Is a fetus capable of feeling pain? If so, should fetal pain be treated during an abortion? Five researchers from the University of California...

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PHILADELPHIA — Is a fetus capable of feeling pain? If so, should fetal pain be treated during an abortion?

Five researchers from the University of California, San Francisco (UCSF) reviewed nearly 2,000 studies on the hotly debated question. They conclude that legislative proposals to allow fetal-pain relief during abortion are not justified by scientific evidence.

Their seven-page report in today’s Journal of the American Medical Association (JAMA) has a weakness, though: It does not mention that one author is the director of a clinic that provides abortion services, while the lead author — a medical student — once worked for NARAL Pro-Choice America.

“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. He 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.”

JAMA Editor-in-Chief Catherine DeAngelis said she was unaware of the apparent conflicts of interest, and acknowledged that an appearance of bias could hurt the journal’s credibility.

“This is the first I’ve heard about it,” she said. “We ask them to reveal any conflict of interest. I would have published” the disclosure if it had been made.

DeAngelis said the decision to publish the review was not politically motivated. “Oh, please,” she said. “If I had a political agenda, I wouldn’t pick fetal pain.”

“We thought it was critical to include an expert in abortion among the authors,” said UCSF obstetrician-gynecologist Eleanor Drey, medical director of the clinic at San Francisco General Hospital. “I think my presence … should not serve to politicize a scholarly report.”

Figuring out when fetuses — and even newborns — are in pain is not easy because the sensation involves both physical and mental processes.

“Until about 1987, the medical community thought newborns do not feel pain,” said anesthesiologist Sanjay Gupta, director of the Atlantic Pain and Wellness Institute at Lankenau Hospital in the Philadelphia area. “We were doing circumcisions and even heart surgeries without anesthesia.”

The UCSF authors — including a neuroscientist, a pediatrician and an anesthesiologist — concluded that the fetus cannot perceive pain until 29 or 30 weeks of gestation. That’s when pain-signaling nerve pathways from the spinal cord to the brain are fully wired.

But other experts — many of them anti-abortion activists — believe the fetus may feel pain as early as 13 weeks, when pain receptors are connected to a part of the brain that relays impulses, but not to the part responsible for processing sensory information.

Because no one can remember being a fetus or get into the mind of one, any judgment about fetal pain “will have to be inferred from evidence other than subjective experience,” Emory University bioethicist Michael Benetar wrote in a 2001 article that concluded that fetuses can feel pain around 28 weeks’ gestation.

Circumstantial evidence — such as fetal stress-hormone levels, or standard tests of brain-wave activity — is not conclusive.

The UCSF authors note that a fetus reflexively will pull away from a surgical instrument — but so will an infant born without a brain or a person in a persistent vegetative state.

Dr. Nancy Chescheir, chairman of obstetrics and gynecology at Vanderbilt University and a board director at the Society of Maternal-Fetal Medicine, said the article “will help to develop some consensus” on when fetuses feel pain. “To date, there hasn’t been any.”

Legislation proposed in Congress, the Unborn Child Pain Awareness Act, would require physicians to tell women seeking abortions 20 or more weeks after fertilization that the fetus may feel pain, and that they may opt for fetal pain treatment. A handful of states have enacted similar laws.

About 1.4 percent, or 18,000, of the 1.3 million annual U.S. abortions are performed this late in pregnancy. (Washington and most other states ban abortion when the fetus can survive outside the womb, about 24 weeks’ gestation, unless the mother’s life or health is at risk.)

Not all abortion-rights activists object to the proposed law. NARAL Pro-Choice America “does not intend to oppose” it, President Nancy Keenan said in a January statement, because “pro-choice Americans have always believed that women deserve access to all the information relevant to their reproductive-health decisions.”

But the UCSF researchers conclude that, even if the fetus can feel pain, offering anesthesia or analgesia is not justified because current techniques “provide unknown fetal benefit and may increase risks for the women.”

UCSF neuroscientist Henry Peter Ralston said he hopes the review will help legislators who are “trying to figure out whether we are causing pain at 12 or 13 weeks.”

“The evidence might at least sway their vote,” he said.

Not likely, said Douglas Johnson, legislative director of National Right to Life in Washington, D.C.

“If Congress wanted to know if lambs feel pain,” he said, “it wouldn’t ask the veal industry for an analysis of the scientific evidence.”

Comments by Anand, DeAngelis and Chescheir were reported by The Associated Press; information on Washington state law was provided by Seattle Times staff.