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At What Point In Its Development Can a Human Being Feel Pain?

Jonathan Wells
Planned Parenthood
Photo credit: Fibonacci Blue / CC BY (https://creativecommons.org/licenses/by/2.0).

Editor’s note: See also Dr. Wells’s earlier article, “Why Should a Baby Live?

This is Part Two of a two-part series about abortion. This part focuses on the second question I raised in Part One: At what point in its development can a human being feel pain? I will attempt to answer the question scientifically, as a developmental biologist. By “scientific” I mean based on evidence, not on materialistic story-telling or the current “scientific consensus.” I will conclude with a brief personal reflection. 

The title of my first essay was “Why Should a Baby Live?” It was adapted from a 2012 article by Alberto Giubilini and Francesca Minerva, “After-birth abortion: why should the baby live?” That article cites a 1985 book co-authored by Peter Singer titled Should the Baby Live? Ten years before, Singer had published his seminal work, Animal Liberation. In that book he wrote: “The Darwinian revolution was genuinely revolutionary. Human beings now knew that they were not the special creation of God, made in the divine image and set apart from the animals; on the contrary, human beings came to realize that they were animals themselves.” (p. 214) Singer argued that animals, like humans, deserve protection because of their ability to suffer. The fact that they cannot speak is irrelevant. We cannot refuse “to attribute pain to those who do not have language… Human infants and young children are unable to use language. Are we to deny that a year-old child can suffer? If not, language cannot be crucial.” (p. 15) 

Giubilini and Minerva flipped the logic of the Catholic belief that “fetuses and newborns share the same moral status” to argue that because “abortion is largely accepted,” newborns (like fetuses) do not have a right to life. But I would flip Peter Singer’s logic: If we cannot deny that a year-old child can feel pain, how are we to deny that a fetus can feel pain? 

Logic isn’t a sufficient answer to the question I raised, however. For a scientific answer, we need evidence.

At What Point Can a Human Fetus Feel Pain?

If I gently poke a living cell in a Petri dish, it may recoil from the stimulus. But people don’t usually call that “pain.” Dictionary definitions differ, but they generally include (1) physical and emotional distress due to injury or disease; (2) mediation through nerve impulses to the brain; and (3) aversive action. Only the last of these is exhibited by the cell in the Petri dish.

If pain requires the transmission of nerve impulses to the brain, then a human embryo (up to eight weeks post-fertilization) probably cannot feel pain. (NOTE: I am not arguing that this justifies abortion before eight weeks, only that we cannot say that an embryo feels pain in the full sense of the word.) After eight weeks embryonic age (ten weeks gestational age), a developing human being is called a fetus. Unfortunately, it is not currently possible to establish the point at which the fetus can feel pain by working forward from the eight-week stage. So let’s start by working backwards.

From 1964 to 1998 I worked periodically as a clinical laboratory technologist. One of my responsibilities was to collect blood samples from two-to-three-day-old newborns. The samples were used to test for phenylketonuria (PKU), an inherited disorder that can occur in as many as 1 out of every 10,000 births. A baby with PKU cannot properly metabolize the amino acid phenylalanine, a necessary nutrient in the human diet. The result is a build-up of toxin that can lead to severe mental impairment, among other things. If PKU is detected early, however, the child can be fed a special diet that contains only the minimum amount of phenylalanine, and mental impairment can be prevented.

I would routinely collect a drop of blood from a newborn — even if it was premature — by sticking a small, sterile metal blade into its heel. That blood was used to test for PKU. Every time I did this, however, the newborn would scream at the top of his or her tiny lungs, and it would jerk spasmodically in the only aversive activity of which it was capable. I did it for the baby’s welfare, but clearly the baby felt pain.

According to a 2005 study, not even intravenously administered morphine can block the pain of a heel stick in premature newborns. A 2009 Italian study reported: “Scientific research in recent years has continued to confirm that neonates, especially when preterm, are more sensitive” to pain than older children. And a 2016 American study noted that “preterm infants have demonstrated an exaggerated acute response to pain” compared to babies born at full term.

So barring very rare neurological conditions, premature newborns can definitely feel pain. Let’s work backwards from there.

How Young Can a Human Be and Still Survive Premature Birth?

Recall from Part One that pregnancy is normally measured from the first day of the last menstrual period (gestational age). The gestational age at which a newborn has a 50 percent chance of surviving is called the “age of viability.” In 2015 this age was estimated to be 23 to 24 weeks in developed countries where good intensive care nurseries are available. (In less developed countries the age of viability was up to 34 weeks.) Thanks to technological improvements, in 2018 the age of viability was lowered to 22 to 23 weeks (gestational age). In other words, a fetus has a 50 percent chance of surviving by 20 weeks (fetal age).

I have seen no evidence that passage through the birth canal jumpstarts a human’s ability to perceive pain. So the available evidence clearly shows that a 20-week-old fetus can feel pain. Indeed, pain might be felt even earlier: Anesthesiologists who participate in fetal surgeries report that “a physiological fetal reaction to painful stimuli” occurs from 16 weeks (gestational age) on. But this is indirect evidence. By observing premature babies directly we know — as well as we know anything in science — that a fetus can feel pain by the time it is 20 weeks old (fetal age).

Abortion Incidence and Procedures — Before 16 Weeks

WARNING: What follows contains graphic descriptions that some people may find disturbing. Reader discretion is advised.

In 2019, the pro-abortion Guttmacher Institute published a report on the incidence of abortion in the United States in 2017. According to the report, abortions in the U.S. have declined in recent years (probably due to increased access to contraceptives), yet in 2017 an estimated 862,320 abortions were provided in clinical settings. (That’s a nationwide average of 2,363 per day, or one about every six minutes.) About 339,640 of these were “medication abortions.”

The “abortion pill” is actually two pills. The first, mifepristone, prevents the embryo from receiving any nourishment from the mother, and the embryo dies as a result. The second pill, misoprostol, is taken within 48 hours and induces contractions that expel the dead embryo from the mother’s uterus.

The U.S. Food and Drug Administration (FDA) is responsible for (among other things) testing medicines and approving or disapproving them for use in human beings. It approved mifepristone for obstetric use in humans in 2000. According to the U.S. National Institutes of Health, as of July 2020, the FDA had not officially approved misoprostol for abortions. Nevertheless, in 2016 the FDA announced that mifepristone “is approved, in a regimen with misoprostol, to end a pregnancy through 70 days gestation.” So misoprostol is widely used “off-label” along with mifepristone to induce abortion early in pregnancy. According to Planned Parenthood, the largest abortion provider in the U.S., the combination is more than 90 percent effective if used by the tenth week of gestation.

From the tenth week through the sixteenth week of gestation, abortions are commonly performed in-clinic by “dilatation and curettage,” or D&C. In this procedure the cervix is dilated (“dilatated”), and a thin tube connected to a suction device is inserted into the uterus. According to Planned Parenthood, “the pregnancy tissue” (a euphemism for the fetus and placenta) is then sucked out, and a surgical tool called a “curette” is used to scrape out any remaining parts.

Abortion Incidence and Procedures — After 16 Weeks

From the sixteenth week of gestation onward, abortions are commonly performed (again in-clinic) by “dilatation and evacuation,” or D&E. The fetus is now too big to be merely scraped and sucked out. Planned Parenthood describes a D&E as the “use [of] a combination of medical tools and a suction device to gently take the pregnancy tissue out of your uterus.” As above, “pregnancy tissue” is a euphemism for the fetus and placenta. And “gently” may apply to the experience of the mother, who is typically sedated or anesthetized during the procedure, but it certainly does not describe what is happening to the fetus. 

The “medical tools” used in a D&E include forceps such as a “Sopher clamp,” an instrument that is about a foot long and made of stainless steel. According to a doctor who used to perform D&Es, “At one end are located jaws about 2 inches long and about [half] an inch wide with rows of sharp ridges or teeth. This instrument is for grasping and crushing tissue.” After the mother’s cervix has been dilated, the person performing the abortion inserts the Sopher clamp into her uterus, grabs whatever part of the fetus is closest (often an arm or a leg), and pulls hard until it comes loose. The part is then removed or suctioned from the uterus, and the process is continued until all parts of the fetus have been taken out. The pieces are set aside so an inventory can determine whether all parts of the fetus have been evacuated.

In 2015, a controversy arose over Planned Parenthood’s practice of charging for aborted baby parts to be used in research. Critics claimed the practice violated federal law, while the organization claimed it was merely recovering costs and not making a profit. An undercover video made in 2014 showed two senior Planned Parenthood officials discussing the matter. When asked whether the method of abortion would be modified for babies who had been earmarked ahead of time for organ harvesting, one official suggested (at 6:10) that they might use “a less crunchy technique to get more whole specimens.”

According to the authors of a 2020 article titled “Reconsidering Fetal Pain,” a “D&E procedure… may involve fetal pain before fetal death.” Sometimes the fetus is killed first by lethal injection (“feticide”), but sometimes not. In a D&E, the authors wrote, “the fetus is removed in pieces via several surgical manoeuvres using grasping forceps… [F]etal death follows either direct feticide performed before the D&E or the trauma of the D&E results in the death of the fetus.” The authors did not propose banning D&Es, but they recommended using anesthesia beforehand.

A 2019 U.S. Centers for Disease Control study based on 2016 abortions in the U.S. concluded that 91.0 percent of abortions were performed up to 13 weeks’ gestation, 7.7 percent of abortions were performed at 14–20 weeks’ gestation, and 1.2 percent were performed after 21 weeks’ gestation. Applying those percentages to the Guttmacher Institute’s report on U.S. abortions in 2017, 14,659 fetuses older than 21 weeks were aborted that year, presumably by D&E. That’s an average of 28 per day, or more than one every hour.

A few years ago, Montana State Representative (and orthopedic surgeon) Albert Olszewski introduced legislation that would require doctors to give fetuses older than 20 weeks painkillers before aborting them. By the time it passed it had been amended to allow mothers to forgo fetal anesthesia if they gave informed consent. The bill never made it into law, however. Montana Governor Steve Bullock vetoed it.

In the debates before the bill was passed by the legislature the Washington Post reported that Montana State Representative Jenny Eck said: “I’m sorry if women’s bodies get in the way of some people’s political beliefs… I’m sorry that women have autonomy, self-determination and constitutional rights. But that’s the way it is. And until men can carry babies or artificial incubators can build babies, you’re stuck with that reality: that women have our own rights, our own lives, our own wills.” 

Apparently, for Representative Eck, those include the right to dismember an unborn human being who can feel pain.

Concluding Personal Reflection

There are reports that hundreds of babies have been born alive after failed abortion attempts. Two of the best-known cases involve Ana Rosa Rodriquez and Nik Hoot. Ana Rosa Rodriguez was born alive in New York in October 1991. She was a healthy little girl, except that she was missing her right arm. It had been torn off during a D&E that failed because her mother had gone into labor in the middle of the attempted abortion. The doctor who performed the procedure was subsequently convicted of violating a New York law that prohibited abortions after 24 weeks.

Nik Hoot was born alive in Russia on September 19, 1996. He, too, was a victim of a failed D&E. Before his premature birth at 24 weeks, his left foot and most of his right leg had been torn off, along with parts of his fingers on both hands. An American couple adopted him a year later. One of his parents later said: “Personal liberties are one thing, but not at the cost of physical damage and pain to another human which limits their ability to pursue life, liberty and happiness.” 

Amazingly, Nik overcame his partial dismemberment and became an inspiration to others. He eventually made the news as a varsity wrestler at an Indiana high school. With the help of prosthetic legs, he also played baseball, football, and basketball. In a televised interview in 2013, Nik said: “I knew that I was supposed to be an aborted baby and it failed. It makes me angry because I would never want for that to happen to any kid… I just look at myself as a miracle.”

That’s why a baby should live.