Human Foetuses Experience Pain: A Position Paper.

Abstract

The perception and assessment of foetal pain remains a contentious topic due to challenges in evaluating and detecting non-verbal behaviours. While it is widely accepted that newborns experience pain, measured through validated behavioural scales, debate persists regarding the onset of pain perception during intrauterine development. We reviewed the available literature to prepare a position paper, aiming to argue that foetuses in their 2nd to 3rd trimester may in fact feel pain and exhibit different shades of consciousness. Emerging evidence challenges the binary view of consciousness (e.g., present/absent), suggesting that foetuses may possess some aspects of consciousness such as levels of awareness and responsiveness, both necessary and sufficient for pain perception. Advances in 4D ultrasound technology have enabled the assessment of foetal facial expressions indicative of pain, leading to the development of specialised foetal pain behaviour scales. Targeted hand movements, MEG and EEG provide further evidence of goal-directedness and action planning, while engagement in different learning paradigms (ex. habituation) provides evidence for preliminary memory and higher-order cognition. Research into foetal pain will contribute not only to better clinical care but will enrich the fields of bioethics and neurodevelopmental neuroscience. This position paper provides an overview of the current research concerning foetal pain behaviour and awareness. Reflections on foetal pain may bring insights not only to the pain field, but also to neuroethics, clinical and neurodevelopmental sciences.