A Pain Too Awful to Imagine

Last fall, many Canadians were shocked to learn that pregnant women from Quebec, Ontario and British Columbia were sent to abortion clinics in the United States for late-term abortions. Some provinces define “late-term” as over 20 weeks and other provinces as over 24 weeks. According to Statistics Canada, a further 246 late-term abortions (between 21 and 40 weeks gestation) were performed in Canada in 2001. Even though there is no limit in Canada after which abortions may not be performed, it seems that some physicians are not willing to perform abortions after 20 weeks gestation. A September 2004 article in Le Devoir announced that late-term abortions will soon be available in Quebec since a specialist is presently being trained to perform abortions on pregnant women over 23 weeks gestation. Cathy Rouleau, spokesperson for the Quebec Minister of Health, announced that a physician should be trained and available in a year or two. This should reduce the number of women traveling to the United States for abortions.

Any discussion of late-term abortion should include the reality that the fetus feels pain by 20 weeks gestation and maybe even before 20 weeks. For this reason, we are reprinting portions of an article on fetal pain by Dr. Paul Ranalli. This article first appeared in the April 2004 issue of the National Right to Life News. Even though some of the information refers to events in the United States, the information on fetal pain is extremely important for us to consider in any discussion regarding late-term abortions in Canada.

By Paul Ranalli, M.D.

The evidence on fetal pain perception has been building for the past 20 years. Pain receptors first appear in the skin of an unborn baby's face at just eight weeks gestation and have gradually covered the body several weeks later. Pain signals are sent from the receptors back along nerves to the spinal cord and then up to the brain's pain relay station, the thalamus, a connection that is fully wired by 14 weeks.

The final connection from the deeply-located thalamus up to the cerebral cortex on the brain's surface (where the baby is made aware of pain) is fully wired by 20 weeks. This is the time in pregnancy - - the exact half-way point - - when scientists have solid evidence of a fully-connected pain system.
While critics have contended that a fetus at this stage does not possess the consciousness necessary to be aware of pain, at 20 weeks the fetus has the full complement of neurons present in adulthood. Brain waves can be recorded at 20 weeks by a standard electroencephalogram (EEG). These findings were reviewed in Dr. K. S. Anand's landmark 1987 article, "Pain and its effects on the human neonate and fetus," in the New England Journal of Medicine. Dr. Anand is the world’s foremost authority on research into pain perception in the fetus and newborn child.

And the unborn might feel pain even earlier. It has been known since the late 1980s that blood circulation in the fetal brain changes in response to pain (just as it does in an adult) as early as 16 weeks gestation.

Then a 1994 British study startled the world with its finding that a painful procedure performed on an unborn baby as young as 18 weeks triggers a massive release of stress-related hormones - - just as it does in an adult. Dr. Vivette Glover, an English fetal pain researcher, told the BBC in 2000 that "between 17 and 26 weeks it is increasingly possible that it [the unborn] starts to feel something . . . I think the evidence is that the system is starting to form by 20 weeks, maybe by 17 weeks." The latest research has focused on internal pain chemicals called Enkephlin and Substance P, which have been detected in the fetal brain at 13 and 11 weeks, respectively.

Judge Richard Casey of the Southern District of New York touched upon many of these details in the Order to dismiss the ACLU/National Abortion Federation(NAF) motion challenging the Partial Birth Abortion Ban Act in the U.S. He also mentions research pointing out that the second-trimester fetus not only feels pain but feels more pain than a full-term newborn, or an adult. He states, "At twenty to thirty weeks of gestation, a fetus has the highest density of pain receptors per square inch in human development."

A particularly weak aspect of the motion by ACLU/NAF and several abortion doctors to forbid Dr. Anand's testimony about fetal pain during the challenge to the Partial-Birht Abortion Ban Act was the attempt to categorize his evidence as insufficiently reliable. Judge Casey reviewed Dr. Anand's career as a Harvard and Oxford-trained Rhodes scholar whose "opinion on fetal pain is the product of his more than twenty years of work in the field and has not been prepared solely for this case." Judge Casey pointed out that Dr. Anand's work has been published in reputable scientific journals and publications, including numerous peer-reviewed journals.

The American abortion establishment is fighting a losing rearguard action on this subject. Their abortion-performing colleagues in Britain and France have already thrown in the towel on fetal pain, acknowledging its likelihood in many second-trimester abortions. England's Royal College of Obstetricians and Gynecologists first broached the subject with a Working Paper in 1997 that was conservative in its estimate of likely fetal pain at 24 weeks gestation. The Working Paper suggested that if abortions were to be done at this stage or beyond the least that could be done was to consider giving anaesthesia specifically for the doomed fetus.

By 1999 this had been updated in the British Journal of Obstetrics and Gynecology with the following statement: "Given the anatomical evidence, it is possible that the fetus can feel pain from 20 weeks and is caused distress by interventions from as early as 15 or 16 weeks."

If the average decent American citizen is repulsed by the thought of the excruciating pain an unborn baby must feel as the back of its skull is stabbed and pried open in a partial-birth abortion, what about the other methods performed on pain-sensitive unborn babies at, or just before, the same stage of gestation?

It does not take a medical expert to imagine the horror of suffocation (hysterotomy and extraction), scalding (saline induction), or being carved apart (dilation and curettage or dilitation and extraction) with the full capacity to feel every final moment.

Dr. Ranalli is a neurologist at the University of Toronto and an advisory board member of the deVeber Institute for Bioethics and Social Research. This article first appeared in the April 2004 issue of the National Right to Life News and is reprinted with permission.