The Invisible Woman

The Times Magazine published a story this weekend about the question of “fetal pain,” which I encourage you to read in its entirety. It’s inanely titled The First Ache, but really might as well be called The Silent Scream:

As NICU technology improved, the preterm infants [fetal pain researcher Kanwaljeet Anand] cared for grew younger and younger — with gestational ages of 24 weeks, 23, 22 — and he noticed that even the most premature babies grimaced when pricked by a needle. “So I said to myself, Could it be that this pain system is developed and functional before the baby is born?” he told me in the fall. It was not an abstract question: fetuses as well as newborns may now go under the knife. Once highly experimental, fetal surgery — to remove lung tumors, clear blocked urinary tracts, repair malformed diaphragms — is a frequent occurrence at a half-dozen fetal treatment centers around the country, and could soon become standard care for some conditions diagnosed prenatally like spina bifida. Whether the fetus feels pain is a question that matters to the doctor wielding the scalpel.

And it matters, of course, for the practice of abortion. Over the past four years, anti-abortion groups have turned fetal pain into a new front in their battle to restrict or ban abortion. Anti-abortion politicians have drafted laws requiring doctors to tell patients seeking abortions that a fetus can feel pain and to offer the fetus anesthesia; such legislation has already passed in five states. Anand says he does not oppose abortion in all circumstances but says decisions should be made on a case-by-case basis. Nonetheless, much of the activists’ and lawmakers’ most powerful rhetoric on fetal pain is borrowed from Anand himself.

Now, I read that last paragraph over and over a few times. And I’m still trying to wrap my head around the first sentence. Being the baby-hating feminazi that I am, I’m not entirely sure why research about the ability of born premature babies to feel pain must “of course” matter with regards to abortion. Particularly, I’m confused as to why the pain that a fetus born at more than 20 weeks gestation would be relevant to a discussion on abortion when only one percent of abortions take place at 21 weeks gestation or later, and almost all are for health reasons. If a fetus could feel pain at that point, when we’re talking about a woman’s health, does it really even matter anymore? In fact, matter so much that we can take it as a given that it would? Are we just to assume that whatever anti-choice activists say must somehow be important? Or am I missing something?

Actually, I’m pretty sure that I know. What I’m “missing” is the public discourse that abortion is about the “unborn child,” and not about the fully born, definitely conscious, absolutely without a doubt pain-feeling woman carrying it. We’re supposed to focus on the fetus, because to focus on the woman is “selfish” or “heartless.” We’re supposed to focus on the fetus, in fact, specifically because the woman carrying it is human, and is therefore flawed. She may have had unprotected sex, do drugs, drink on weekends, have gotten pregnant from a one night stand, cheat on her partner, cheat on her taxes, not like children, not like puppies, be a generally mean person, not give to charity, waste food — you name it, there is something out there to make every single woman seeking an abortion undeserving in someone’s eyes, and because she is human, certainly not perfect. But a fetus . . . well, a fetus can do no wrong, can it? In fact, this is a rallying cry of the anti-choice movement: “the baby is innocent.”

Now, before someone decides to start screaming at me (though I imagine that those most likely to do so are going to anyway), I’m not a sadist. In fact, I’m quite the opposite. I don’t believe in causing others unnecessary pain. That’s why I oppose war, rape, the death penalty and torture, to name a few. The same cannot be said of many in the anti-choice camp (and yes, probably of a good number in the pro-choice camp). Contrary to what many people think of those who work at Planned Parenthood, I don’t kick babies for fun. And though I don’t think that a fetus is a baby, I don’t exactly want to poke it with sharp objects just for something to do. If a fetus can genuinely feel pain in the same way that born humans can, yeah, we might want to at least consider anesthesia and weigh those benefits up against the risk to the woman involved. But here’s the problem, folks: though Anand’s research gets first billing, at the end of the third and beginning of the fourth pages, we start to hear an alternate point of view:

But anatomy is not the whole story. In the fetus, especially, we can’t deduce the presence or absence of consciousness from its anatomical development alone; we must also consider the peculiar environment in which fetuses live. David Mellor, the founding director of the Animal Welfare Science and Bioethics Center at Massey University in New Zealand, says he was prompted to consider the role of fetal surroundings in graduate school. “Have you ever wondered,” one visiting professor asked, “why a colt doesn’t get up and gallop around inside the mare?” After all, a horse only minutes old is already able to hobble around the barnyard. The answer, as Mellor reported in an influential review published in 2005, is that biochemicals produced by the placenta and fetus have a sedating and even an anesthetizing effect on the fetus (both equine and human). This fetal cocktail includes adenosine, which suppresses brain activity; pregnanolone, which relieves pain; and prostaglandin D2, which induces sleep — “pretty potent stuff,” he says.

Combined with the warmth and buoyancy of the womb, this brew lulls the fetus into a near-continuous slumber, rendering it effectively unconscious no matter what the state of its anatomy. Even the starts and kicks felt by a pregnant woman, he says, are reflex movements that go on in a fetus’s sleep. While we don’t know if the intense stimulation of surgery would wake it up, Mellor notes that when faced with other potential threats, like an acute shortage of oxygen, the fetus does not rouse itself but rather shuts down more completely in an attempt to conserve energy and promote survival. This is markedly different from the reaction of an infant, who will thrash about in an effort to dislodge whatever is blocking its airway. “A fetus,” Mellor says, “is not a baby who just hasn’t been born yet.”

Ah, well isn’t in convenient that even though newspapers know damn well that most readers don’t read past the first few paragraphs in any given article, let alone past the first page in an article six pages long, that this highly relevant information would be buried deep in the middle?

Whether intentional or not, the Times published another article (a book review of sorts) that makes baseless attempts to assign human rights to gestational human tissue. Nope, not fetuses — this one is about embryos — and is charmingly titled Little Children. Now, at this point we shouldn’t be surprised when William Saletan makes ridiculously failed attempts to pretend that he’s a moderate on abortion, but he still does have the ability to make one cringe:

Biotechnology is arguably more insidious than abortion. Abortions take place one at a time and generally as a response to an accident, lapse or nasty surprise. Their gruesomeness actually limits their prevalence by arousing revulsion and political opposition. Conventional stem-cell harvesting is quieter but bolder. It’s deliberate and industrial, not accidental and personal. In combination with cloning, it entails the mass production, exploitation and destruction of human embryos. Yet its victims don’t look human. You can’t protest outside a fertility clinic waving a picture of a blastocyst. You have to explain what it is and why people should care about it.

[. . .]

Of all the lines we could draw in human development to mark the onset of moral worth, conception is the brightest. But that line is no more absolute in ethics than in science. We should never create or destroy embryos lightly. We owe them our respect. We just don’t owe them the same respect we owe one another.

Here is my really a big problem with those who believe that it is immoral to destroy embryos for the purpose of developing life-saving technology, a group that Saletan at least sympathizes with, and also where pro-lifers get muddled in their arguments. They want to use the “pain” argument as way of making fetuses feel more human. But they also want embryos to have more rights than other living creatures.

In their use of pain to make the fetus seem more fully human, anti-abortion forces draw on a deep tradition. Pain has long played a special role in how society determines who is like us or not like us (“us” being those with the power to make and enforce such distinctions). The capacity to feel pain has often been put forth as proof of a common humanity. Think of Shylock’s monologue in “The Merchant of Venice”: Are not Jews “hurt with the same weapons” as Christians, he demands. “If you prick us, do we not bleed?” Likewise, a presumed insensitivity to pain has been used to exclude some from humanity’s privileges and protections. Many 19th-century doctors believed blacks were indifferent to pain and performed surgery on them without even that era’s rudimentary anesthesia. Over time, the charmed circle of those considered alive to pain, and therefore fully human, has widened to include members of other religions and races, the poor, the criminal, the mentally ill — and, thanks to the work of Sunny Anand and others, the very young. Should the circle enlarge once more, to admit those not yet born? Should fetuses be added to what Martin Pernick, a historian of the use of anesthesia, has called “the great chain of feeling”? Anand maintains that they should.

When, exactly, are U.S. prisoners going to enter this “great chain of feeling?” And not just the ones at Guantanamo who are being tortured experiencing “enhanced interrogation,” but the ones being killed by tasers and sexually assaulted in jails? When do those on death row get a ticket in? Or the people in Iraq that we senselessly blew up, or the people in Darfur or the Congo who we senselessly refuse to help? Does the circle get that big? Hell, how about the male babies that are circumcised without anesthesia? In fact, the article discusses those babies briefly in a different context, and doesn’t seem to encounter any ethical discrepancy as to why boys are caused pain for no good reason but we’re arguing about the pain that it might be necessary to cause fetuses, if they could feel it.

Of course the circle doesn’t get that big. Because unlike people, embryos are innocent.

We torture lab rats every day, in addition to other, more complex animals. And short of finding cures for debilitating and deadly diseases, these animals get to suffer for causes as noble as knowing that lipstick most likely isn’t going to kill us. And though I certainly don’t want lipstick to kill anyone, something seems innately wrong to me in suggesting that this kind of behavior is acceptable but that we can’t kill embryos, which even people like Anand aren’t claiming can feel pain, to save actual human lives.

My cat will yelp and run away when I accidentally step on her paw. She feels pain. I also believe that she feels semi-complex emotion like love, or at least affection. But we kill cats every day at the pound, simply because they don’t have a home. And I can see few people arguing that I have a moral obligation to use my body as life support for hers. Unless, of course, cats ended up inside of women’s bodies through horrible dirty pleasurable acts involving genitals that need to be punished, and if the cats inside of women’s bodies had been used to control women for thousands of years. Then, I can see people considering animal rights to be more than just a fringe movement. Suddenly, like fetal pain, feline pain would become very, very important.

Anand claims to not have an abortion agenda in mind. But he also sure as hell doesn’t seem to lean towards the interests of women:

And in fact, both Nicholas Fisk and Marc Van de Velde have raised the possibility of administering pain relief to fetuses undergoing difficult deliveries. Obstetricians have yet to embrace the proposal. But Sunny Anand, for one, says the idea may have merit. Though he has “misgivings about messing with a process that has worked for thousands of years,” he can envision an injection of local anesthetic into the fetus’s scalp where it is grasped by the forceps or vacuum device. “Let’s try and work out what’s best for the baby,” he says.

He wants to do what’s best for the baby (woman? what woman?). But does he, really?

On April 4, 2004, Sunny Anand took the stand in a courtroom in Lincoln, Neb., to testify as an expert witness in the case of Carhart v. Ashcroft. This was one of three federal trials held to determine the constitutionality of the ban on a procedure called intact dilation and extraction by doctors and partial-birth abortion by anti-abortion groups. Anand was asked whether a fetus would feel pain during such a procedure. “If the fetus is beyond 20 weeks of gestation, I would assume that there will be pain caused to the fetus,” he said. “And I believe it will be severe and excruciating pain.”

Among those educated enough to know better — which I can only believe that Anand is — this argument about “partial birth abortion” always betrays them. They claim to care because of the pain that the procedure would supposedly cause the fetus. But while they were so damn busy trying to win this ideological battle, they didn’t utter a single peep about what procedure would most commonly replace it. That procedure is not only more dangerous for the woman involved, it would also be far less pleasant for a fetus that could feel pain. While ideologues made a ruckus about the abortion of intact fetuses, they didn’t exactly want to explain how that procedure would cause more pain than dismembering the fetus in utero would. As someone who can feel pain — which, it bears repeating, is not something that has been proven for fetuses — I can’t imagine that either way of dying would be fun. But given the choice, I’d go with the intact dilation and extraction, thank you very much.

So no, we’re not talking about ethics here. But we are in fact talking about rights. And women don’t have them. The fetus has a right to not feel pain. But the woman doesn’t have a right to an affordable abortion near her home, because the cost of fetal anesthesia is so high. Fetuses have a right to not feel pain, but a woman doesn’t have a right to not be manipulated out of her likely-difficult decision to abort. Fetuses have a right not to feel pain, but women don’t have the right to obtain the safest possible medical care. Doctors have an ethical obligation towards a fetus, but just might sexually assault a woman by performing a non-consensual exam on her while she is unconscious.

The point is that, as we know, fetuses have rights and those rights are growing. And if we don’t find a way to change the conversation, women are going to have fewer and fewer rights left. Folks like Anand and the people who use his research for political gain seem to me to be an awful lot like the fellow with the umbrella up above. In the end, he can slight the woman all he wants. But regardless of the fetus in her uterus, she is still out there.