On the nature, assessment, and treatment of fetal pain: neurobiological bases, pragmatic issues, and ethical concerns.
Over the past 2 decades, the issue of fetal pain and stress has attracted considerable attention and has become the focus of ongoing debate in light of advances in medical diagnostics and technology that allow invasive prenatal medical intervention(s), and an enhanced understanding of fetal neurophysiology, together with a broadened appreciation for the relationship of brain and consciousness. In this essay, we explore the issue of fetal pain based upon knowledge of both the ontogeny and function of the nervous system and the interaction of brain, mind, and pain. We posit that contemporary understanding of neurological development fortifies appreciation that pain sensation and perception occurs during (later) fetal life and that this pain warrants clinical consideration during the conduct of invasive prenatal procedures. We present differing perspectives on this issue, discuss the relative merits and difficulties of these positions, and ultimately describe the fundamental basis for a consideration of fetal pain and address this consideration with regard to pragmatic and ethical benefits, burdens, and risks. We adopt a neurocentric, yet consilient approach that entails both scientific and philosophical orientations. By attempting to reveal inherent limitations in our contemporary appreciation and approach(es) to fetal pain, we hope to illustrate the need for and posit potential venues toward resolving these limitations and dilemmas.
Johns Hopkins University Medical Center, Baltimore, MD, USA.
Anita
A
Gupta
James
J
Giordano
D000698:Analgesia / Q000941:ethics / Q000379:methods; D002490:Central Nervous System / Q000033:anatomy & histology / Q000196:embryology / Q000502:physiology; D003243:Consciousness; D004992:Ethics, Medical; D005260:Female; D005315:Fetal Diseases / Q000503:physiopathology / Q000517:prevention & control; D046128:Fetal Therapies / Q000941:ethics*; D006801:Humans; D010146:Pain / Q000503:physiopathology / Q000517:prevention & control*; D011247:Pregnancy / Q000941:ethics*; D011296:Prenatal Diagnosis / Q000941:ethics