I don’t have time to research this in depth, but am pretty sure this post is missing a lot of nuance about how anesthesia works in abortion. Importantly, because mother and fetus share a circulation, IV sedation that is given to the mother will—to some extent—sedate the fetus as well, depending on the specific regimen used. So it’s not quite right to say “The fetus is administered a lethal injection with no anesthesia.” Correspondingly, I think this post overstates the risk of fetal suffering associated with abortion.
This description of labor induction abortion says:
The skin on your abdomen is numbed with a painkiller, and then a needle is used to inject a medication (digoxin or potassium chloride) through your abdomen into the fluid around the fetus or the fetus to stop the heartbeat.
That sounds like local anesthesia for the mother, which from what I understand is achieved through an injection which numbs the tissue in a specific area rather than through an IV drip. So I don’t think this protocol would have any anesthetic effect on the fetus, though I’m not a medical expert and could be wrong.
Based on this, I think the sentence “The fetus is administered a lethal injection with no anesthesia” is accurate.
Again, I think this post is missing nuance; for example:
Induction of fetal demise is done through a variety of means in multiple respects—different medications are given (i.e., digoxin, lidocaine, or KCl) via different routes (i.e., intra-fetal vs. intra-amniotic). (Given that lidocaine is a painkiller, I could see a different version of this post compellingly making the case that to the extent clinicians have discretion in choosing what agents to use to induce fetal demise, they should prioritize using ones that are likely to have off-target analgesic effects.)
So, the link you post refers to a small minority of abortions, as it’s only routine to inject the amniotic fluid (specifically) with potassium chloride (specifically) prior to the delivery of anesthesia in some second-trimester abortions.
Potassium chloride is a medication that’s routinely given via IV to replete potassium. The dose has a significant effect on how painful this is, as does the route of administration; people tolerate oral potassium fine. Importantly, the fetus is not even being given KCl intravenously (vs. intra-amniotically or intra-fetally), so it’s hard for me to infer from “it is sometimes painful to get KCl via IV” that it would be painful for a fetus to get potassium via a different route. Correspondingly, then, I don’t think the “inflames the potassium ions in the sensory nerve fibers, literally burning up the veins as it travels to the heart” applies.
I agree that clinicians should use lidocaine or digoxin over potassium chloride (KCL) for the reason you gave.
I wrote that the injection is “often of potassium chloride”, not always.
Given that the fetus is receiving a lethal dose of potassium chloride, I don’t think adults tolerating a much smaller medicinal dose should tell us much about how painful a lethal dose would be?
I agree that the fetus isn’t being given potassium chloride intravenously, although I didn’t know that when I wrote the post (another commenter pointed it out). I’ll add a line in the post disclaiming that comparison.
It is common ground in the lethal-injection context that the administered fatal dose of KCl would be excruciatingly painful without proper anesthesia (although that is in an IV context). I don’t know what dose is being used in abortions, but the lethal-injection dose is 100 to 240 mEq at once. I was given 15 mEq per hour in the hospital last month, although it can be done somewhat more quickly if there is an acute need. So I agree that adult toleration of a very gradual dose isn’t helpful evidence here.
I don’t have time to research this in depth, but am pretty sure this post is missing a lot of nuance about how anesthesia works in abortion. Importantly, because mother and fetus share a circulation, IV sedation that is given to the mother will—to some extent—sedate the fetus as well, depending on the specific regimen used. So it’s not quite right to say “The fetus is administered a lethal injection with no anesthesia.” Correspondingly, I think this post overstates the risk of fetal suffering associated with abortion.
This description of labor induction abortion says:
That sounds like local anesthesia for the mother, which from what I understand is achieved through an injection which numbs the tissue in a specific area rather than through an IV drip. So I don’t think this protocol would have any anesthetic effect on the fetus, though I’m not a medical expert and could be wrong.
Based on this, I think the sentence “The fetus is administered a lethal injection with no anesthesia” is accurate.
Again, I think this post is missing nuance; for example:
Induction of fetal demise is done through a variety of means in multiple respects—different medications are given (i.e., digoxin, lidocaine, or KCl) via different routes (i.e., intra-fetal vs. intra-amniotic). (Given that lidocaine is a painkiller, I could see a different version of this post compellingly making the case that to the extent clinicians have discretion in choosing what agents to use to induce fetal demise, they should prioritize using ones that are likely to have off-target analgesic effects.)
So, the link you post refers to a small minority of abortions, as it’s only routine to inject the amniotic fluid (specifically) with potassium chloride (specifically) prior to the delivery of anesthesia in some second-trimester abortions.
Potassium chloride is a medication that’s routinely given via IV to replete potassium. The dose has a significant effect on how painful this is, as does the route of administration; people tolerate oral potassium fine. Importantly, the fetus is not even being given KCl intravenously (vs. intra-amniotically or intra-fetally), so it’s hard for me to infer from “it is sometimes painful to get KCl via IV” that it would be painful for a fetus to get potassium via a different route. Correspondingly, then, I don’t think the “inflames the potassium ions in the sensory nerve fibers, literally burning up the veins as it travels to the heart” applies.
I agree that clinicians should use lidocaine or digoxin over potassium chloride (KCL) for the reason you gave.
I wrote that the injection is “often of potassium chloride”, not always.
Given that the fetus is receiving a lethal dose of potassium chloride, I don’t think adults tolerating a much smaller medicinal dose should tell us much about how painful a lethal dose would be?
I agree that the fetus isn’t being given potassium chloride intravenously, although I didn’t know that when I wrote the post (another commenter pointed it out). I’ll add a line in the post disclaiming that comparison.
It is common ground in the lethal-injection context that the administered fatal dose of KCl would be excruciatingly painful without proper anesthesia (although that is in an IV context). I don’t know what dose is being used in abortions, but the lethal-injection dose is 100 to 240 mEq at once. I was given 15 mEq per hour in the hospital last month, although it can be done somewhat more quickly if there is an acute need. So I agree that adult toleration of a very gradual dose isn’t helpful evidence here.