Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    Wednesday, August 24, 2005

    Fetal Feelings: Can a fetus feel pain? Today's JAMA says no, just in time to counter a bill that would require that doctors counsel women that performing an abortion may be painful to the fetus:

    Taking on one of the most highly charged questions in the abortion debate, a team of doctors has concluded that fetuses probably cannot feel pain in the first six months of gestation and therefore do not need anesthesia during abortions.

    Their report, being published Wednesday in The Journal of the American Medical Association, is based on a review of several hundred scientific papers, and it says that nerve connections in the brain are unlikely to have developed enough for the fetus to feel pain before 29 weeks.

    The finding poses a direct challenge to proposed federal and state laws that would compel doctors to tell women having abortions at 20 weeks or later that their fetuses can feel pain and to offer them anesthesia specifically for the fetus.

    Whether or not an abortion is painful to the fetus hardly matters, it certainly is harmful to it. And offering anesthesia seems misguided as well. Kind of like requiring anesthesia before an execution. Are we to believe that anyone involved in the abortion process cares enough about the fetus to prevent it from feeling pain? But then, that's probably the purpose of the legislation - to get women to think about the life they're carrying before they toss it aside.

    The truth of the matter is, no one knows when a fetus first feels pain. The authors are just making a guess, based on their reading of other people's research. (According to the abstract, the cornerstone of their argument is that there's no EEG evidence of pain recognition in a fetus. Which raises the question - how do you do an EEG on a fetus?) Unfortunately, the authors of the paper have an agenda, as do the legislators whose bill they oppose:

    Dr. Eleanor A. Drey, one of Dr. Rosen's co-authors, said that as an obstetrician who sometimes performs abortions, she would find it troubling to be compelled to bring up the subject of fetal pain with her patients.

    "I would be forced to drag them through potentially a lot of misinformation," she said. "Our systematic review has shown it's extremely unlikely that pain exists at a point when abortions are done. I'm going to have to talk about something I know will cause the patient distress, something that by our best assessment of the scientific data is not relevant."

    But Dr. Rosen acknowledged that it is impossible to say with 100 percent certainty that there is never pain before 29 weeks.

    But, there is some fairly compelling evidence that a fetus does feel pain in that 23-29 week window:

    Dr. K.S. Anand, a pediatrician at the University of Arkansas for Medical Sciences, said: "There is circumstantial evidence to suggest that pain occurs in the fetus."

    For example, he said, tiny premature babies, as young as 23 or 24 weeks, cry when their heels are stuck for blood tests and quickly become conditioned to cry whenever anyone comes near their feet."In the first trimester there is very likely no pain perception," Dr. Anand said. "By the second trimester, all bets are off and I would argue that in the absence of absolute proof we should give the fetus the benefit of the doubt if we are going to call ourselves compassionate and humane physicians."

    Whether or not a fetus feels pain depends, apparently, on whether the observer views the fetus as a patient or as a disease.

    posted by sydney on 8/24/2005 07:14:00 AM 0 comments


    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006