Sunday, September 20, 2015

Can fetuses feel pain?



Several commentors have challenged my observation that fetuses can feel pain, probably before 10 weeks of gestation. There is actually no real debate about this: there are simply people who acknowledge the truth, and people who deny it.

Much ink has been spilled in the medical literature by scientists claiming that mature cortical development and connections are necessary for pain perception. According to the fetal pain deniers, children in the womb cannot experience pain until at least 26 (or so) weeks.

How can such an issue be resolved?

The obvious resolution is this: identify human beings who lack a cortex or who lack normal thalamocortical projections, and ascertain whether they can experience pain. "Knock out mice" are an example of the use of this strategy in determining gene function. We study the effects of the absence of a gene in deficient mice to understand the normal function of the gene.

To understand the normal experience of pain as a function of neuroanatomy and neurophysiology, we should similarly study pain reaction in human beings who lack a cortex or who lack normal thalamocortical projections.

Fetuses are one such subset of human beings--the fact is that they react violently to pain at very early stages of gestation, and efforts of 12-week gestation fetuses to withdraw from noxious stimuli are very well documented (Silent Scream). Ultrasounds of fetuses undergoing various stressful procedures show obvious reactions to pain--the fetuses open their mouths as if to scream, they withdraw violently from the stimulus, and sampling of fetal blood shows massive release of stress-related hormones.

But the evidence for pain experience in the absence of normal cortex or normal thalamocortical projections goes far beyond evidence from fetuses.

There are two kinds of birth defects that leave a person without any cortex at all: hydranencephaly and anencephaly. Patients with hydranencephaly completely lack a cerebral cortex and white matter.  The usual cause is a massive stroke during prenatal life. They are  left only with a diencephalon (thalamus) and a brainstem and cerebellum. Patients with anencephaly also completely lack a cerebral cortex and white matter.  The usual cause is a genetic abnormality that precludes normal brain formation. They too are  left only with a diencephalon (thalamus) and a brainstem and cerebellum. I've taken care of scores of patients with these handicaps over 30 years. Their survival after birth is limited. Many die after several months, some live into later childhood (my longest survivor is 10 years).

They all feel pain, despite having no cortex at all. When stuck with a needle or in any way given a painful stimulus, they scream, cry, withdraw, and exhibit intense discomfort. Their autonomic response is identical to that of people without handicaps--their heartbeat increases markedly, their breathing becomes fast and shallow, etc.

They feel pain as surely as you and I feel pain. In fact, my impression is that they feel pain more intensely than people without handicaps.

Furthermore, there are tens of millions of people with neurological disabilities that severely impair cortical function or impair thalamocortical connections. These disorders include lissencephaly, microencephaly, polymicrogyria, among others. These patients often have limited life expectancies, but they all experience pain and are all treated medically with full analgesic therapy--pain killers, local and general  anesthesia for surgery, etc.

Probably the largest group of people with markedly deficient corticothalamic projections are people with perventricular leukomalacia (PVL), which is one of the most common causes of cerebral palsy. Many people with PVL have massive global loss of cerebral white matter, which is the brain tissue that comprises connections between the thalamus and the cortex.

Yet people with cerebral palsy obviously experience pain. No one but a sadist would subject a child with cerebral palsy to surgery or other painful procedures without anesthesia. To do so would be worse than malpractice. It would be an actual prosecutable crime.

The claim by some pro-abortion doctors and scientists that lack of a mature cortex or thalamocortical projections precludes the experience of pain is a damnable lie.

Pain is experienced at a subcortical (probably thalamic) level. The cortex is necessary for the interpretation of pain, but is not necessary for the experience of pain. The traditional neuroscientific teaching holds true: pain enters awareness at the thalamus, not the cortex. There is massive evidence to support this: the daily experience of tens of millions of neurologically handicapped people, who experience pain in a very real way. 

The only reason this long-understood and uncontroversial fact about the neuroscience of pain perception has been tossed down the memory hole is that this scientific fact casts a bad light on our abortion industry. Ideology trumps science, and when science conflicts with pro-abortion ideology, science gets tossed aside.

Fetuses (once they have a thalamus, which is about 7 weeks) feel pain, just as surely as children with hydranencephaly and cerebral palsy feel pain. To kill a fetus by dismemberment in the womb is the moral equivalent of killing a child with cerebral palsy by dismemberment.

Fetuses feel pain, just as people with severe neurological handicaps feel pain. That the scientific and medical profession does not universally acknowledge this simple fact is disgusting and profoundly evil.

28 comments:

  1. It's not an established fact of neuroscience that an individual without a functioning cortex can feel pain. Individuals who insist that a foetus before 10 weeks gestation, well before the thalamocortical connections have developed, can feel pain are making spurious arguments to support their already formed opinion that abortion is wrong at all stages even immediately after conception, when the embryo consists of just a clump of cell.

    'The Silent Scream' was a dishonest film, with the foetus shown at normal speed prior to the abortion and then the ultrasound rapidly speeded up during the abortion. As a result normal background foetal movements just appeared to speed up with abortion. And foetuses tend to have their mouths open most of the time.

    There's no evidence that stimulation of the thalamus alone can cause conscious awareness of pain. Reflexes maybe, but not conscious awareness. There's a analogous phenomenon of blind sight, due to damage to the primary visual cortex. They have a functioning thalamus and lower cortical visual areas, but are consciously blind. However, they can manually pick objects of a given colour or shape when asked significantly more frequently than chance, despite not being aware of the objects.

    No cortex - no mind - no conscious awareness. The consensus amongst neuroscientists is still that foetuses before 24 weeks gestation can't feel pain, and some argue that it's 29 weeks. And neuroscientists aren't performing abortions. They're arguing on the basis of the science, not financial gain. Opponents of abortion are distorting the science in order to justify a religious opposition to all abortions.

    Agreed. Abortion shouldn't be encouraged. It should be the last resort, not the first resort as a form of birth control in effect. Readily available contraception and sex education in schools should prevent most unwanted pregnancies and hence abortions.

    Abortions should also be as early as possible. Certainly well before 20 weeks gestation.

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    1. bach:

      Patients with hydranencephaly and anencephaly (who have no cortex at all) obviously feel pain--I've taken care of them for 30 years, and I know very well how they react to pain. \

      Patients with PVL who lack thalamocortical projections obviously feel pain--they comprise a large portion of CP kids.

      Your denial that people with deficient cortices and deficient thalamocortical projections feel pain is unprofessional and borders on delusional.

      Do your ideological commitments matter so much to you that you need to lie about handicapped people, and denigrate their humanity?

      Delete
    2. Michael,

      I don't have any ideological commitment to abortion, beyond the belief that an individual has the right to decide what should happen to her body.

      A woman has the right to have an abortion, within limits. You don't have the right to ban her rights.

      You don't have any evidence that a foetus of 10 weeks gestation with a thalamus can feel pain. Comparing a foetus with just 10 weeks development to a postnate with at least 40 weeks development is just silly.

      I agree that babies with cerebral palsy, which by definition is mainly a motor condition, can feel pain. But they also have a functioning cortex. And they've also developed much more than a 10 week foetus.

      There's no evidence that the thalamus gives conscious awareness - the mind. No mind - no conscious awareness of pain - no suffering.

      Anyway. I'm retired. I don't have any interest in abortion, professional or otherwise. I just go along with the neuroscience consensus that a foetus before 24 weeks gestation is unable to feel pain.

      Delete
  2. Bachfiend: "Agreed. Abortion shouldn't be encouraged. It should be the last resort, not the first resort as a form of birth control in effect. Readily available contraception and sex education in schools should prevent most unwanted pregnancies and hence abortions."

    You and I are on the same page with this. But I wonder where Dr. Egnor stands on artificial birth control and progressive and early, non-judgmental, sex education? Two things that are known to reduce the rates of teen pregnancy. I wonder where he stands on the idea of giving teens access to birth control without requiring parental approval? Another practice that is known to reduce teen pregnancy.

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    1. Here's where I stand:

      Birth control is a human insecticide.

      It is a sin and a scourge on mankind. I would not outlaw it, because it cannot actually be stopped, it would engender massive disrespect for the law, and there are liberty issues. But B.C. is a very bad thing--the worst thing has happened in the West since 1960 is the pill. It will be, mark my words, the end of Western civilization.

      On sex education, that is a family's responsibility, not the schools'. There is no evidence whatsoever that sex education and bc lower rates of teen pregnancy--teen pregnancy skyrocketed during the 1960's and 1970's at exactly the same time that sex ed and bc were being pushed. Chastity and self-respect entail more than learning to put condoms on bananas.

      As far as providing kids with bc without parental approval, it is child abuse and should be a crime. If someone gave my underage kid that bc without my knowledge or consent, only my Christian ethics and waiting time for gun purchases would constrain me.

      Delete
    2. "There is no evidence whatsoever that sex education and bc lower rates of teen pregnancy--teen pregnancy skyrocketed during the 1960's and 1970's at exactly the same time that sex ed and bc were being pushed. Chastity and self-respect entail more than learning to put condoms on bananas."

      Don't you just hate it when the facts disagree with your hopes?

      http://www.guttmacher.org/pubs/gpr/17/3/gpr170315.html

      "As far as providing kids with bc without parental approval, it is child abuse and should be a crime."

      The age of consent in Canada, and most states, is 16. In Canada, any girl over 16 (and in some cases 14) can get the pill without parental consent. Anyone, at any age can get condoms. As well, Canada has a fairly progressive sex education curriculum relative to most states. Guess which country has a much lower teen pregnancy rate than the other.

      Somehow, I don't think that you would like to live here.

      Delete
  3. Steve12 here (really need to make an account):

    You can't say that a being experienced pain because it "looked like" they did. That's not science.It looks like my cat rubs it's nose against mine because it experiences love for me (sort of like you feel for Teddy Beale Michael). To state that as scientific conclusion is obviously absurd.

    Banana slugs move from noxious stimuli in a way that appears like it feels pain. Can I conclude that they do from that? Obviously not.

    Showing the intact neural architecture for some process is not evidence that it's experienced consciously.

    What is a stimulus w/o consiousness? You have to at least take a stab at this Michael. You can't just leave out a HUGE issue like that and then conclude:

    "They feel pain as surely as you and I feel pain."

    So are they conscious? Maybe the are. In science we have to show evidence, though, not simply ignore all the stuff we don't like.



    "They feel pain as surely as you and I feel pain."

    Is scientifically indefensible. Gleaning the experience from another being is famously tricky territoty

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    1. I see you really have trouble with Solipsism. Most people pass through that stage after the sophomore year of high school. It seems you're stuck in it.

      How can you be sure that anything other than yourself actually exists? How can you be sure that other people are not meat robots without consciousness at all?

      The only insight we have into the external world and the people in it is behavior. We have no direct access to their subjective experience.

      If you really believe that a handicapped child screaming when she is given a needle injection isn't having pain, then you are just beneath contempt.

      Delete
  4. Steve12 here....

    So inquiring about your proposed linkage of neural architecture X to conscious experience IN YOUR OWN CLAIM that the mere existence of said neural architecture = conscious experience is either (a) surrendering to solipsism and/or (b) cruelty toward the handicapped? Really?

    Please try harder. This sort of confused "argument" is too boring to continue on with. For some reason I actually expect more out of you....


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    1. @Steve:

      [is either (a) surrendering to solipsism and/or (b) cruelty toward the handicapped? Really?]

      Its actually both a moronic philosophical error (solipsism) and egregious cruelty (denial that handicapped people with malformed cortices or deficient thalamocortical radiations feel pain).

      The "neuronal architecture" of consciousness is not well understood, and there is no reason to think it ever will be.

      There is no reason whatsoever to think that a simple insect or animal doesn't have some kind of awareness--the notion that lower forms of life are machines without subjective experience is one of Descartes' more egregious mistakes, and is not taken seriously by anyone with any sense today.

      The denial that we can know that other people feel pain when they act like they feel pain is a moronic philosophical error and revolting cruelty.

      I assure you, Steve12, that handicapped people feel pain, as do children in the womb who have a modicum of neural development (certainly beyond 10 weeks, probably beyond 7 weeks).

      Your denial that 'inferior' humans don't really feel pain but just act like it is something that sounded more convincing in the original German.

      Delete
  5. steve12 here...

    Trying to cast a legitimate scientific Q re: a claim about consciousness (from a cognitive neuroscientist who specialized in this sort of thing, no less) as Nazi-sim. Wow.

    You realize that other people can read this, right?

    In all seriousness, if I were you I would ban me and delete all of this.

    Between your defense of Beale to your portraying my fair questions as Nazism, you come off looking really bad in all of this Michael.

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    1. "A cognitive neuroscientist who specialized in this sort of thing" who hasn't gotten past solipsism and who denies that handicapped people and children in the womb feel pain is a pitiful thing, and dangerous too.

      Fully half of the medical and scientific profession in Germany were enthusiastic Nazis--the most Nazified segment of German society. Denial of the full humanity of other people, and bizarre philosophical delusions about the nature of reality, was endemic in the Reich.

      It's interesting to see it emerging with gusto in 21st century America. I always did think that the Nazis weren't really completely defeated, they were just laying low until they had a chance again.

      ME

      ME

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  6. Steve12 here:

    You wonder why I sound like Dr. Phil! The guy who embraces the White Nationalist who defends acid attacks on women calls OTHER people Nazis.

    I don't like the Nazi comparisons. It's dismissive of the actual Holocaust. You're not a Nazi. Beale is more clown than Nazi.

    You, however, can't get enough of the Nazi comparisons. When you embrace the kind of ugliness that you do, you need to try and lower others so you don't look quite so bad.

    Come on Michael - I'm not the first person telling you that there's some psychological issues going on here! Everyone's a Nazi but you push the book of an open racist like Beale?

    Hello!?!

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    1. [I don't like the Nazi comparisons.]

      Understandably. People who deny that handicapped people feel pain are generally quite uncomfortable when the topic of Nazism is broached.

      Delete
    2. [Everyone's a Nazi...]

      You're not a Nazi, Steve. You lack the stamina.

      But your ideas are the conceptual dung from which Nazism arose.

      Delete
  7. Call me a Nazi all you want. It just makes you look small and absurd.

    And stamina? Ha - if you only knew me....

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  8. Michael, here is a hypothetical for you. You are in a hospital and there is s fire that threatens two units. There is one baby in one unit and thirty babies in the other. You only have one fire extinguisher and can only save the baby(s) in one of the units, with the knowing certainty that the baby(s) in the other will die. Which fire do you put out?

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    1. Actually, I prefer the hypothetical about the fire and the adult and the refrigerator full of human embryos.

      I'd save the adult, unless it was the guy who asked me this hypothetical.

      Delete
    2. I NOTICED notice that you changed the term from baby to adult. Why is that? To distance your use of the word "baby" when referring to embryos, or blastocysts, that are aborted?

      I also noticed that you didn't respond to me when I provided you with research refuting your claim that access to birth control and progressive sex education does not reduce teen pregnancy. Why is that? Still trying to find a paper (or white supremacist) who agrees with you?

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    3. [I also noticed that you didn't respond to me]

      The fuse that exploded the teen pregnancy epidemic was the Sexual Revolution. You can fiddle with the debris, but the Revolution belongs to you, and it has been a catastrophe.

      Delete
    4. [Why is that? Still trying to find a paper (or white supremacist) who agrees with you?]

      I've consulted the white supremacist literature--the Democrat Party archives, to no avail.

      Rule # 3: SJW's always project.

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    6. "The fuse that exploded the teen pregnancy epidemic was the Sexual Revolution."

      I guess that there were no teen pregnancies prior to the sexual revolution. But there were an awful lot of teens getting married and having their first child less than 9 months later.

      The fact remains that both teen pregnancies and teen abortions have been declining. I thought that you would see this as good news. And it is largely the result of better sex education and access to reliable birth control. But it is this latter fact that has you so upset, isn't it? It doesn't fit in neatly with your narrative.

      I like that word, "NARRATIVE". I think that I will start using it more.

      Delete
  9. [In all seriousness, if I were you I would ban me and delete all of this.]

    If you were me, I would ban you which would ban me so I wouldn't be able to ban you because you banned me.

    [Between your defense of Beale to your portraying my fair questions as Nazism, you come off looking really bad in all of this Michael.]

    And what's the problem with that?

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  10. "And what's the problem with that?"

    With looking bad? Nothing I guess....

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  11. I am not going to express an opinion.
    I am just going to ask you, as a Neuro surgeon, if you have seen the areas of the brain that "light up" when
    pain is experienced?
    Has any such "imagining" been applied to the unborn when undergoing either fetal surgery or abortion?
    IF this could be ACCURATELY done, that would add a LOT OF WEIGHT to this debate!



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