In a recent exchange with the media, Spain’s Minister of Health, Mónica García , was directly questioned by a journalist about whether it is possible, from a healthcare perspective, to guarantee that the fetus does not suffer during an induced abortion and whether this procedure leaves lasting effects on the mother. The response from the nation’s top health official not only avoided providing a detailed technical or medical explanation, but also adopted a tone that directly questioned the relevance of the question itself.

In response to the reporter’s question, the Minister repeatedly stated that she did not understand the argument and challenged the journalist, asking if he believed there was evidence of fetal distress. After the reporter clarified that he was asking the question in his capacity as a journalist and not as a healthcare professional, Ms. García characterized the question as containing a “deniable undercurrent of denial regarding the reality of women’s rights.” During her remarks, the Minister categorically asserted that “there is more than enough scientific evidence that clearly demonstrates there is no suffering,” further maintaining that the procedure does not cause trauma to women.

Mónica García also accused political representatives of trying to convey to women that abortion is a trauma from which they will not recover, and argued that introducing the variable of fetal distress is “perverse enough to prevent what we are trying to avoid with this campaign , which is blaming women.” Finally, the Minister of Health defended women’s right to choose freely, protected by law, and framed the government’s position as being at the forefront of protecting the right to decide about motherhood.

Need for scientific comparison

The vehemence with which the health authority denied the existence of fetal distress and labeled the mere formulation of the neurobiological doubt as ‘perverse’ demands rigorous analysis. Is the assertion that there is ‘more than enough’ scientific evidence demonstrating the total absence of fetal distress scientifically and medically sound? Or are we, on the contrary, witnessing a simplification of the scientific debate motivated by ideological biases?

In contrast to the categorical ministerial statements, the Bioethics Observatory offers a considerably more complex and rigorous overview of the reality of neurodevelopment in the prenatal stage and the perception of pain.

Development of the nervous system and nociceptive pathways

Biological evidence indicates that the maturation of the human brain begins very early, specifically in the third week of gestation, undergoing extremely rapid growth and maturation throughout the entire pregnancy. Due to this dynamic of continuous development, it is scientifically unfeasible to establish a static or categorical threshold that sharply divides the stages of absolute absence and presence of pain.

Neuroanatomy and neurophysiology studies reveal that the connections between peripheral pain receptors and the thalamus in the human fetal brain are effectively established between weeks 19 and 22 of gestation. This functional interconnection allows for the transmission of nociceptive stimuli and the actual perception of painful sensations.

The neuroadaptive phenomenon of pain

In this regard, pediatrician and bioethics expert Dr. Carlo Bellieni states in his academic publications that fetal pain is not an illusion or an outdated concept, but rather a ‘neuroadaptive phenomenon that arises in the second half of pregnancy, around 20 to 22 weeks of gestation, and becomes increasingly evident to observers and significant to the fetus throughout the remainder of the pregnancy.’ Denying this neurobiological reality in the second half of gestation is to ignore the progress of current scientific literature.

Discussion on late pain thresholds and their clinical implications

There are institutional positions, such as that expressed by the American College of Obstetricians and Gynecologists (ACOG) , or specific publications in journals like Nature Neuroscience, that support much later pain thresholds. According to these positions, pain perception would not be possible before week 24 or 25 (when the maturation of the cerebral cortex is complete) or they even maintain that it is unlikely before weeks 29 or 30 of pregnancy.

However, as Dr. Bellieni clarifies, and as we at the Bioethics Observatory confirm, this ‘late pain threshold’ has received severe criticism from the scientific community due to its fragile physiological basis. Dogmatically asserting that pain only exists when the cerebral cortex is fully developed ignores the integrative role of subcortical and thalamic structures in processing suffering.

Ethical risks in clinical practice

Furthermore, the unquestioned adoption of a delayed pain threshold has disastrous clinical and ethically unacceptable consequences in daily medical practice:

• Care for extremely premature newborns: Currently, neonatal medicine achieves the survival of babies born very prematurely at 22 weeks of gestation. If it were assumed that they do not feel pain until week 24, 29, or 30, these newborns would be deprived of the fundamental right to pain relief during invasive medical procedures.
• Prenatal surgery and fetal analgesia: Similarly, fetuses under 24 weeks of gestation undergoing intrauterine surgery to correct congenital anomalies would not receive anesthesia or analgesia during the operations. Fortunately, nowadays anesthesiologists and neonatologists routinely administer analgesic medications to fetuses and newborns during these surgical procedures.

The precautionary principle in medicine

Faced with uncertainty or complexity in precisely defining the experience of pain, medicine and bioethics demand the rigorous application of the precautionary principle. Withholding analgesia during invasive surgery based on the dogmatic belief that the fetus does not experience pain constitutes medical malpractice and a malevolent and unacceptable act from the perspective of medical ethics.

Bioethical assessment

Human life possesses intrinsic value and inviolable dignity at every stage of its development, from the moment of conception until its natural end. The embryo and fetus are not mere cell clusters or appendages of the mother’s body, but human beings belonging to the species Homo sapiens with biological continuity and their own developing identity.

There is a growing trend in contemporary public debate: the attempt to use the supposed absence of fetal pain as an argument to lessen the ethical implications of abortion. The idea that ‘killing without pain is more humane, less reprehensible, or more compassionate’ is now widespread—a reductionist logic that is being applied to both induced abortion and contexts of euthanasia or the death penalty.

We believe this position contains a serious ethical fallacy. The moral gravity of taking the life of an innocent human being does not depend on whether the act is carried out with a greater or lesser degree of physical suffering or under the effect of analgesia. Taking a life remains an intrinsically reprehensible act and contrary to the principle of non-maleficence simply because it is performed using painless techniques.

Far from the distortion expressed by the Minister of Health, the reality of induced abortion encompasses profound dimensions of physical and psychological suffering that affect all parties involved:

1. The suffering of the aborted fetus: In abortions performed from weeks 19-22 of gestation onward, there is neurobiological evidence of the presence of thalamic receptors and connections that allow for the actual experience of physical pain during the destructive procedure. But even in earlier stages, when the nociceptive network is not fully formed, the fetus suffers the absolute ontological violence of being deprived of its own existence and its lifelong development.
2. The suffering of the mother: To claim that abortion is a neutral and harmless intervention that does not generate lasting effects or psychological impact is a misrepresentation of the available evidence on the consequences associated with induced abortion. Women who have abortions are immersed in a traumatic process where social pressures, a lack of alternatives, and the emotional pain resulting from the loss of a life in gestation frequently converge. Other effects, such as an increased risk of death, exacerbate the consequences for women who have abortions.
3. Induced abortion constitutes an act of violence through which a vulnerable and defenseless human life is deliberately ended.

From the perspective of public service ethics and medical responsibility, political representatives and healthcare administrators have an inescapable duty to act with scientific accuracy and objectivity. Dismissing questions about neurodevelopment and fetal and maternal suffering by labeling them ‘denialist,’ ‘perverse,’ or ‘blaming’ represents an intolerable trivialization of the issue, driven by ideological pressures and ignoring scientific evidence.

Manipulating scientific evidence or concealing data on fetal development to promote a political agenda or diminish the moral impact of abortion, thereby contributing to its widespread adoption, is unacceptable conduct that undermines institutional rigor. True compassion and respect for human dignity demand acknowledging the biological reality of the fetus and offering women genuine alternatives and comprehensive support, rather than ignoring the suffering inherent in the destruction of nascent life.

In conclusion, the categorical assertion by the Minister of Health, Mónica García, claiming that there is “more than enough” scientific evidence regarding the absence of fetal and maternal suffering related to induced abortion, does not correspond to the scientific and medical complexity documented in current neurobiological and obstetric literature. As demonstrated by the studies cited throughout this report, which can be found via the links embedded in the text, from weeks 19 to 22 of gestation, there are anatomical and functional bases that allow for the perception of pain in the fetus.

The attempt to deny fetal pain in order to lessen the drama of abortion constitutes an ideological bias that ignores the precautionary principle inherent in medical practice. From a personalist bioethical perspective, the dignity of nascent human life resides in its ontological status as a person, and any deliberate act aimed at destroying it is morally reprehensible, regardless of the presence of pain relief. Public administration must ensure truthfulness, scientific rigor, and the effective protection of the most vulnerable lives.

Hiding this information from women who experience unwanted pregnancies and are considering abortion constitutes an attack on their dignity, freedom, and autonomy.

(The hyperlinks inserted in the text contain the sources of scientific literature that support these claims.)

Julio Tudela. Cristina Castillo. Bioethics Observatory. Catholic University of Valencia