For Aborted Fetuses, a Question of Pain

Opening a provocative new front in the war over abortion, a Los Angeles County lawmaker wants to require that painkilling drugs be given to fetuses aborted during the third trimester.

The proposal by Assemblyman George Runner Jr. (R-Lancaster) is expected to spark emotional debate in the Capitol, one that turns on the issue of what a fetus may be capable of feeling--and when.

The bill, expected to be introduced this month, is “a first [in the nation] as far as I can tell,” said Vicki Saporta, executive director of the National Abortion Federation in Washington.

Saporta, whose group supports abortion rights, called Runner’s proposal typical of efforts by abortion foes seeking new ways to limit use of the procedure. Other states have passed laws requiring patients to watch videotapes or read pamphlets about abortion, and many also mandate counseling, she said.

“It’s all part of an effort to whittle away at access,” Saporta said. Runner, a conservative in his first Assembly term, acknowledges that he would prefer to ban abortion outright. But he says that “even the biggest pro-abortion zealot” should support his bill if in fact a fetus senses pain.

“These are babies at an age that would enable them to live if they were born,” he said. “How can anyone argue that they should not be protected from pain?”

Runner said his inspiration for the bill was a British panel of medical and scientific experts, who declared in October that fetuses may sense pain as early as 26 weeks. By that time, nerve connections are established between the cortex and the thalamus of the developing brain, the panel said.

Appointed by the Royal College of Obstetricians and Gynecologists, the panel advised British doctors to administer anesthesia to fetuses in late-term abortions and for various diagnostic tests.

Runner’s legislation would affect a very small number of abortions. Of the 1.4 million performed nationwide each year, only 1% occur after 20 weeks’ gestation--and fewer than 600 are performed after 26 weeks, according to the nonprofit Alan Guttmacher Institute in New York. (Figures for California are not available.)

Third-trimester abortions are typically performed only in cases of a severe fetal defect or when the mother’s health is in jeopardy, said Charlotte Newhart, chief administrative officer of the American College of Obstetricians and Gynecologists in California.

“Procedures at this late stage are extremely rare,” Newhart said, “and in almost all cases they require approval of a hospital’s medical staff or ethics committee. . . . This is not a situation where someone simply decides she is sick of being pregnant.”

In the United States, the issue of fetal pain rose to prominence in 1985, when a documentary called “The Silent Scream” shocked Americans with its sonogram depiction of an abortion. The film, which purportedly showed a 12-week fetus wailing as it succumbed to suction equipment, was denounced by medical experts as inaccurate and misleading.

Today, obstetricians agree that fetuses develop the neurological equipment to perceive pain at some point during the third trimester. A baby born prematurely at 28 weeks, for example, reacts to an intravenous prick with a grimace and a cry, while a fetus of the same age may move about in utero when stuck with a needle.

Is that an expression of pain or is it a reflex? And at what point do raw sensory impulses become the stuff of consciousness?

“It’s difficult, and you have to be careful not to confuse reflex with pain sensation,” said Dr. Mark I. Evans, vice chairman of obstetrics and gynecology at Wayne State University in Detroit. “Just because a spinal reflex has developed, that doesn’t mean it is translated into pain at the cortical level.”

Either way, he believes Runner’s proposal is unnecessary and accused him of “political grandstanding.

“Third-trimester abortions are hardly ever done,” Evans said. “And when they are, medicine is usually used to stop the heartbeat” so that the fetus is already dead when aborted.

Other specialists said the proposal has some merit. Dr. Edmund F. LaGamma, a professor of pediatrics and neurobiology at University Hospital in Stony Brook, N.Y., called it “a reasonable idea” but added words of caution.

“You have to balance it against the effect on the mother and the risks she might face,” LaGamma said. “How do you deliver the analgesic to the fetus? Do you have to give the mother general anesthesia to do it? There are many relevant questions.”

Newhart, who represents obstetricians and gynecologists in California, said the bill would also open another door: “If you start requiring anesthesia during abortions, then what about standard labor and deliveries,” which involve a traumatic, head-banging journey down the birth canal, she said.

Although Runner hopes his bill will prove tricky for some abortion rights supporters to oppose, he will face long odds as he tries to maneuver it through the Legislature. Democrats hold the majority in Sacramento, and they have easily blocked past attempts to restrict the availability of abortion.

Last year, a proposal to ban late-term abortions died in a Senate committee. Also killed were several budget amendments that would have cut public funding of abortions and required parental consent for minors who want to undergo the procedure.

“There is a solid pro-choice majority in the Legislature, so while this will get a lot of attention, it won’t get far,” said Kristy Wiese, a lobbyist for Planned Parenthood Affiliates of California, which supports abortion rights. “Conservatives are picking this sort of hysteria-generating issue more as a vehicle to get attention than a vehicle to create public policy.”

The bill’s first legislative stop will probably be the Assembly Health Committee, headed by Assemblyman Martin Gallegos (D-Baldwin Park). He called the bill an inappropriate intrusion of politics into medicine.

“I think we’re going down a slippery slope as a Legislature when we begin to dictate the specifics of the practice of medicine,” Gallegos said. “This is an issue that needs to be resolved through medical research, not legislation.”

Dr. Patricia Robertson, a specialist in high-risk obstetrics at UC San Francisco, said she annually refers one or two patients for third-trimester abortions, either because of maternal health risks or severe fetal defects.

“These are medical decisions between the family and the physician, and they are very difficult, traumatic decisions,” she said. “If the family wants anesthesia administered to the fetus, so be it. . . . It frightens me to think that the Legislature would try to play a role in that decision.”

Still, Runner is already finding support in the Capitol’s circle of antiabortion legislators, who plan a fresh attempt this year to ban late-term abortions.

Sen. Ray Haynes (R-Murietta), who has his own bill to tighten regulation of abortion clinics, said he will vote for Runner’s proposal. And Assemblyman Scott Baugh (R-Huntington Beach) expressed support for Runner, though he predicted that the politics of abortion would doom the bill to failure.

“If someone admits that a fetus is being tormented by the abortion, then they’re a step closer to saying the procedure shouldn’t be permitted,” Baugh said. “[Abortion rights supporters] won’t take that step.”