Law would require physicians offer anesthesia
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Law would require physicians offer anesthesia

Date: February 21, 2007
By: Arlene L. Bishop
State Capitol Bureau
Links: HB 196

JEFFERSON CITY - A Missouri state senator wants to write into law a practice on which the medical community has not yet come to a consensus.

Sen. Chuck Gross, R-St. Charles County, sponsored a bill to require abortion providers to notify a woman whose fetus is 20 weeks or more gestational age that there is a chance her fetus might feel pain during the procedure. The physician would also be required to offer the mother the option of anesthisia or anelgesic for the fetus as well as advise her of the associated risks.

Under the legislation, the information must be given to the mother in person at least 24 hours before the procedure or by mail at least 72 hours before. The mother would be required to certify that she received the information before the procedure could begin.

"Mr. Chairman, I believe that denying this option, denying the relief of pain for unborn children is denying their humanity," Gross said before the Senate Judiciary Committe Monday.

He said a large number of experts have agreeed that by 20 weeks gestational age a fetus has the capacity to experience pain.

Alison Gee, Vice President of Public Policy for Planned Parenthood of the St. Louis region, testified that there is no consenus in the medical community about when fetuses develop the physical structure to experience pain.

According to an August 2005 article on fetal pain in the Journal of the American Medical Association, several studies have been done, with varying results. One study concludes fetuses develop the necessary structure as early as 21 weeks gestation. Another concludes that they develop it as late as 30 weeks. The article also stated that one may need to learn pain.

"Because pain is a psychological construct with emotional content, the experience of pain is modulated by changing emotional input and may need to be learned through life experience," it reads. The article also stated that to experience pain, one must have the presence of consciousness and doctors have not determined when or if this occurs druing fetal development.

Gee testifed that no fetal anasthesiologists exist in Missouri.

The JAMA article stated that anasthesisa is used during surgery in utero, although not for the purpose of killing pain. Rather it is used to prevent fetal movement, increase muscle tone, prevent postpartum infant stress, and prevent long-term adverse developmental problems.

The article also stated that because pain perception is unlikely to occur until the third trimester, fetal anasthesia should not be required.

"Fetal anasthesia or analgesia should not be recommended or routinely offered for abortion because current experimental techniques provide unknown fetal benefit and may increase risks for women," it stated.

Gee also testified that few abortions of more than twenty weeks gestation occur in Missouri. Those that do occur past that stage, she said, were due to delays in access and unexpected, possibly fatal complications.

The JAMA article stated that this kind of legislation, which passed in Arkansas and Georgia in 2005, would affect few abortions, "because only 1.4% are performed at or after 21 weeks gestational age."

Committee chairman Sen. Matt Bartle, R-Jackson County, told Gee that if there is lack of consensus there is doubt.

"If there's doubt in the medical community, shouldn't that doubt be resolved in favor of providing pain prevention to the fetus that's being terminated?" he asked.

Gee said she was concerned about the mother's safety because she already receives analgesia during abortion.

"I'm concerned about what it would mean in terms of increased risk to the woman," she said. "Because when you look at it, you are indeed either asking for a procedure to be performed that isn't currently performed -- and that's anasthesia of the fetus -- or you're requiring an increased dosage to the woman which could prove fatal."

The JAMA article stated that there are no standards for administering anasthesia or analgesic for the purpose of aborting a fetus.

Sen. John Loudon, R-St. Louis County, supported the bill saying that anasthesia is used during surgery in utero.

"I think the question though really is very basic," he said. "If we don't allow cruelty to animals and we don't want to see anybody abusing something that can't protect itself, causing unnecessary pain. If we're going to euthanize dogs, we inject them in a painless process. So if we're going to carve up the smallest members of our own species, I would think we would want to err on the side of caution."

After several committee members demonstrated a lack of medical expertise, Sen. Chuck Graham, D-Columbia, said that part-time legislators shouldn't be making medical decisions and writing them into law.

"I imagine that these things are so extremely delicate that it takes such highly trained individuals with experience to make their best judgments for what's best for both (the mother and the fetus) and when we start writing things into statute as part-time legislators trying to practice medicine, I think that's where we can cause unintended consequences," he said.

Todd Scott, chief of staff for Bartle, said that the bill could come up for a committee vote as early as Monday. If passed, it would go to the Rules Committee before going before the full Senate.