Abortion time limits
A briefing paper from the BMA
May 2005
Part two - Factors influencing views on abortion time limits
Fetal pain
As with fetal viability, some people believe that there is moral significance associated with when a fetus can “feel pain” and this has an impact on how the fetus is perceived in relation to the debate on abortion. Others believe that even if a fetus does not have moral status, it should nonetheless be protected from pain in any abortion or therapeutic procedure undertaken.
At what point does a fetus experience pain?
The International Association for the Study of Pain defines pain as 'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.' [Go to reference 52] Whether, and at what stage, a fetus experiences pain, and whether this will ever be determinable, have been the subject of much debate. [Go to reference 53] Some argue that there are defined points during the development of the fetus when it acquires the physical structures to experiences pain and therefore it may experience pain from this point onwards. Others argue that the experience of pain is not just about biological development [Go to reference 54]. but is also about factors acquired after birth, when certain coordinated cognitive faculties are in place and are exposed to the external environment; only then can a baby begin to 'experience' and make sense of 'pain'. For example, Fitzgerald reported to the Department of Health in 1995 '…true pain experience [develops] postnatally along with memory, anxiety and other cognitive brain functions'. [Go to reference 55] Some go as far as to suggest that pain is not experienced until approximately 12 months of age. [Go to reference 56].
Interpretation of the evidence on fetal pain is conflicting, with some arguing that the fetus has the potential to experience pain at ten weeks’ gestation, [Go to reference 57] others arguing that this stage is not reached until 26 weeks’ gestation (see below) and still others arguing for some unspecified gestational period in between, [Go to references 58,69,60] for example 17 weeks. [Go to reference 61] It has been argued, however, that those who adopt a stage early in fetal development confuse the notion of pain – as an experience – with reflex or hormonal 'stress' responses. [Go to reference 62] The Royal College of Obstetricians and Gynaecologists, following a detailed review of the evidence, argued that there is no possibility of fetal awareness before 26 weeks:
'It is possible by direct means to identify the minimum stage of structural development that is necessary – but not that which is sufficient – to confer awareness upon the developing fetus. This minimum stage of development, with structural integration of peripheral nerves, spinal cord, brain stem, thalamus and, finally, the cerebral cortex, has not begun before 26 weeks’ gestation.' [Go to reference 63].
Although debate continues about whether, and if so when, the fetus can experience pain, current mainstream professional guidance suggests that a fetus cannot begin to have the possibility of experiencing pain until after 26 weeks’ gestation. This view is reflected in practical guidance on the use of analgesia during invasive procedures carried out on the fetus in utero. [Go to reference 64] The BMA’s view is that even if there is no incontrovertible evidence that fetuses experience pain, the use of pain relief, when carrying out invasive procedures, may help to relieve the anxiety of the parents and of health professionals. [Go to reference 65]
Public perceptions of fetal experiences
Confusion about the ability of the fetus to experience pain and to experience 'human' emotions has been exacerbated by media coverage in the summer of 2004 of the newly developed 4D scanner. The equipment produces detailed 3D/4D images showing fetuses apparently exhibiting behaviours such as yawning at 18 weeks, and smiling, blinking and crying at 26 weeks, [Go to reference 66]behaviours that could be interpreted as being associated with human emotional responses. Deborah Kirklin has pointed out that although not immediately apparent when viewing these clips, they are, in fact, video loops, with the same movements shown again and again. Thus, she says the 'waving' fetus is an illusion created by showing the movement of the fetus’ arm, from left to right across its body over and over again. [Go to reference 67] The powerful effect of these images, however, was to highlight the discomfort many people felt about terminating an entity which is so clearly recognisable as having human characteristics.