation runs in the direction of minimal risk, given the small amount of anesthesia used. Some fetal surgeons believe the anesthesia given the woman crosses the placental barrier; others disagree. Some fetal surgeons provide anesthesia for the fetus; others do not.

We support federally funded research into this matter for both fetal surgery and abortion.

3. In our experiences in the provision of abortion services, a significant number of women who had decided to have an abortion were interested in knowing about the fetus. They asked about fetal size, level of development and awareness and asked: "Will my fetus (or baby, the term we have heard women use most often) feel pain?"

4. We are guided by several values: first, the belief that women should be fully informed about all aspects of the abortion they are seeking and that informed consent means more than a description of the medical procedure and the risks and complications. It should include relevant biological, psychological and ethical information, which includes accurate information about the fetus. We believe women should be presented with the range of options for types of procedures and anesthesia, with the decision left to the woman. For example, while it is true that complication rates from abortion where women receive local anesthesia are lower than where general anesthesia is provided, we believe women should be given the information and the option.

We think informing women of the state of the medical discussion on fetal pain, the various opinions about this and allowing them to choose whether or not they want anesthesia for the fetus is consistent with our values regarding informed consent.

Our second commitment is to compassion and the alleviation of suffering and to abortion provision that is as physically and emotionally as painless as possible for all concerned. …