Fetuses can feel pain

Editor—Derbyshire argues against the ability of fetuses to feel pain.¹ He states: “Good evidence exists that the biological system necessary for pain is intact and functional from 26 weeks.” He then adopts a definition of pain from the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” but concludes that pain is “a conscious experience” rather than “merely the response to noxious stimuli,” so a fetus cannot experience pain.

This is a specious argument. There are many examples of the ability of babies of this gestation to feel pain. In the first few moments after birth, even with extremely premature neonates (23-26 weeks), a noxious stimulus—for example, phlebotomy—can cause bradycardia, desaturation, and hypertension as a stress response. A neonatologist would seek to relieve this distress with analgesia, and a parent would seek to soothe. Also, as Derbyshire notes, fetal procedures (such as in utero chest drain placement) are increasingly being carried out with analgesia.²

Figure 1.

Credit: JIM STEVENSON/SPL

The problem lies with his definition of pain and the subsequent development of his argument. If a pregnant woman asks whether the fetus feels pain a conscious rationalisation is not necessarily implied. The Oxford English Dictionary instead describes pain as “a strongly unpleasant bodily sensation such as is produced by illness, injury or other harmful physical contact.”³ There is thus a gap between the definition Derbyshire has adopted and his patients' understanding of pain, resulting in ill-informed counselling or, worse (as he encourages in his conclusion), “avoiding a discussion of fetal pain with women.” His argument that fetuses cannot feel pain needs correcting.