Fetuses don't feel pain until late in pregnancy, researchers claim

CHICAGO -- U.S. Sen. Sam Brownback thinks discussing fetal pain is one way to curb abortions without making them illegal -- even in light of a new medical review that says brains are too immature to feel pain until late in pregnancy.

The Kansas Republican is sponsoring legislation pending in Congress that would require doctors to provide fetal pain information to women seeking abortions when fetuses are at least 20 weeks old, and to offer women fetal anesthesia at that stage of the pregnancy.

"I'm pro-life and if a woman decides not to abort her fetus with this information, that would certainly be fine by me," said Brownback, who has been named as a potential 2008 presidential candidate.

A handful of states have enacted or are considering similar measures, but University of California, San Francisco researchers who reviewed dozens of medical articles say those efforts and Brownback's are misguided and might even subject women to potentially dangerous health risks from anesthesia.

Hearings have yet to be scheduled on Brownback's measure, and though he said he's willing to open the topic for "a robust debate," he argued that the review "seems to me to fly in the face of common experience and common sense."

The review says medical evidence shows that brain structures involved in feeling pain begin forming earlier, but likely do not function until around the seventh month, when fetuses are about 28 weeks old.

Some scientists say younger fetuses show pain by moving away from a stimulus, but that likely is a reflex action and not an indication that they are actually feeling pain, said UCSF obstetric anesthesiologist Dr. Mark Rosen, the study's senior author.

Based on the evidence, "discussions of fetal pain for abortions performed before the end of the second trimester should be noncompulsory," the report said.

It appears in Wednesday's Journal of the American Medical Association.

Critics angrily disputed the findings, noted that a co-author runs a UCSF abortion clinic, and claimed the report is biased.

"They have literally stuck their hands into a hornet's nest," said Dr. Kanwaljeet Anand, a fetal pain researcher at the University of Arkansas for Medical Sciences, who believes fetuses as young as 20 weeks old feel pain. "This is going to inflame a lot of scientists who are very, very concerned and are far more knowledgeable in this area than the authors appear to be. This is not the last word -- definitely not."

Dr. Nancy Chescheir, chairman of obstetrics and gynecology at Vanderbilt University and a board director at the Society of Maternal-Fetal Medicine, said "it's an important article that can be used in a rational discussion" about the proposed federal legislation.

Dr. Catherine DeAngelis, JAMA's editor-in-chief, said the decision to publish the review was not politically motivated.

"Oh, please," DeAngelis said. "If I had a political agenda, I wouldn't pick fetal pain."

JAMA does not publish "politically motivated science. We publish data-based, evidence-based science," DeAngelis said.

The measure pending in Congress would affect about 18,000 U.S. abortions a year performed in the fifth month of pregnancy or later, said Douglas Johnson, legislative director of the National Right to Life Committee. He said the review is slanted, but Rosen disagreed.

"We tried to review the literature in an unbiased fashion. This was a multidisciplinary effort by experts on anesthesia, neuroanatomy, obstetrics and neonatal development," Rosen said.

When doctors operate on fetuses to correct defects before birth, general anesthesia is given to the mother primarily to immobilize the fetus and to make the uterus relax, Rosen said. Anesthesia during fetal surgery increases the mother's risks for breathing problems and bleeding from a relaxed uterus, the researchers said.

Rosen said those risks are medically acceptable when the goal is to save the fetus but there's not enough evidence to show any benefit from fetus-directed anesthesia during an abortion.

Administering anesthesia directly to the fetus also is sometimes done, but generally to reduce the release of potentially harmful fetal stress hormones, Rosen said. There is little research on its effects, the authors said.

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