Andaya Elise, Campo-Engelstein Lisa
Department of Anthropology, University at Albany, USA.
Institute for the Medical Humanities, Preventive Medicine and Population Health, University of Texas, USA.
Soc Sci Med. 2021 Jan;269:113558. doi: 10.1016/j.socscimed.2020.113558. Epub 2020 Nov 29.
In 2020, the Pain Capable Unborn Child Protection Act was brought to an unsuccessful Senate vote for the third time in five years. The Act seeks to prohibit abortions after 20 weeks post-conception based on the scientifically contested claim that fetuses are at that point capable of feeling pain. It thus seeks to undermine Roe v. Wade's viability standard by asserting that the capacity for pain perception is sufficient for "compelling governmental interest" in fetal life. The ability of many NICUs to offer life-sustaining interventions for periviable neonates means that, in many states, neonatologists and physicians who provide second-trimester abortion care may manage cases of the same gestational age. Given this overlap, this qualitative study examines how clinicians think about the capacity of periviable entities to feel pain and how these ideas shape clinical practice and understandings of compassionate care. Drawing on twenty semi-structured interviews conducted between June 2019 and April 2020 with clinicians providing second-trimester abortion care and NICU care in the Northeast United States, it examines how pain is "known" in the periviable period and how clinicians think about pain in relationship to personhood. A key finding is that the meaning of pain and implications for clinical care is shaped by the anticipated futures and personhood status of periviable entities as determined by pregnant people and families of neonates. Clinicians also stated that concerns around the alleviation of suffering, defined as long-term or chronic distress for pregnant people and/or neonates and their families, were more pressing than the potential experience of short-term physical pain. Legislative attempts to make contested ideas of "fetal pain" the basis for "governmental interest" ignores other forms of suffering that might result from denial of options, and potentially places clinicians at odds with their own conceptions of competent and compassionate care.
2020年，《能感知疼痛的未出生胎儿保护法》在参议院进行表决，这是该法案五年内第三次未获通过。该法案试图禁止在受孕20周后进行堕胎，其依据是一项存在科学争议的主张，即胎儿在这一阶段能够感知疼痛。因此，该法案试图通过声称疼痛感知能力足以构成政府对胎儿生命的“迫切利益”，来削弱罗诉韦德案确立的 viability 标准。许多新生儿重症监护室有能力为接近 viability 的新生儿提供维持生命的干预措施，这意味着在许多州，提供孕中期堕胎护理的新生儿科医生和内科医生可能会处理相同孕周的病例。鉴于这种重叠情况，本定性研究考察了临床医生如何看待接近 viability 的个体感知疼痛的能力，以及这些观念如何塑造临床实践和对关怀护理的理解。基于2019年6月至2020年4月期间在美国东北部对提供孕中期堕胎护理和新生儿重症监护护理的临床医生进行的20次半结构化访谈，研究考察了在接近 viability 阶段疼痛是如何被“知晓”的，以及临床医生如何思考疼痛与人格的关系。一个关键发现是，疼痛的含义及其对临床护理的影响，是由孕妇和新生儿家庭所确定的接近 viability 的个体的预期未来和人格状态所塑造的。临床医生还表示，对于减轻痛苦的担忧，被定义为孕妇和/或新生儿及其家庭的长期或慢性痛苦，比短期身体疼痛的潜在体验更为紧迫。将存在争议的“胎儿疼痛”观念作为“政府利益”基础的立法尝试，忽视了因剥夺选择权可能导致的其他形式的痛苦，并可能使临床医生与他们自己对胜任和关怀护理的观念产生冲突。
