Twins' Surgeon Talks of Failed Separation

B A L T I M O R E, July 12 -- Renowned Johns Hopkins neurosurgeon Dr. Ben Carson was one of the lead doctors who this week sought to separate conjoined twins Laleh and Ladan Bijani.

Survival odds were stacked against them. Should doctors still have attempted to grant the Iranian twins their wish?

Dr. Carson discussed medicine and morals with Nightline's Chris Bury. Excerpts of the interview appear below:

CHRIS BURY: You've performed at least three successful surgeries on conjoined twins, but these were all done with infants, with children. What made this particular operation [this week] different, and perhaps more difficult?

DR. BEN CARSON: The big difference here is that these young ladies had been fused for 29 years, so their brains were extraordinarily adherent to each other. So we didn't have the advantage of being able to establish planes and to pull them apart.

Number two, the bones were incredibly thick, particularly along the base, like a brick. And number three, they're large individuals. With the babies, we can work on the front, flip them over, work on the back. This was not going to be a possibility with individuals of a combined of 100 kilograms or more. So those were things that precluded us from being able to do things in the normal fashion. …

BURY: Did they meet the definition of informed consent? … I read that one of the surgeons on the team actually argued to them that they shouldn't undergo this operation.

CARSON: More than one. They made a very strong bid to dissuade them from having surgery, but again, they continued to reiterate that their lives, as they existed, were worse than death.

BURY: Was this, though, at the end of the day, elective surgery? I mean, after all, they had been living as conjoined twins for 28 years. They could have gone on living for some number of years beyond.

CARSON: They probably would have lived on for several more years. As you probably know, conjoined twins frequently die considerably earlier than the general population, simply because complications that might not normally affect someone have profound effects on them. …