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JAMA Conflict of interest possible in report on fetal sensations



Published: Wed, August 24, 2005 @ 12:00 a.m.



One of the article's authors is the medical director of an abortion clinic.

KNIGHT RIDDER NEWSPAPERS

PHILADELPHIA -- Is a fetus capable of feeling pain, and if so, should fetal pain be treated during an abortion?

In today's Journal of the American Medical Association, five researchers from the University of California, San Francisco review 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.

But their seven-page article has a weakness: It does not mention that one author is an abortion clinic director, while the lead author -- a medical student -- once worked for NARAL Pro-Choice America.

JAMA editor-in-chief Catherine D. DeAngelis said she was unaware of this and acknowledged it might create an appearance of bias that 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.

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

Challenging question

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 -- conclude that the fetus cannot perceive pain until 29 or 30 weeks of pregnancy. 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.

Since no one can remember being a fetus or get into the mind of a fetus, 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 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 point out that a fetus will reflexively pull away from a surgical instrument -- but so will an infant born without a brain or a person in a persistent vegetative state.

Related legislation

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.

About 1.4 percent, or 18,000, of the 1.3 million U.S. abortions are performed this late in pregnancy. (Most states ban abortion when the fetus can survive outside the womb, about 24 weeks' gestation.)

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."




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