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Correspondence to Dr Stuart WG Derbyshire, Psychology, National University of Singapore, Singapore; [email protected]
Introduction
In 1983, President Ronald Reagan wrote an article in Human Life Review that (to our knowledge) first directly raised the possibility that the fetus can “respond to pain”.1 Subsequently, the possibility of fetal pain was raised in a review in the New England Journal of Medicine,2 an accompanying editorial,3 and a clinical trial examining the use of analgesia and anaesthesia for neonatal surgery.4 More recently, debate about fetal pain has become embroiled in discussions about abortion, and the possibility of fetal pain has been cited in several US laws aiming to restrict access to abortion.5
The two authors of this paper have very different views on the morality of abortion. One of us believes that abortion is necessary for women’s health and autonomy, while the other believes that abortion violates the ethical principle of non-maleficence and ought to be restricted and discouraged. Regardless of our stark differences on this question, we both believe that our moral views on abortion should not interfere with discussion of whether fetal pain is possible and whether the science of fetal development can rule out the possibility of fetal pain. We also agree that if fetal pain is likely then that has ethical and clinical significance independent of any views on the morality of abortion per se. That said, it is also clear to us that the issue of fetal pain has ethical significance because of abortion practices and not because of other surgical or therapeutic fetal procedures.
Worldwide, it is estimated that there are 56 million induced abortions each year, corresponding to 25% of all pregnancies.6 In high income countries with relatively liberal abortion laws, over 90% of all abortions take place before 13 weeks’ gestation.7 We argue that abortions before 13 weeks’ gestation do not involve any meaningful likelihood of pain for the fetus. Abortions after 13 weeks are typically either medical or surgical.8 Medical abortions involve a drug or drug combination provided to the patient to induce abortion. Today the drug combination is commonly mifepristone and misoprostol that do not kill the fetus. Fetal death follows either direct feticide (an injection of potassium...