Dorries and the fallacy of foetal pain

Nadine Dorries is back on abortion trail yet again, courtesy of as yet unpublished interview with the Guardian in which, if this post on her personal pseudoblog is anything to go by, she’ll once again claim that her views on abortion are based on science rather than religious belief:

I am sure she felt that my reason for wanting to do this was influenced by religion and not science, rebutting my claims of foetal sentience with a statement that there was only one report which claimed that a foetus could feel pain in the womb post 20 weeks gestation.

Following the interview, Dorries appears to have tried to counter this suggestion by sending her interviewer an editorial by Dr Martin Ward Platt, a neonatologist at Newcastle’s Royal Infirmary, which was published in the British Medical Journal’s Archives of Disease in Childhood Foetal Neonatal edition in February 2011, in which Ward Platt disputes the the findings of the Royal College of Obstetricians and Gynaecologists’ (RCOG) working party on foetal awareness, Fetal Awareness – Review of Research and Recommendations for Practice.

Ward Platt’s editorial is, to say the least, rather uneven in its appreciation of the scientific evidence relating to foetal awareness, although it takes a fairly deep understanding of the evidence, and particular of research in cognition and the neuroscience to understand why, and that – unfortunately – leaves his arguments open to misinterpretation. Skipping past the preamble, Ward Platt provides the following summation of RCOG’s position on foetal awareness:

The core of the scientific argument in the document can be summarised thus:

- The fetus is rendered unconscious during intrauterine life by endogenous substances.

- And the fetus at under 24 weeks does not have the neuroanatomical apparatus that would allow pain perception at a cortical level.

– Therefore the fetus is neither aware, nor can feel pain, under 24 weeks.

That’s a rather narrow summation of the argument advanced by RCOG which, for our purposes, is best addressed by reference to the section which offers guidance on what to tell women who are considering an abortion should they ask about foetal pain:

Will the fetus/baby feel pain?

No, the fetus does not experience pain. Pain relates to an unpleasant sensory or emotional response to tissue damage. To be aware of something or have pain, the body has to have developed special sensory structures and a joined-up nerve system between the brain and the rest of the body to communicate such a feeling. Although the framework for the nervous system in the growing fetus occurs early, it actually develops very slowly. Current research shows that the sensory structures are not developed or specialised enough to experience pain in a fetus less than 24 weeks.

After 24 weeks, it is difficult to say that the fetus experiences pain because this, like all other experiences, develops postnatally along with memory and other learned behaviours. In addition, increasing evidence suggests that the fetus never enters a state of wakefulness inside the womb. The placenta produces chemicals that suppress nervous system activity and awareness.

To the layman, pain might seem to be a fairly straightforward concept – you stub your toe and it hurts. You experience a very obvious sensation in the location that has been damaged. There may be other physiological responses, i.e. a sudden increase in your heart rate and respiratory rate, leaving you with a feeling of breathlessness and, of course, you ‘feel’ the pain in terms of it bringing about an emotional reaction the outward manifestation of which can range from a stream of expletives to a few tears.

However, if you move beyond everyday conscious perceptions and consider what’s happening at an anatomical and cognitive level, pain becomes a much more complex phenomenon:

The content of pain

Few living creatures are unresponsive to a noxious stimulus (for example, a pinch or burning flame). Light a flame next to a fruit fly larva, for example, and it will bend and roll away. These responses depend on specialised sensory neurones, similar to free nerve endings in humans, which preferentially respond to stimuli that can damage tissue. Although the larva clearly has a biological apparatus to detect and respond to dangerous stimuli, can it be said to feel pain?

If the larva feels pain, then it presumably has some conscious or mental representation of the pain. The pain must consist of such experienced concepts as the location, feel, and cognition associated with the pain. Without this content, there is the response to noxious events, otherwise known as nociception, but no pain. The larva thus cannot be said to have the capacity for pain: there is no evidence for the conceptual content that the experience of pain implies.

A proper understanding of pain must account for the conceptual content that constitutes the pain experience. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” By this definition pain is not merely the response to noxious stimuli or disease but is a conscious experience. The definition further states that “pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life.” The limited neural system of fetuses cannot support such cognitive, affective, and evaluative experiences; and the limited opportunity for this content to have been introduced also means that it is not possible for a fetus to experience pain.

Derbyshire SWG. ‘Can fetuses feel pain?‘, BMJ 2006;332,909–12.

For an organism to experience pain there must be some capacity for awareness, for the organism to have subjective experiences even if those experiences are only rudimentary by comparison to those of an adult human. Consequently, when we consider the question of whether foetuses can feel pain at any point during its development we must necessarily consider not only whether its nervous system is sufficiently developed to generate physiological responses to noxious stimuli but also whether the neuroanatomical structures necessary for sentience, awareness and, eventually, consciousness are present, connected and active at a particular stage of development. If these structures are absent, incomplete and/or immature then the foetus cannot experience pain, or have any other subjective experiences, although it may be capable of nociception, i.e. encoding an processing noxious stimuli as a neural process somewhat earlier in its development.

Ward Platt’s take on this issue is, to say the least, interesting but, in places, far from scientific:

Let us first take the issue of awareness, bearing in mind that the report states: “There is increasing evidence that the fetus never experiences a state of true wakefulness in utero and is kept, by the presence of its chemical environment, in a continuous sleep-like unconsciousness or sedation”. This is a far-reaching statement, since it implies that any research on the cognitive capacity of the human fetus is impossible.

Impossible? Not necessarily as this does not necessarily preclude the use of neuroimaging to assess early cognitive development but what it does suggest is that some of the common research techniques, which rely on the measurement of what appear to be physiological responses to external stimuli, i.e. changes in mean foetal heart rate or foetal activity, may be unreliable methods of seeking information about the cognitive capacity of the human foetus, and if that is indeed the case then so be it.

In addition, the reason that the issue of awareness assumes such importance in the report is because if you can argue yourself into the position of refuting the possibility of awareness while in utero, you don’t need to take into account the measurable experiences of infants who, having been born at the gestational ages under discussion, can be observed much more rigorously than the fetus. By deploying the argument that the fetus is in a different conscious state to the newborn, anything observed in the baby at an equivalent gestation can be dismissed as irrelevant to the discussion.

Maybe, maybe not – regardless of the politics that surrounds this issue, the question of whether awareness in utero is possible is a scientific question and, therefore, a matter to be determined by the evidence not by one’s own political opinions. As yet, Ward Platt has not produced any evidence to contradict RCOG’s position or support a contention of bias, which is what he’s suggesting here and, as such, he is raising this issue in his editorial rather prematurely, a practice which often suggests that an author is about to take a biased position of their own.

So, what is the evidence that the human fetus lacks ‘awareness’? In a word, there is none. The only evidence, including the bit about the chemical environment, is in sheep and one or two other experimental animals. I have looked at the references in the report, and the references in the references, and when I finally got back to the primary literature I found no evidence for the contention that human fetuses lack awareness, or exist in some different conscious state, beyond the unwarranted extrapolation from sheep.

Sorry?

If Ward Platt is thinks there is no evidence then he must a have a different version of RCOG’s report to the one I’ve got, that or his examination of the references given in the studies cited by RCOG has been rather less exacting than my own.

Although the evidence for the soporific effects on the intrauteraine environment does come from animal studies, the key evidence relating to the neuroanatomical development of the foetus does come from a combination of animal studies and human tissue studies conducted on aborted foetuses, miscarriages and stillbirths, where these have been donated for research purposes, as the results of these investigations is summarised, by Stuart Derbyshire, as follows (warning, this next bit is rather technical):

Notwithstanding limitations, it is useful to view the pain system as an alarm system. Viewed in this way, a noxious stimulus is an event that activates free nerve endings in the skin, similar to pushing an alarm button. The electric cable from the button to the alarm is similar to the connection between the nerve endings and the brain. The brain is the alarm that rings out pain. Whether the fetus can respond to a noxious stimulus with pain can thus be decided in part by determining when the alarm system is completely developed.

Free nerve endings, the “alarm buttons,” begin to develop at about seven weeks’ gestation; projections from the spinal cord, the major “cable” to the brain, can reach the thalamus (the lower alarm) at seven weeks’ gestation. An intact spinothalamic projection might be viewed as the minimal necessary anatomical architecture to support pain processing, putting the lower limit for the experience of pain at seven weeks’ gestation. At this time, however, the nervous system has yet to fully mature. No laminar structure is evident in the thalamus or cortex, a defining feature of maturity. The external wall of the brain is about 1 mm thick and consists of an inner and outer layer with no cortical plate. The neuronal cell density of the outer layer is much higher than that of a newborn infant or adult and at seven weeks’ gestation has yet to receive any thalamic projections. Without thalamic projections, these neuronal cells cannot process noxious information from the periphery.

The first projections from the thalamus to cortex (the higher alarm) appear at 12-16 weeks’ gestation. By this stage the brain’s outer layer has split into an outer cortical rim, with a subplate developing below. The thalamic projections that develop from 12-16 weeks penetrate the subplate. Within the subplate, cortical afferents establish prolonged synaptic contacts before entering the cortical plate. The subplate is a “waiting compartment,” required for mature connections in the cortex. The major afferent fibres (thalamocortical, basal forebrain, and corticocortical) can wait in the subplate for several weeks, before they penetrate and form synapses within the cortical plate from 23-25 weeks’ gestation. Subsequent dissolution of the subplate occurs through prolonged growth and maturation of associative connections in the human cerebral cortex. Spinothalamic projections into the subplate may provide the minimal necessary anatomy for pain experience, but this view does not account for the transient nature of the subplate and its apparent role in the maturation of functional cortical connections. A system necessary for pain is intact and functional from around 26 weeks’ gestation.

In layman’s terms, we’ve figured out the basic wiring requirements for pain in humans by studying adults and, when we look for the same wiring in foetuses we find that it isn’t fully in place until around 26 weeks gestation. From there is but a short logical step to the conclusion that foetuses cannot feel pain in any meaningful, subjective, sense until their brains are properly wired up.

Okay, so its quite that straightforward as Derbyshire goes on to point out when moving on to the consider ‘foetal psychology':

Without verbal reports and direct access to the mind of a fetus, inferences about what fetuses are able to experience depend on the interpretation of secondary evidence. As discussed, neuroanatomical pathways necessary for processing pain, similar to those observed in adults and older children, could be in place by 23 weeks’ gestation. The stereotypical hormonal stress response of adults or older infants, of about 18 months onwards, reporting pain is observable in fetuses at 18 weeks’ gestation. Behavioural reactions and brain haemodynamic responses to noxious stimuli, comparable to adults or older infants, occur by 26 weeks’ gestation. These and other observations (figure) are taken to suggest that the fetal mind can support an experience of pain from at least 26 weeks’ gestation.

Inferences of fetal pain from such indirect evidence, however, present considerable difficulties. One is that many environmental factors inherent to the womb provide for a distinction between the environment of fetuses and that of neonates. The placenta provides a chemical environment to encourage sleep and to suppress higher cortical activation in the presence of intrusive external stimulation. The environment of the womb consists of warmth, buoyancy, and a cushion of fluid to prevent tactile stimulation. In contrast to this buffered environment, the intense tactile stimulation of birth and the subsequent separation of the neonate from the placenta, facilitate the rapid onset of behavioural activity and wakefulness in the newborn infant. Birth marks the transition from laying down brain tissue while in the womb to organising that tissue for the wider world outside the womb.

The detection of a hormonal stress response to noxious stimuli at 18 weeks gestation by, in particular, Dr KJS (Sunny) Anand, has been used, in the United States, as evidence to support/justify lowering the upper time limit for elective abortions for all this evidence fails to demonstrate anything other than nociception and provides no evidence of awareness on the part of the foetus. When pressed on this last point, the best that Anand – who has acted as a paid expert witness is several court cases arising out of legislation restricted access to abortion on the basis of claims relating to foetal pain – has been able to suggest is that there could be some other mechanism for pain perception is foetuses which operates prior to 23-26 weeks gestation, although he has yet to provide any evidence of the existence of such a mechanism or even speculate on what it might look like and how it might operate. In short, his   this area fall some considerable way short of amounting to a hypothesis and provide no actual evidence of pain perception at all.

Again this weight of neuroanatomical evidence, Ward Platt sets nothing more substantial than his ‘everyday experiences’ as a neonatologist:

In contradiction to the notion of the ‘unaware’ fetus, the everyday experience of pregnancy – the felt behaviours and responses of the unborn baby, especially to sound – as well as much primary research literature on the human fetus, contains strong evidence for an opposite view. There is an extensive literature, in humans, on fetal sleep and wakefulness, fetal motility, fetal memory, fetal hearing, fetal breathing and its control and fetal behaviour – and these are just examples that scratch the surface. None of this work is easily reconciled with the notion of a permanently unconscious human fetus. The third point in box 1 is simply not true.

Ward Platt does throw in a clutch of references – 6 in total – from the ‘extensive literature’ that he believes he has to support his position, however, his views on the merits of this research literature are, to say the least, somewhat questionable:

Most of the evidence that we have on prebirth experiences affecting later childhood or adulthood is anecdotal, unscientific, and based on subjective interpretation.

James et al. ‘Fetal learning: a prospective randomized controlled study‘, Ultrasound in Obstetrics and Gynecology, 2002; 20: 431–438

This study, which actually reports an apparent habituation response in foetuses to auditory stimuli ‘analogous to a simple form of programming or learning’ makes some interesting observations when discussing its own limitations:

However, we acknowledge that our study has limitations also. Though the mothers in the Study Group could not hear the sound generated by the earphone, they could have been aware of vibrations on the abdomen. In theory, this could have influenced fetal behavior. There are studies relating maternal anxiety, emotional, and psychological state to fetal behavior. Thus, it is possible that awareness that music was being played to their fetus could have led to different levels of anxiety between the two groups. We did not measure this. In addition the study does illustrate the inherent problems in using behavioral responses such as heart rate, activity, and mouthing or sucking in the fetus and newborn in fetal learning research. For example, in the Control Group over the 4 hours of study there was a spontaneous and significant change in fetal behavior (Table 3). Examination of the response to a stimulus must take into account the spontaneous variation in fetal and newborn behavior. Most of the published studies have not addressed this issue.

Indeed – the commentary on the short comings of earlier research in this field, including some of the research cited by Ward Platt, is particularly illuminating:

In summary, several of these studies of fetal learning using an exposure model have produced convincing evidence of fetal learning. However, they illustrate that this area of research is very difficult with many of the studies having methodological limitations summarized in Table 5. These limitations include not being prospective, not being randomized, not using a novel stimulus (one that the fetus and newborn could never have heard before), not using a ‘sham’ or ‘dummy’ stimulus, not including a control group, not demonstrating both a fetal response to the stimulus and an evolution of that response with repeated exposure, and not excluding the possibility that neonatal exposure learning could have occurred.

Based on that list of methodological limitations, I’m not sure quite how anyone could claim that this is ‘convincing evidence’ and keep a straight face at the same time, and it must be stressed that when James et al refer to ‘learning’ all they are actually talking about is rudimentary form of ‘programming’ along the line of Pavlovian conditioning. Not a single one of these studies provides any concrete evidence of actual awareness, let alone consciousness and, so far as I can ascertain, none were conducted on foetuses before they reached 28 weeks gestation.

Nevertheless, Ward Platt goes on to state:

Once the notion of the ‘unaware’ fetus is robustly dismissed, the observations of parents, nurses and neonatal doctors, on newborn but extremely premature babies, together with rigorous research, become relevant. We know from our everyday experience that there is no substantial difference between the behaviours and responses of babies at 23, 24 and 25 weeks.

Which might be well and good had the notion of the unaware foetus actually been robustly dismissed – which it hasn’t been – after which Ward Platt make an appeal, for the second time, to ‘everyday experience’ or – to put it more succinctly – to anecdote, the plural of which is not evidence.

Superficially, Ward Platt may appear to advancing an evidence-based, scientific argument – and its one that has certainly fooled Nadine Dorries, not that that’s much of feat – but in reality the argument he deploy is simply the all-too-familar argument from personal incredulity.

I, Dr Martin Ward Platt, cannot imagine how the ‘behaviours’ I see in severely premature neonates could arise in the absence of awareness and subjective experience therefore these neonates – and by extension, foetuses at the same stage of development – must be aware.

That he has no actual evidence beyond his own subjective, and unreliable, interpretations of what he sees while doing the day job is neither here nor there – seeing is believing.

Except that, in reality, it isn’t and our ‘everyday experiences’ are often anything but reliable. The human mind isn’t a computational engine which analyses sensory input from the external world in precise and exacting detail. Its more of a collection of assumptions, biases, heuristics and bit of educated guesswork, short-cuts which often come together to trick us into seeing things that, in reality, just aren’t there.

Many of the more obvious examples of this phenomenon relate to the processing of visual information, i.e. optical illusions such the Necker cube and the phenomenon of pareidoila which explains, amongst other things, why some people ‘see’ images of religious figures, such as Jesus, or the Virgin Mary, in the stains on brickwork or the burn marks on a tortilla or a piece of toast. Pareidoila is a subclass of a phenomenon called apophenia – or, as Michael Shermer calls it, ‘patternicity’ – a tendancy to seek patterns in random data, events and natural phenomena.

What Ward Platt is exhibiting here is somewhat akin to what the philosopher Daniel Dennett calls the ‘intentional stance':

Here is how it works: first you decide to treat the object whose behavior is to be predicted as a rational agent; then you figure out what beliefs that agent ought to have, given its place in the world and its purpose. Then you figure out what desires it ought to have, on the same considerations, and finally you predict that this rational agent will act to further its goals in the light of its beliefs. A little practical reasoning from the chosen set of beliefs and desires will in most instances yield a decision about what the agent ought to do; that is what you predict the agent will do. -The Intentional Stance, p. 17

Foetuses and neonates are not, in actuality, ‘rational agents’ but they are, nevertheless, small humans in appearance and it is therefore very easy to ascribe a degree of agency to them without even thinking about it – given half a chance, humans will happily ascribe agency to inanimate objects as well, which is why the sight of Basil Fawlty thrashing an old Austin 1100 with a tree branch is just incredibly funny. Throw saliency and attribution theory into the mix and its not at all difficult to understand how a neonatologist might arrive at the [false] assumption that foetuses and  seriously premature neonates exhibit behaviours which suggest awareness even if if the neuroanatomical evidence indicates that this is not yet a possibility at a given gestational age. This also explains how and why researcher’s subjective impressions when trying to study foetal ‘behaviours’ in utero can prove to be deceptive and, of course, at a much cruder level, anti-abortion campaigners trade on these same biases as a matter of routine by peddling ultrasound and computer generated of foetuses exhibiting behaviours such as ‘walking’ and thumb-sucking in utero with the suggestion that these are somehow conscious/voluntary behaviours when, in reality, this is anything but the case.

Having slipped off the path of science into wishful thinking, Ward Platt begins to regain some ground with his next observation, this first sentence of which Dorries quotes in her post in the mistaken belief that it supports her position on abortion:

Over the last 20 or more years, researchers have accumulated good observational, experimental and pathophysiological reasons to consider that babies at these gestations do feel pain, that they benefit from analgesia, and that pain experiences in early life cast neurophysiological and behavioural shadows far down childhood. Equally importantly, babies have a right to receive humane treatment. We work from an ethical imperative that even though these babies cannot verbalise their experiences, and cannot remember them in any way comparable to a child or adult, they should not be subject to pain or distress if we can possibly prevent or treat it. From this argument, there is no reason not to treat the 23-week fetus like a 24- or 25-week fetus, just as we do for babies.

Ethically-speaking, Ward Platt is back on solid ground but he is still – on the best current evidence – wrong in asserting that argument for using analgesia in severely premature neonates – or foetal anaesthesia where corrective surgeries are performed in utero – has anything to do with these neonates, or foetuses ‘feeling’ pain as this article by Luke la Hausse de Lalouvière indicates:

Though it is understood that the fetus is unlikely to be aware in the womb, this does not mean that noxious stimulation in utero can be ignored. The central and peripheral nervous systems undergo profound changes throughout gestation and the normal maturation of the cortex relies, in part, on the signals it receives from the outside world and from movement in the womb. Cushioned by amniotic fluid and potentially kept in a sleep-like state, the fetus’s exposure to noxious stimulation is very limited. In the case of extremely premature infants, as young as 23 weeks, the immature nervous system is thrown into a world of sensory information. Due to their immaturity, these infants are committed to prolonged stays in intensive care units. Within this setting, pain is a daily reality for these patients. Frequently performed procedures, such as heel lancing, intubation and cannulation, are both invasive and painful. The immaturity of the cortex brings the potential for cortical reorganisation and spinal sensitisation due to noxious input. As a result, clinicians have turned to analgesics to prevent the adverse consequences of painful interventions.

The issue is not that neonates feel pain but rather that the foetuses immature cortex is not equipped to handle the sensory input from noxious stimuli and this, it turn, may have an adverse impact on future cortical development, a very real issue in itself but not one that relies on the neonate possessing the awareness or undergoing pain as a subjective experience, which is why the article goes to conclude that:

As with most individuals who cannot communicate, it may never be possible to categorically determine when exactly the human fetus or neonate feels pain. The evidence for the existence of fetal pain is weak. Hormonal responses reflect the activity of areas other than the cortex and act as surrogate measures of arousal rather than pain. The neural building blocks that relay nerve impulses from the skin to the cortex are likely to be in place by at least 24 weeks gestation, but the intracortical connections required for the full pain experience take longer to become established. In addition, there is evidence that the fetus may not be conscious and therefore have no awareness during this time.

What cannot be ignored, however, is the profound ability of sensory information to shape the developing brain. Adverse noxious events both within the womb and beyond, in neonatal intensive care, may have detrimental effects upon the developing nervous system. Thus, effective analgesia in very immature infants could be viewed more as relief from future problems rather than from immediate pain.

For a neonatologist this is valuable information.

For a woman considering having an abortion, its of no relevance whatsoever. The overwhelming majority of abortions take place long before pain becomes even a hypothetical issue and, on current evidence, it could arguably be considered relevant only in relation to the very small number of abortions which take place after 24 weeks gestation, most of which arise as a consequence of serious foetal disability.

To sum up, there is no evidence that foetuses can feel pain before 24 weeks gestation and there is no evidence that foetuses are sentient or possess even a rudimentary spark of awareness before cortical development begins in earnest from the third trimester onwards.

Dorries’ claim that:

Late abortion procedure now caters for the fact that a foetus can feel pain. This is why Drs wont perform a late term abortion until the baby has first been injected with a lethal injection into the heart whilst in utero and then left for long enough to ensure the injection has worked before operating.

…is a complete nonsense.

Feticide is used in part as a sop to the sentimental feelings of adults involved in the procedure, including, of course, the women whose pregnancy is being terminated – it offers reassurance even where the scientific evidence indicates that none is actually needed – and it ensures that the foetus is dead before its expelled or removed from the womb, depriving the anti-abortion lobby of one of its favourite, and mostly apocryphal, horror stories. Whether feticide is used or not makes absolutely no difference whatsoever to the foetus – dead is dead however you want to try and look at it.

I said earlier that there’s a punchline to this article, which Dorries helpfully provided in her own pseudoblog post, and it comes in two parts, starting with:

But it’s all about science. Which is about the definition of fact. Which facts are indisputable and which are not. There are as many ‘facts’ as you wish to choose from on both sides of the argument.

I have chosen the ‘fact’ I wish to believe. It’s up to those who don’t believe a foetus in the womb can feel pain to test their facts and prove that it can’t and that is the issue, it cannot be proven. Science is about testing until the facts are indisputable and absolute. There is enough evidence to suggest a baby could feel pain, pretty compelling actually, for me to be of the opinion that if  if there is any element of doubt, shouldn’t the decision whether or not to abort at 20 weeks be a value based decision? If the scientific evidence either way cannot be proven 100% we have to ask what kind of society are we?

Is there a competition underway for the most errors you can compress into three sentences?

Science is not about the definition of fact, nor is about which facts are indisputable and which are not – some facts may easily be undisputed as but still lead to disagreements over the correct manner in which they should be interpreted in light of other evidence.

In science, you don’t get to choose which facts you do and don’t wish to believe – facts are facts. Dorries’ problem here is not her choice of facts but the absence of facts, and other credible scientific evidence, to support her position. That’s why she resorts to the fallback position of cranks and quacks the world over and demands absolute proof.

Sorry Nadine, but science doesn’t do absolute proof, even without resorting to Humean radical scepticism. Not even those few laws of physics that are expressed in mathematical terms can be genuinely considered to absolutes, as should be obvious to anyone who takes the time to contrast Newtons Law of Gravity with the picture of gravity set out in Einstein’s General Theory of Relativity. Scientific knowledge is alway provisional and based on the best available evidence, and the best available evidence we have for the time being indicates that foetuses don’t feel pain, in fact they don’t have any subjective feelings at all, they just are.

Cranks like Dorries demand ‘100% proof’ only because the scientific evidence doesn’t support their position at all and, of course, because they know absolutely fuck all about science – just about the only time you’ll ever hear a scientist use the words ‘100% proof’ is when they’re asking a lab technician to pass them a bottle of pure ethanol – and what this tells about our society is simply that one of the downsides of democracy is that even complete morons like Dorries get given a public platform, although the upside is, of course, that the internet now provides us with unprecedented opportunities for us all to point and laugh at idiots like Dorries.

As for the question of whether the decision whether or not to abort at 20 weeks be a value based decision. It is a value based decision – I don’t know of a single scientist who has ever suggested otherwise. The real question is that of exactly whose values that decision should be based upon, those of the woman who wants a termination or those of know-nothing MP and her religious buddies and, for me, that’s a bit of no brainer with or without bothering to hack my way through all the science.