The Evidence Against
The undisputed discovery that the neonate and fetus launch a hormonal and neural response to invasive practice can not be considered definitive proof that there is anexperienceof pain. Anexperienceimplies that sensations have been interpreted in a conscious manner. Even when combined with the observations of behavior and improved clinical outcome when using anesthetics, there is still no proof that there is anexperienceof pain. Although all of these phenomena are associated with the notion of 'pain', none of them adequately describe or explain the phenomenological experience of 'pain'. These phenomena may exist independently of conscious experience. The relationship between the physiological responses of nociceptors, the hormonal and other responses of the CNS and the behavioral outcome of these changes to the psychological response has yet to be determined (19).
Unless it can be reasonably suggested that the fetus has a conscious appreciation of pain post 26 weeks gestation, then the responses to noxious stimulation post 26 weeks are still essentially just behaviorally complexreflexresponses, similar to the responses prior to 26 weeks. Despite the importance of providing evidence for the conscious appreciation of pain, the fetal and neonatal literature largely tries to ignore this issue. Anand, for example, highlighted the clinical findings with neonates as being of greater importance than 'any philosophical view on consciousness and 'pain perception''. Giannakoulopoulos et al distanced themselves from any implied fetal pain experience with the statement 'a hormonal response cannot be equated with the perception of pain'. In a report for the British Department of Health (Foetal pain: an update of current scientific knowledge. A paper for the Department of Health May 1995) Fitzgerald even went so far as to say that 'true pain experience [develops] postnatally along with memory, anxiety and other cognitive brain functions' leaving confusion as to what the 'untrue' pain experience of a fetus may be. More recently Lloyd-Thomas and Fitzgerald have suggested that if feeling and pain are properly understood then the fetus cannot be said to feel pain (20).
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