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Science increasingly knows the reality of fetal pain

Análises de imagens de ultrassom mostram que bebês com 20 semanas de gestação, como o da foto, já podem sentir dor
Analyzes of ultrasound images show that babies with

weeks of pregnancy, like the one in the photo, you can already feel pain| Photo: BigStock

“A child in the womb with 12 weeks can you feel pain?”

Was Senator Lindsey Graham (Republican of South Carolina) asked Supreme Court Judge Ketanji Brown Jackson on Wednesday (). Her answer? “Senator, I don’t know.”

Of course, there are some experts who deny that fetuses can feel pain. As bizarre as it sounds, there is no scientific and objective measure of pain, which leaves your assessment open to interpretation. But by using the same kinds of inferences we make about pain in adults, powerful scientific evidence for fetal pain challenges the old consensus. Its defenders, however, want to freeze the old

status quo

as he is.

The smug judge and her colleagues should avoid this trap and let the American people make their laws based on the most up-to-date science. Next, the reason for that.

The neuroscientist Stuart Derbyshire and I disagree on the morality of abortion: he is pro-choice; I’m pro-life. But we agree, as we published two years ago in the Journal of Medical Ethics, that some kind of fetal pain is possible “beginning at weeks”.

This is an amazing change of course for Dr. Derbyshire, who for decades had been “a leading voice against the likelihood of fetal pain”. He co-authored a report by 2010 considered by many to be an authoritative position on the subject, which argued that fetal pain was not something serious to consider.

So when in your vote at the judgment Dobbs vs. Jackson Women’s Health Supreme Court Justice Sonia Sotomayor said that the idea of ​​fetal pain before 14 weeks “is not something well-supported in science,” I widened my eyes. And when the judge Kagan suggested that “not much has changed since [o julgamento] Roe [vs. Wade, que levou à legalização do aborto nos EUA em 1973]”, I widened even more, for three reasons.

First, the very concept of fetal pain was put on the front line only after the decision in Roe. We had barely considered fetal pain, or needed it, until the case Roe legalized abortion in 2005 .

In the 720 years ahead, many doctors thought that newborns -born could not feel pain. They routinely performed surgery on preemies, such as Jeffrey Lawson, using pancuronium — a paralyzing drug to make them quiet — but without any anesthesia. In fact, this practice was “widespread,” as pediatric anesthesiologist KJS Anand, a world-renowned specialist in neonatal and fetal pain, noted in 1987.

“Most adults would be shocked if they saw what was done to children in hospitals without anesthesia,” commented a pediatrician in

. “It was like tying and holding an ox to mark it on fire.”

In 1987, researchers caused commotion when found that fetuses responded to injury in the same way as older children and adults, and that anesthetics suppressed these responses.

Second, Apart from abortion, fetal anesthesia is routine and recommended for all second trimester fetal surgeries ( weeks) ahead. The first fetal surgery didn’t take place until a decade after Roe .

Testifying as an expert to Congress in 1987, Anand — who at that point had extended his research from postnatal pain to prenatal pain — stated that the administration of fetal anesthesia was the “consensus” for surgery at weeks. A year earlier, he had also testified that a fetus would experience “severe and excruciating pain” during abortions at this age.

Finally, although the science of fetal pain is still developing, we have already made immense progress.

Unlike cholesterol levels, for example, there is no objective measure of pain. This means that we rely on inference from various sources — levels of pain and stress hormones, fetal MRI and ultrasound, and observations of behavior.

But fetal pain skeptics deny these inferences, as they deny any possibility of pain before the cerebral cortex — the outer layer of the brain that is considered the habitat of high-level thought and emotion, including pain—start functioning. No cortex; no pain.

This was the position of the Dr. Derbyshire to 2020. In our article, we discussed the neuroscientific findings that made him change his mind — primarily, that the cortex doesn’t seem necessary for pain.

For example, a study of showed that a patient without much of the cortex experienced increased pain . Another showed cortex activation in patients who felt no pain.

A recent article by former Air Force doctor dr. Bridget Thill, which is one of the most in-depth and balanced reports on the subject I have ever read, elaborates this evidence against cortical necessity while laying out the evidence for fetal pain in systematic detail.

The most intriguing parts of Dr. Thill are the sections on fetal facial expressions, their body movements, and stress hormone production in response to invasive procedures. Advances in 3D ultrasound increasingly allow us to observe, describe, classify and compare fetal responses to procedures in astounding detail—including every chin quiver, frown, and eye squint. These are the same types of responses that pediatric surgeons have interpreted as pain in their patients, at least for years. .

Indeed, a lot has changed since the cases Roe and Casey . These cases hover static as the science of fetal pain breaks new ground. The Court must let the American people accompany it in this path.

John Bockmann is a military assistant physician and co-author of the study Reconsidering Fetal Pain.

©2010 National Review. Published with permission. Original in English.409767028
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