Breda O’Brien: Foetus’s pain should be a focus for both sides of abortion debate

On the third anniversary of the repeal of the Eighth Amendment, a vast gulf remains between those who voted yes and those who voted no. One side thinks removing protection from new human lives is a progressive victory for women while the other believes it is a tragedy both for the youngest humans and the women who carry them.

It is always interesting when people find ways to bridge that gulf. For example, some people radically disagree on abortion but agree that many women are forced into it through poverty or lack of housing and so work together to alleviate those issues.

It is much rarer that people with opposing views co-operate on something directly related to abortion. In a January 2020 article in the Journal of Medical Ethics, Reconsidering Foetal Pain, one author is pro-choice while the other is not but both are willing to consider something as contentious as whether later-term abortions cause pain to the one being aborted.

Prof Stuart WG Derbyshire is the author with pro-choice views.

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From the mid-2000s, there was a concerted push to reduce the 24-week limit on abortions in England and Wales to 20 weeks. The two main grounds were viability, that is, the ability of the foetus to survive outside the womb at earlier gestational stages, and the possibility of foetal pain during abortion.

Prof Derbyshire was a significant witness at a House of Commons Committee addressing the issue of foetal pain. In no small part due to his evidence, the committee concluded that foetal pain was not relevant to a change in abortion law.

Ethically incompatible

Prof Derbyshire dismissed both viability and foetal pain as irrelevant in a 2008 Spiked! article. Bluntly but accurately, he said, "Whether a baby can survive after birth doesn't really matter because we all know that babies can readily survive if the pregnancy is allowed to progress. Someone seeking an abortion does not want the pregnancy to continue to a live birth, which is the point of abortion." He dismissed foetal pain with equal bluntness, calling it a "misguided notion".

John C Bockmann, the other author, believes that abortion is ethically incompatible with good medical practice. In short, he shares the position of a considerable number of Irish medical practitioners. It is no coincidence that only one in 10 GPs provides abortions and just under half of maternity services do. While healthcare professionals have varying reasons for not partaking in abortions, it is not preposterous to presume that many are motivated by the fact that they want to preserve life and not to take it.

Derbyshire and Bockmann set aside their differences on abortion to look at what current scientific thinking says. It is highly significant that Derbyshire, one of the premier advocates dismissing the possibility of foetal pain, has changed his position.

Both authors conclude that “current neuroscientific evidence supports the possibility of foetal pain before the ‘consensus’ cut-off of 24 weeks” and they “no longer view foetal pain (as a core, immediate, sensation) in a gestational window of 12–24 weeks as impossible based on the neuroscience”.

Experience of pain

At the risk of over-simplification, it was previously believed that activation of the cortex was necessary for the experience of pain. According to the authors, it now appears “that pain can be supported by structures less advanced than the cortex, such as the brainstem, midbrain, and subplate that show clear evidence of maturity by 18 weeks’ gestation”.

Derbyshire has not changed his mind about abortion, only that ‘it is reasonable to consider some form of foetal analgesia (pain relief) during later abortions”.

Even animal welfare legislation makes it mandatory for vets to administer pain relief to animals when performing procedures that may cause suffering

It may be reasonable, but it was dismissed by Simon Harris at the time of the original abortion legislation. He seemed unaware that even animal welfare legislation makes it mandatory for vets to administer pain relief to animals when performing procedures that may cause suffering.

With the support of Peadar Tóibín of Aontú and eight other TDs, Carol Nolan TD introduced the Foetal Pain Relief Bill 2021 earlier this month. It surely is something that any person of goodwill could support, regardless of their position on abortion. If there is even a possibility that abortion causes pain, the precautionary principle would support pain relief.

Some 124 Irish abortions after 12 weeks were carried out in 2019, of which about 100 were on the grounds of a life-limiting condition. Foeticide is the medical practice of stopping a baby's heart, usually by lethal injection, so that it will not be born alive in a later-term abortion. A qualitative study involving 10 Irish foetal medicine specialists published in the British Journal of Obstetrics and Gynaecology included comments describing foeticide as "brutal" and "awful", with one saying it was like "stabbing the baby in the heart".  Another doctor recalls getting sick afterwards in a corridor.

French obstetricians routinely administer foetal anaesthesia before foeticide. Shouldn't Irish doctors do the same? The procedure will still be brutal and awful but at least it will not be painful, too.

Instead of the promised review of abortion legislation simply widening the availability of abortion, there is the possibility of doing something small to bridge the gulf.