When does a human fetus experience pain?

One of the most frequently asked and controversial questions that has arisen in the area of ​​sexual and reproductive health, in one of the discussions on abortion law and management, is: Does a human fetus feel pain? In part, these discussions followed the idea that the early stages of central nervous system development are a sufficient condition for experiencing pain.

Since there is no consensus on how to resolve this issue, in this article we present some of the research and theories that have been conducted to discuss the issue.

    Can a human fetus feel pain?

    In 2006, Stuart Derbyshire, a member of the Department of Psychology at the National University of Singapore and an expert in cognitive science, discussed this issue on the basis of US government policy. The latter determined that it was the doctor’s duty warn women who intend to have an abortion on the existence of certain indications according to which abortion can cause pain to the fetus.

    From there, the doctor also had the obligation to offer the woman the possibility of reducing this pain by applying drugs before the abortion. The consequence of not noticing all of the above could cost doctors thousands of dollars.

    On the other side of the world, in England, at the beginning of the last decade, a series of images was proposed which sought to argue for the idea that the fetus has a series of cognitive and emotional experiences. These images finally impact on UK policies on pre-abortion pharmacological interventions to relieve fetal pain.

    Stuart Derbyshire discusses the available evidence on all of the above by analyzing the neurobiological development of the fetal period as well as the experiential dimension of pain.

      When does the development of the fetus begin?

      Fetal development is that which occurs from week 12. In other words, it is considered as a “fetus” in the embryo which has evolved after the first 3 months of gestation.

      Over the next 5-6 months until birth, the fetus is expected to develop cells, organs, tissues and even systems that will be a necessary condition for its birth. That said, we will define what pain is from a psychological point of view, as well as the elements considered necessary to be able to feel it.

      What is pain?

      The International Association for Pain Studies (IASP) says pain is an unpleasant feeling and emotional experience associated with potential or actual tissue damageOr, it is an experience described in terms of this evil.

      From this we can say that pain is a conscious experience, and not just the response to noxious stimuli (Derbyshire, 2006). It is therefore also a subjective experience that can change qualitatively from one person to another. In addition, in order for an organism to experience pain, they are necessary a series of physiologically mature structures. A complex network of cortical regions must be activated; which can happen even in the absence of actual harmful stimulation.

      In the event of harmful stimulation, the latter is an external event that generates electrical activity between the brain and the nerves in the skin, which ultimately generates a painful experience. In other words, for an organism to feel pain, first there must be the possibility that the nervous system is activated.

      Likewise, for the experience of pain to pass, it must develop other cognitive processes related to the state of consciousness and memory, which in turn make it possible to mean and discriminate an event as “painful” (a question in which how we learn to name this event through others).

      In other words, although pain is an individual experience (physiological and cognitive processes with which we generate a mental representation of pain), it can also be seen as an experience lived in interaction with others.

      Experience of pain and fetal development

      It is around week 7 of gestation that nerve endings begin to develop, as well as parts of the spinal cord (which is a fundamental connector to the brain and will give rise to the thalamus, an important organ). experiences).

      This lays the foundation for creating a hypothalamic structure which is a necessary condition for experiencing pain. But the latter does not mean that hypothalamic activity is consolidated: the density of neuronal cells that line the brain is being consolidated. Before this consolidation is complete, neural cells are unable to process harmful information. from the outskirts.

      In other words, the nervous system is not fully developed and mature, so we can hardly support or conclude that the experience of pain occurs during fetal development.

      The first tests of sufficient hypothalamic activity begin to occur between the 12th and 16th week of gestation.. This is when the neural connections within the cerebral cortex begin to mature. Afferent fibers develop from week 23 to week 25. However, there is not enough functional neuronal activity to speak of a fetal pain experience, because the spinothalamic fibers have not been connected to the plaque, to the cerebral cortex.

      Week number 26 and other key milestones

      Thalamic projections on the plate of the cerebral cortex are the minimum anatomical condition necessary to feel pain and are completed by the 23rd week of gestation. At the same time, peripheral nerve endings develop, generating reflections in the cerebral cortex.

      For this reason, several studies have suggested that the minimum gestational week to suspect the experience of fetal pain is number 26 (around 7 months gestation), that is, when electrical activity is similar to that exhibited by children and adults when reacting to dangerous situations, Or, when they recount such a painful experience.

      On the other hand, the secretion of different hormones is also necessary; process that begins to be observed in fetuses from the first 18 weeks of gestation.

      The problem, Derbyshire (2006) tells us, is that what happens inside the placenta is very different from what happens outside, Both in neurochemical terms and in the way we react to noxious stimuli, and therefore on sensitive experiences.

      Likewise, the most classic studies of pain experiences have been to relate the electrical activity of the brain to the pain experience reported verbally by the person himself.

      Because it cannot be done with a fetus, scientific research has focused on theorize about the possibility of feeling pain by analyzing the embryonic development of the nervous system. From there, they suggest that the experience of pain exists because it is similar to that already verbalized by a child or an adult.

      That is, the research had to resort to the interpretation of secondary evidence, and for the same reason could only talk about clues and not conclusive results about the experience of pain in the developing fetus.

      to summarize

      To feel pain not only we need the ability to distinguish between different sensory stimuli. It is also not about reacting to potentially harmful stimuli (a quality known as ‘nociception’). The experience of pain also involves consciously responding, that is, we also need the ability to distinguish between different experiences; problem that is generated by interactions with our caregivers after birth, among other processes such as the development of the mind.

      We therefore need a mature nervous system that allows us to process and represent this stimulus as harmful and then painful.

      there are many important neurobiological processes that begin at week 7, week 18, and week 26 of gestation. These were considered by many to be the stages where a human fetus could experience pain. What Derbyshire (2006) quickly warns us is that the subjective experience that accompanies pain cannot be inferred directly from anatomical development, because these developments are not the ones that give rise to the conscious contents of pain.

      Bibliographical references:

      • Derbyshire, S. (2006). Can fetuses feel pain? BMJ, 332: 909-912.

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