Fetal awareness and fetal pain: the Emperor's new clothes
- Correspondence to Dr Martin Ward Platt, Newcastle Neonatal Service, Ward 35, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK;
- Accepted 5 January 2011
- Published Online First 3 February 2011
In June 2010, the Royal College of Obstetricians and Gynaecologists (RCOG) published Fetal Awareness – Review of Research and Recommendations for Practice.1 The College's purpose was to update their 1997 publication2 in the light of more recent evidence, and also to provide “information for women and parents”. Although they use the term ‘fetal awareness’, both publications predominantly address the issue of whether or not the fetus feels pain, and at what gestational ages this might be so. The conclusions of the summary of the evidence review are set out in box 1, and the main practice points derived from this are set out in box 2. The report caused a considerable furore in the media, where it was widely portrayed as being a political rather than a scientific document that aimed to shore up the pre-existing position of the RCOG rather than to take a dispassionate view of the scientific evidence. I do not intend to take on the political dimension, but it is worth re-examining some of the science.
The core of the scientific argument in the document can be summarised thus:
▶ The fetus is rendered unconscious during intrauterine life by endogenous substances.
▶ And the fetus at under 24 weeks does not have the neuroanatomical apparatus that would allow pain perception at a cortical level.
▶ Therefore the fetus is neither aware, nor can feel pain, under 24 weeks.
Let us first take the issue of awareness, bearing in mind that the report states: “There is increasing evidence that the fetus never experiences a state of true wakefulness in utero and is kept, by the presence of its chemical environment, in a continuous sleep-like unconsciousness or sedation”. This is a far-reaching statement, since it implies that any research on the cognitive capacity of the …