November 1996

Contents

3 The Abortion Awakening

5 Does The Fetus Feel Pain?

6 Fetal Sentience.
        All Party Parliamentary Pro-life Group

13 The Christian Doctor in Practise: How Does
        The Politician Help? - Michael Ancram MP

19 Statement by Mrs. Elizabeth Peacock MP

21 A Fresh Look At Courage - Fr John Harvey

23 Sex Education And Behaviour Modification -
        Helen Davies

25 Old Frog Opines

27 Tadpole Observes

28 Dr Ernest Intention: Flying Alone?

29 You May Have Missed

31 Correspondence with the Chief Medical Officer

32 Letters to the Editor

34 Video Review

35 Book Reviews

 

 

 

DOES THE FETUS FEEL PAIN ?

 

Interest in this problem has arisen from a questionnaire recently submitted to 151 members of the Association of Paediatric Anaesthetists of Great Britain and Ireland asking them whether they thought newborn infants of less than 1 week of age, neonates aged 1 week to 1 month, and infants of less than 60 weeks post conceptual age who were delivered preterm (before 37 weeks) were able to feel pain.(1) It was designed to allow comparison with a similar survey conducted in 1988. In that survey eight (13%) respondents thought that newborn infants and four respondents (7%) that neonates did not feel pain. Fourteen (23%) in 1988 were undecided. In contrast the new survey reveals that all the anaesthetists believe that the newborn suffer pain and nine out of ten always or usually use systemic opioids when newborn infants are having major surgery. Such a remarkable change of opinion has created a poignant background to the question of whether the fetus can feel pain.

The received opinion of the Department of Health, based on a paper by Fitzgerald which reviewed the biological development of the fetus, ruled out the possibility of a fetus experiencing pain before 26 weeks of gestation.(2) The recorded responses to stimulation before 26 weeks were described as reflex, not dependent on conscious appreciation. It is assumed that reflexes provoked by tactile stimulation or light pressure are not pain sensitive. Another commonly held view is that, as the cortex is not developed, how is it possible for pain to be experienced?

Such opinions are seriously and effectively challenged in the paper included in this issue based on the work of Peter McCullagh and others, including members of the Guild.

The International Association for the Study of Pain defines pain as 'an unpleasant emotional experience associated with actual or potential tissue damage'. This is fine, points out Dr. McCullagh, when it is applied to a communicative human subject with a good vocabulary. But how is the emotional context of 'pain' in a young animal to be evaluated? Is pain, as defined by the IASP, to be restricted only to those species in which we know something about the emotional accompaniment? It seems improbable, and is certainly unknowable, whether a new- born kitten that has been injured has the experiential and emotional accompaniment that influences pain perception in a mature human subject. Nevertheless, there is widespread belief in the community that to inflict injury on the kitten is wrong. (3)

Again, observed human fetal avoidance responses are often dismissed as withdrawal reflexes only because of the assumption that mature cortical function is essential for sentience. Yet opinions concerning the extent (if any) of cortical development required for the awareness of unpleasant sensations represent conjecture. There are abundant indications that individuals with grossly disrupted cortical development can experience pain.

References:

  1. Jonathan de Lima et al., Infant and neonatal pain: anaesthetists' perceptions and prescribing pattern, BMJ, 313, 28/9/96.
  2. Fitzgerald M. for the Department of Health, Fetal pain: an update of scientific knowledge, London: DoH, 1995.
  3. McCullagh P., Determining fetal sentience, Hospital Update, January 1996.

 

 

Fetal Sentience.
The Medical and Scientific Advisory Group
to the
All Party Parliamentary Pro-life Group

 

"A fisherman once told me that fish have neither sense nor sensation. But how did he know this?  He could not tell me"
Bertrand Russell: - Human knowledge: Its scope and limitations

 

This publication can be obtained from SPUC, 5/6 St Matthew St, Westminster, London, SW1P 2JT.   Tel No: (44) 171 222 5845.  Fax No: (44) 171 222 0630

 

 

Letters exchanged between
The Guild of Catholic Doctors,
Muslim Doctors and Dentists Association,
The Christian Medical Fellowship
and
The Chief Medical Officer

 

29th May 1996
To:
Sir Kenneth Calman. C.M.O.
Department of Health Richmond House
79 Whitehall,
London,
SWIA 2NS
ABORTION ACT 1967 CONSCIENCE CLAUSE
Dear Sir Kenneth
We write to seek formal clarification that the Department of Health Guidelines on duties concerning the performance of an abortion whilst in training will apply to the new specialist registrar grade.
The guidelines were clear in that there could be no requirement upon any doctors in training to participate in the performance of an abortion. We consider this to be a very important matter, not only for the profession, but also for the public.
A number of women are beginning to request that the management of their pregnancy is undertaken by doctors not involved in abortions. In spite of the House of Commons Social Services Select Committee Report of 1989-90 on the working of the Conscience Clause of the 1967 Act, it remains difficult for doctors who do not perform abortions to be appointed to permanent posts in Obstetrics and Gynaecology.
It has even come to our attention that advice has been given to a candidate for the MRCOG examination to the effect that they need to have performed abortions. We know this to be mistaken but nevertheless, it is a disincentive. We are also aware that there are many unfilled consultant posts in Obstetrics and Gynaecology at present.
We hold that the profession must be open to all suitably qualified persons whatsoever their moral tradition, and that as such it would be in the best position to meet the needs of a plural society.
Yours sincerely

 

Signed by:
Dr.A.P.Cole, Master Guild of Catholic Doctors
Dr.J.Qureshi, Founder President, Muslim Doctors and Dentists Association.
Dr.M.Hodson, Chairman, Christian Medical Fellowship.

 

Reply:
Our Ref. PO Jkr 96/184

Dr A P Cole and others.

 

21 June 1996

Dear Dr Cole,

Thank you for your letter, received on 29 May, regarding the Abortion Act 1967 and the reforms to specialist medical training.

As you will know, Section 4 of the Act provides that, except where the treatment is necessary to save the life of or prevent grave permanent injury to the pregnant woman, no person shall be under any duty to participate in any treatment authorised by the Act to which he or she has a conscientious objection. The provisions in Section 4 of the Act will, of course, apply to doctors in the new Specialist Registrar grade.

If medical staff have strong ethical or moral objections to participating in treatment for termination of pregnancy, we consider it right that they should not be obliged to participate in such procedures. Nor should conscientious objection be detrimental to their career and appointments.

 

signed:

SIR KENNETH CALMAN Chief Medical Officer