The Times Magazine had an interesting article on whether or not “preterm infants” can experience pain. “Experience” is the key word in that sentence:
In a series of clinical trials, he [Kanwaljeet Anand] demonstrated that operations performed under minimal or no anesthesia produced a “massive stress response” in newborn babies, releasing a flood of fight-or-flight hormones like adrenaline and cortisol. Potent anesthesia, he found, could significantly reduce this reaction. Babies who were put under during an operation had lower stress-hormone levels, more stable breathing and blood-sugar readings and fewer postoperative complications. Anesthesia even made them more likely to survive. Anand showed that when pain relief was provided during and after heart operations on newborns, the mortality rate dropped from around 25 percent to less than 10 percent. These were extraordinary results, and they helped change the way medicine is practiced. Today, adequate pain relief for even the youngest infants is the standard of care, and the treatment that so concerned Anand two decades ago would now be considered a violation of medical ethics.
But the benefits of pain relief weren’t limited to newborns. Anand eventually discovered that even extremely premature infants reacted to invasive medical procedures.
“So I said to myself, Could it be that this pain system is developed and functional before the baby is born?” he told me in the fall. It was not an abstract question: fetuses as well as newborns may now go under the knife. Once highly experimental, fetal surgery — to remove lung tumors, clear blocked urinary tracts, repair malformed diaphragms — is a frequent occurrence at a half-dozen fetal treatment centers around the country, and could soon become standard care for some conditions diagnosed prenatally like spina bifida. Whether the fetus feels pain is a question that matters to the doctor wielding the scalpel.
Obviously, the question of whether or not fetuses feel pain is a loaded political question: the existence of fetal pain is one of the more popular arguments used by abortion opponents. The article goes on to cite numerous scientists who disagree with Anand’s conclusions and argue that fetuses are simply exhibiting a “reflex,” and not actually experiencing pain.
The problem with debates like this is that the premise of the debate is fundamentally flawed. People are trying to transpose a binary political fight – you are either pro-life or pro-choice – onto a biological gradient. They are looking for black and white answers in the murky gray world of neuroscience. From the perspective of the brain, it’s pointless to try to define the single moment (or week or month) when babies begin to experience pain. There is no switch in the cortex that suddenly activates our nociceptive pathways. If cellular biology knows anything, it’s that life is a gradient. Our consciousness slowly accumulates. When we try to translate that gradient into definitive markers, when we attempt to say that experience begins here (or here or here), we ignore our biological reality. Yes, life is precious, sacred, etc., but this sacredness is an emergent property, which slowly unfolds over the course of a 9 month cellular cycle. These biological facts aren’t comfortable, and they go against many of our dearest intuitions, and neither side gets exactly what it wants, but unless we admit that the development of life doesn’t come with stark signposts, this tiresome debate is going to go on and on.