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Fetal Pain, Abortion, Viability, and the Constitution

Published online by Cambridge University Press:  01 January 2021

Extract

On April 13, 2010, Nebraska enacted a new state ban on abortion in the Pain-Capable Unborn Child Protection Act that ha caught the attention of many on both sides of the abortion debate, and has inspired other states to attempt similar measures. The statute requires the referring or abortion-providing physician to make a “determination of the probable postfertilization age of the unborn child” (defined as, “the age of the unborn child as calculated from the fertilization of the human ovum”) and makes it illegal to induce or attempt to perform or induce an abortion upon a woman when the “probable postfertilization age” of the fetus is “twenty or more weeks” unless the doctor determines in “reasonable medical judgment (1) she has a condition which so complicates her medical condition as to necessitate the abortion of her pregnancy to avert her death or to avert serious risk of substantial and irreversible physical impairment of a major bodily function or (2) it is necessary to preserve the life of an unborn child.”

Type
Independent
Copyright
Copyright © American Society of Law, Medicine and Ethics 2011

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References

Leg. Bill. 1103 § 1(5), 5 (Neb. 2010), available at <nebraskalegislature.gov/FloorDocs/101/PDF/Slip/LB1103.pdf> (last visited March 4, 2011). The act defines “fertilization” as “the fusion of a human spermatozoon with a human ovum.” Id., at §1(3).+(last+visited+March+4,+2011).+The+act+defines+“fertilization”+as+“the+fusion+of+a+human+spermatozoon+with+a+human+ovum.”+Id.,+at+§1(3).>Google Scholar
On February 24, 2011, Kansas’ House approved its own fetal pain law, with a vote in the senate still pending. Hanna, J., “Kansas House Approves Nebraska-style Fetal Pain Abortion Bill,” Associated Press, February 24, 2011.Google Scholar
See supra note 1, at §1. The use of “postfertilization” in the legislation is curious and at odds with clinical practice. Arguably, it connotes a sense of accuracy that is absent in obstetrics. Traditionally, physicians estimate the gestational age of fetus based on the last menstrual period (LMP) of the pregnant woman. Conception is assumed to occur between 11 and 21 days after the first day of the LMP. The standard estimated gestational age by LMP, then, typically includes two “extra” weeks prior to actual fertilization. In this paper, we move back and forth between LMP and postfertilization when referring to gestational age. References to postfertilization gestational age are definitionally two weeks less than references to gestational age calculated by LMP (e.g., 20 weeks postfertilization equals 22 weeks by LMP).Google Scholar
Id., at §5.Google Scholar
It also differs from legislation introduced in several states that require physicians to inform patients seeking abortion that there is the possibility that fetuses feel pain. See Tobin, H., “Confronting Misinformation on Abortion: Informed Consent, Deference and Fetal Pain,” Columbia Journal of Gender & Law 17, no. 1 (2008): 111152, at 113–114.Google Scholar
Roe v. Wade, 410 U.S. 113, 163–64 (1973).Google Scholar
City of Akron v. Akron Ctr. for Reprod. Health, Inc., 462 U.S. 416, 457–458 (1983) (O'Connor, J., dissenting).Google Scholar
Planned Parenthood of Se. Pa.v. Casey, 505 U.S. 833, 860 (1992) (plurality).Google Scholar
Carhart, 550 U.S. at 124.Google Scholar
Sayeed, S., “The Problem of Non-Identity in Valuing Newborn Human Life,” Georgia State Law Review 25, no. 4 (2009): 865899.Google Scholar
Tyson, J. et al., “Intensive Care for Extreme Prematurity - Moving Beyond Gestational Age,” New England Journal of Medicine 358, no. 16 (2008): 16721681.CrossRefGoogle Scholar
Verloove-Vanhorick, S., “Management of the Neonate at the Limits of Viability: The Dutch Viewpoint,” BJOG 113, Supp. 3 (December 2006): 1316. American Heart Association and American Academy of Pediatrics, “2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Neonatal Resuscitation Guidelines,” Pediatrics 117, no. 5 (May 2006): e1029–e1038.CrossRefGoogle Scholar
Kusuda, S., Fujimura, M., Sakuma, I., Aotani, H., Kabe, K., Itani, Y., Ichiba, H., Matsunami, K., Nishida, H., Neonatal Research Network, Japan, “Morbidity and Mortality of Infants with Very Low Birth Weight in Japan: Center Variation,” Pediatrics 118, no. 4 (October 2006): e1130e1138.CrossRefGoogle Scholar
See Sayeed, , supra note 13, at 856–899; Lemons, J. A., Bauer, C. R., Oh, W., Korones, S. B., Papile, L. A., Stoll, B. J., Verter, J., Temprosa, M., Wright, L. L., Ehrenkranz, R. A., Fanaroff, A. A., Stark, A., Carlo, W., Tyson, J. E., Donovan, E. F., Shankaran, S., and Stevenson, D. K., “Very Low Birth Weight Outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 through December 1996. NICHD Neonatal Research Network,” Pediatrics 107, no. 1 (January 2001): E1E8.Google Scholar
See Kusuda, et al., supra note 16; Wood, N. S., Marlow, N., Costeloe, K., Gibson, A. T., and Wilkinson, A. R., “Neurologic and Developmental Disability after Extremely Preterm Birth. EPI-Cure Study Group,” New England Journal of Medicine 343, no. 6 (2000): 378384.Google Scholar
Leg. Bill. 1103 § 2(1).Google Scholar
Id., at § 5.Google Scholar
Leg. Bill. 1103 § 3(6) (Neb. Jan. 1, 2010) (First Reading Version), available at <nebraskalegislature.gov/FloorDocs/101/PDF/Intro/LB1103.pdf> (last visited March 4, 2011). All other references to the bill are to the version that was actually enacted.+(last+visited+March+4,+2011).+All+other+references+to+the+bill+are+to+the+version+that+was+actually+enacted.>Google Scholar
Given that “nonsentient” creatures do not feel pain, the reference to pain to non-sentient creatures in the earlier version of the statute is mysterious.Google Scholar
Leg. Bill. 1103, at § 5.Google Scholar
Lee, S. et al., “Fetal Pain: A Systematic Multidisciplinary Review of the Available Evidence,” JAMA 294, no. 8 (2005): 947954.CrossRefGoogle Scholar
Derbyshire, S., “Fetal Pain: Do We Know Enough to Do the Right Thing?” Reproductive Health Matters 16, no. 31, Supp. (2008): 117126.CrossRefGoogle Scholar
See also Tobin, , supra note 7, at 147–151 (reviewing existing evidence for claim that fetuses feel pain at 20 weeks gestation and declaring them “questionable on the issue of truthfulness, and [] misleading.”). For these reasons we are skeptical of the medical claim that fetuses feel pain and think it poorly factually grounded. As a matter of doctrinal constitutional law, however, it is at least possible that the Roberts court may defer to Nebraska's legislative findings on this issue despite their poor factual foundations. In two of its recent abortion decisions, the Court has sent mixed signals on deference to legislative findings in the abortion context. In Stenberg v. Carhart, 530 U.S. 914 (2000), the majority did not mention deference while the dissent chastised the majority for failing to afford the legislature deference; see id., at 1017 (Thomas, , Dissenting, J.); id., at 967–970 (Kennedy, J., dissenting, ); see Tobin, , supra note 6, at 132–134. More recently, in Gonzales v. Carhart, speaking to the question of a possible health exception the majority suggested no deference, writing: “Although we review congressional factfinding under a deferential standard, we do not in the circumstances here place dispositive weight on Congress' findings[; t]he Court retains an independent constitutional duty to review factual findings where constitutional rights are at stake,” suggesting that “some recitations in the Act are factually incorrect” and that “uncritical deference to Congress’ factual findings in these cases is inappropriate.” 550 U.S. 124, 165–66 (2007). The Court is far from pellucid as to what it means by “in the circumstances here” and “in these cases,” and the same opinion also offers some cues in the other direction. See Tobin, , supra note 7, at 133–134. Thus, while deference seems less likely given these precedents the matter is far from resolved.Google Scholar
International Association for the Study of Pain, “IASP Pain Terminology,” 2004, available at <http://www.iasp-pain.org/AM/Template.cfm?Section=Pain_Definitions&Template=/CM/HTMLDisplay.cfm&ContentID=1728> (last visited March 4, 2011).+(last+visited+March+4,+2011).>Google Scholar
Leg. Bill. 1103, at § 5.Google Scholar
Harrison, M., Evans, M., Adzick, N., and Holzgreve, W., The Unborn Patient: The Art and Science of Fetal Therapy (Philadelphia: W.B. Saunders Co., 2001).Google Scholar
Casey, 505 U.S. at 935.Google Scholar
See, e.g., Singer, P., Animal Liberation (New York: Random House, 1975).Google Scholar
Cohen, I. G., “The Constitution and the Rights Not to Procreate,” Stanford Law Review 60, no. 4 (2008): 11351196. Under the version of the “combination” argument we have been discussing, it is pain to a human fetus coupled with the state's growing but not-yet compelling state interest before viability that in combination constitutes a compelling state interest that overcomes the woman's abortion right claim. We have settled on that variant because it is the most favorable to the Nebraska law, but, inspired by the pain standing alone argument, one could also imagine a less plausible variant that treats pain to all sentient beings alike in terms of the “combination.” Where might the two versions diverge? Imagine that the only way to perform an abortion at 20 weeks postfertilization age was to inject into a woman serum from a chicken brain that could only be gathered by subjecting the chicken to excruciating pain, but which would be painless for the womans fetus. Under this less plausible version of the combination argument, the state should be able to prohibit the abortion because of its interest in preventing pain to a non-person capable of feeling it (the chicken) in combination with its desire to preserve fetal life (of the fetus). On the one hand, that result seems strange, and it seems hard to imagine the Supreme Court upholding such a prohibition. On the other hand, one might ask: Why should the constitutional status of the abortion act change just because it is the same entity to whom we want to prevent pain and preserve life? One answer might be that fetal pain “counts” more because its victim is human, but again one might worry that the reason why is “speciesism” of the kind decried by Singer, supra note 32.Google Scholar
Thus, it is possible that on some of these other theories the presence or absence of fetal pain might be more relevant to the permissibility of abortion.Google Scholar
Thomson, J. J., “A Defense of Abortion,” Philosophy and Public Affairs 1, no. 1 (1971): 4767.Google Scholar
Thomson herself discusses these issues. Id., at 58–65.Google Scholar