Saturday, 13 October 2007

The abortion debate II

Further to this, Channel 4's Dispatches has a programme called Abortion - What We Need to Know on Wednesday at 10.40pm. There's a preview in the Daily Mail (!) by the Dispatches reporter Deborah Davies***:

"In next Wednesday's Dispatches programme on Channel 4 we reveal the deep concern among many doctors who, like Dr Argent, work within the abortion service and are passionate supporters of a woman's right to choose, yet who still believe the current law urgently needs changing."

Sounds like we have a nice sensationalist documentary, but we'll have to see*:
"In the mid-Nineties, partly in response to growing public concern about such issues, he RCOG put together a panel of experts who came to the reassuring conclusion that the foetus couldn't feel pain until 26 weeks gestation - safely beyond the abortion time limit.
But we found disturbing research in America that directly contradicts this established view. It came from Dr Sunny Anand, who has a distinguished record in helping to prove that very young babies can feel pain. When he was based at Oxford University in the 1980s his work helped to ensure that newborn babies were routinely given pain relief for surgical procedures.
He's found similar changes in their hormones and their blood flow, suggesting that foetuses can indeed respond to pain.
Note the distinction between a physiological response to noxious stimuli and feeling pain is elided here.
"He says that while the adult uses the very top section of the brain, the foetus has the first flickerings of sensation in the area below that. Crucially, this part of the brain develops before 26 weeks.

His conclusions could have enormous consequences for the abortion debate. He told Dispatches: "I believe that foetuses can feel pain very likely by 20 weeks of gestation and possibly even earlier.""
I'm not sure how great the consequences of his work are for the abortion debate. In actual fact I can't find any evidence that Anand has done any research in this particular area, rather this follower of guru Sathya Sai Baba has been a high profile advocate for the view that foetuses feel pain in the media**. Presumably he's talking about pain fibre projections to the subplate (rather than the thalamus, which I've never heard anyone claim in any way mediates the feeling of pain). It is highly controversial to say the least to claim that these cells, never previously shown to have any role in pain, and generally believed to have a developmental, but not cognitive role, might mediate foetal pain. As Anand and colleagues said themselves only this year (in the only reference I can find on medline for 'subplate' and 'pain'):
"Connections to the thalamus begin at 14 weeks and are completed by 20 weeks, and thalamocortical connections are present from 13 weeks and are more developed by 26 to 30 weeks. However, it is not possible to measure evoked potentials from the cortex before 29 weeks. Thus, many scientists suggest that it is not until 29 weeks gestational age that there is objective evidence that a peripheral stimulus can cause cortical activation."
There is also further discussion of viability in the article - I wonder if there is a basis for their figures? I wonder how many of the surviving infants could be considered 'intact'?

"Back in July, we filmed a newborn baby named Hope in the neo-natal intensive care unit of Liverpool Women's Hospital. In her incubator, Hope was almost invisible under a pink blanket, surrounded by wires and bleeping monitors.

She had been born at 23 weeks - one week before she could have still been legally aborted. And here she was, three weeks later, still clinging to life with the frailest of grips.

Hope lived for two months, with her parents constantly at her side, before she died. In Britain, modern drugs and high-tech treatment meant she had about a 25 per cent chance of survival - hich would have doubled if she'd been born a week later. The odds were against her from the outset.

But those statistics are changing all the time. In America the chances of her survival would have been better, and what happens over there will inevitably filter through to Britain."

* I'm not confident the way that the reporter for the programme chooses to frame the article. I predict a combination of "but then, Sunny Anand discovered..." and 'he said', 'she said' equivalence of opposing views with no attempt to establish any kind of overview of the scientific consensus. In short, journalists fuck up one more science story, only this time it has repercussions in the real world.

Abortion Review has a good article on the background to this debate.

** Spiked has an interesting article on the partial birth abortion debate in the US, and Anand's role in it:

"...the trials will have a lasting consequence because of multiple damaging testimonies from Dr Kanwaljeet (Sunny) Anand on the issue of fetal pain. The potential for fetal pain was already becoming a common part of the argument against abortion but it is now guaranteed to form a more central role.
It was this evidence that enabled Anand to make the following claim during the course of the trial in New York: ‘I can state my opinion to a degree of medical certainty that all fetuses beyond 20 weeks of gestational age will experience severe pain by the partial-birth abortion

But the statement is pure hyperbole and nonsense, for many reasons (12).
Anand has made this mistake again and again and again and has now done so to the detriment of women seeking abortion. Distressingly these points were never made at trial, and the Plaintiffs might even have made the situation worse by pointing out that if D&X is painful then D&E must be excruciating. Moreover, in his concluding decision, Judge Casey was able to state that Dr Anand’s testimony went unrebutted by the Plaintiff’s, and provided ‘credible evidence that D&X abortions subject fetuses to severe pain’.

While Anand has done much to advance the clinical treatment of neonates and to preserve early life, he has also done much to confuse the understanding of pain and has now damaged the credibility of medicine. His testimony in California, Nebraska and New York, for which he was paid $450 an hour, plus expenses, by the current US government, was based on an evidently dubious and shaky claim of ‘medical certainty’.

It is understandable and proper for physicians and medical experts to wield their expertise in defence of practices that they believe to enhance clinical care, but it is quite another to wield
expertise against clinical care and in defence of hypothetical and unproven experiences. Unfortunately Anand has long interchanged what he believes with what he can prove and now he has done this in the service of reactionary political objectives.

Anand’s testimony has spawned the ‘Unborn Child Protection Act’, which is a Congressional-sponsored attempt to curtail late abortion on the basis of protecting the fetus from pain (21). Similar attempts to introduce fetal pain legislation have already occurred at the State level. In
2003, for example, Minnesota successfully introduced legislation requiring women to be informed of the possibility of fetal pain when seeking a second-trimester termination (22). The state of Virginia attempted to introduce similar legislation in 2004 but the proposal was defeated (23).

Sponsors of the Unborn Child Protection Act have cited Anand’s testimony and those on the
pro-life side of the debate believe that this legislation will replace the Partial-Birth Abortion Act as the main focus of anti-abortion activity, especially now that George Bush has returned to the White House (24)."

*** Oh dear, looks like Deborah Davies also did the Dispatches report on liver disease which diagnosed liver disease in 50% of people tested using an ultrasound and garnered much press coverage (Metro, Daily Mail, Sun, you know, the quality press). This had me shouting at the TV at the time for its sensationalism and scientific and medical flaws:

"Professor Chris Day, professor of liver medicine at the University of Newcastle, said there was no published study that verified a fibroscan could pick up early signs of disease caused by alcohol.

'In really heavy drinkers about 10% will get liver cirrhosis. The test can only really pick up when the liver is badly damaged – which, if they're picking up half, makes you realise the test must be rubbish.'"


gimpy said...

Well how much of a role does science play in the abortion debate anyway? The ideological arguments in favour of abortion were won long before we had a sophisticated understanding of the neurology of pain and consciousness. Abortion has never been a debate based on scientific evidence so why the sudden move to incorporate science now? Possibly because it provides a rationalisation of an undoubtedly unpleasant procedure which allows society to offset guilt because the science says it is ok. Of course this allows those who are against abortion to argue that the science says it is not ok. Perhaps the debate should return to its ideological roots. IMHO.

pj said...

Perhaps because before we could genuinely say we were ignorant about foetal pain (in fact I think people were generally dismissive of foetal pain - it is only relatively recently that pain in neonates has been taken seriously) - but now we have scientific evidence.

The evidence actually points towards the absence of foetal pain in the relevant time window - but that is irrelevant because the media debate about science has been framed in terms of cute pictures of foetuses smiling and waving.

If you read the coverage of this it is clear that questions of foetal pain and viability have become central (in fact questions of foetal viability were key for the reduction from 28 weeks to 24 weeks).

pj said...

In fact, in some ways, by winning the argument in principle the pro-choice movement has allowed the question of where the limit lies to become an argument over science.

I disagree that it is the pro-choice movement that has tried to incorporate science into the debate, rather Campbell and co with their 4D images and improved foetal viability scientific arguments are trying to get the limit reduced - and it is up to the pro-choice movement to respond - but I would not be surprised given current public opinion/ignorance if they got another reduction down to 22-20 weeks.

Andy said...

I find that there is nothing sensational about reporting on abortion.

It is a serious issue and science of course has a part to play. The moral question is far more important. How many 1000s of good lives are we destroying every year? How many 1000s would been born and grown up and lived good lives had we just left them alone? If people were simply more careful about their sexual practices this would be a start.

The issue of viability is also important but the issue of terminating a life or 'potential' life as some call it is the real issue. Far too many people rationalise the guilt of termination. As I said there is nothing sensational about reporting on abortion, it is what it is whether you rationalise it or not.