Court Rules to Separate Conjoined Twins

L O N D O N, Sept. 22, 2000 -- A British court has ruled doctors may operate to separate conjoined twin girls — killing one to spare the life of the other.

Three judges of the Court of Appeal ruled unanimously in favor of the separation despite the Roman Catholic parents’ determination to leave the infants’ fate to “God’s will.”

Doctors said the girls, identified only as Jodie and Mary, would die within months if they remained together, but that Jodie could survive on her own.

The surgery means death for baby Mary, who cannot survive without her sister Jodie.

“Though Mary has a right to life, she has little right to be alive. She is alive because and only because — to put it bluntly but nonetheless accurately — she sucks the lifeblood of Jodie and her parasitic living will soon be the cause of Jodie ceasing to live,” said Justice Alan Ward summarizing the judgment.

The case, however, may not end here. The parents will be allowed to appeal to the the House of Lords. Their lawyers say that decision hasn’t been made.

The questions put to the court, “Do we save Jodie by murdering Mary?” is one of the most stark and haunting asked in a court of law.

“Ultimately this is not a court of morals but a court of law,” said Ward. “We had to choose the least detrimental alternative. The scales came down heavily in Jodie’s favor.”

The court said Mary was “designated for death.”

It has been excruciatingly difficult. One’s heart bleeds for the family,” said Ward. “50 percent of the population will agree with the decision — 50 percent will think we have gone potty.”

Jodie and Mary

Jodie and Mary (fictitious names assigned by the court to protect their identities), were born six weeks ago at Saint Mary’s hospital in Manchester.

The parents of the twins, commonly called Siamese twins, traveled to Britain from a Mediterranean country (a court ruling bans identifying the country or the parents) when it became clear the local hospital couldn’t handle the difficult birth.

The two girls were born joined at the abdomen with their heads at opposite ends of their merged bodies and their legs at right angles from each side.

Jodie has a functioning heart, lungs and liver, Mary does not. Doctors say Mary has only a “primitive” brain and is “essentially a parasite” growing at Jodie’s expense.

Physicians originally gave the joined babies only a few months to live if not separated. A second medical opinion suggests they may live a little longer — perhaps a few years — but no long-term survival is likely without separation.

Separation means certain death for Mary. But it is Jodie’s only chance of surviving.

Parents Want God to Decide

The parents of the twins are deeply religious Roman Catholics. They say it is morally and legally wrong to sacrifice one of their children for the other and opposed the operation.

In a submission to the court they said, “We cannot begin to accept or contemplate that one of our children should die to enable the other one to survive. That is not God’s will.”

Their lawyer, John Kitchingman, said they wanted nature to take its course, even if that meant the loss of both children.

“The parents’ view is the children should be allowed to fulfill whatever life expectancy their medical condition permits.”

The children’s doctors disagreed, taking the case to the courts to fight for Jodie’s life.

The case has challenged the moral beliefs of doctors, judges, ethicists, priests and parents as they struggled with the questions of right and wrong, life and death.

Cormac Murphy O’Connor, Leader of Catholic Church in England and Wales, says the parents have a right to their objection.

“I think that the separation involves the direct killing of one of the children and even though there is a good intention and a good end that’s what I believe.”

The Moral Question

Dr. Richard Nicholson, editor of the Bulletin of Medical Ethics, said there was no obviously right answer in such a case. But he stressed consideration must be given to the wishes of the people who would have to live with the decision.

“The courts will not have to live with the decision, the doctors won’t, but the parents will.”

The three Lord Justices who ruled on this case had to consider difficult and complex issues — toughest of all, whether it would amount to the unlawful killing of Mary to allow the twins to be separated.

Most agree there is no right decision, only a choice between two wrongs.

And that may lead to more appeals, more delays. Some fear despite today’s decision the ultimate outcome will be determined by default, with inaction due to a continuation of the appeals process leading to the death of both children.

“For the judges involved it is one of the hardest rulings they will ever make,” writes Andrew Grubb, professor of medical law at Cardiff Law College, in the London Times.

Lengthy Legal Process

Britain’s High Court ruled on August 25 that the twins should be separated.

The case moved to the Appeals Court, which has agonized for weeks over its decision.

Legal experts say the case may not end here.

“Whoever loses in this case, will no doubt seek an appeal,” said legal expert Michael Zander of the London School of Economics.

As with the U.S. Supreme Court, parties must request and be granted the right to appeal to the nation’s highest court. If granted, it would be a minimum of at least a few weeks before the case could be heard.

Following that decision, the case could be appealed once again to the European Court of Human Rights.

If the case ends up in the European Court, “It could take a very, very long time,” said Zander.

Dr. James O’Neill of Vanderbilt University in Nashville, Tenn., is one of the world’s leading specialists in Siamese twins. He warns, a continuation of the legal appeals process could result in the death of both girls.

“Every day that goes by, the process of the ‘good’ body coming under pressure from the weaker one will increase substantially,” said O’Neill. “This progressive failure would first lead to the collapse of the kidneys, intestines and the liver before moving to impact the coronary system and, ultimately, the brain.

The optimal time for a separation, says O’Neill, is when the twins reached the two to three month period when their organs would be well enough developed to sustain the shock and trauma of the operation.