Twin Dilemma Divides The World
The Age
Saturday September 9, 2000
LONDON
The case of the Siamese twins, known simply as Jodie and Mary has assumed biblical proportions, not least for Britain's judiciary, but even the wisdom of Solomon would seem incapable of resolving the ethical dilemma.
Worldwide, the plight of the twins who cling to life in an incubator in a Manchester hospital, is the subject of fierce debate.
University examiners could hardly compose a tougher test for budding ethicists - to separate the twins and cause the death of the weaker child, or let nature run its course, in which case both children will almost certainly die.
On radio talkback and in online chat rooms votes are being cast, even from Australia.
``Surely the doctors do not think that they have the right to decide on behalf of the parents which child should die?" wrote one Australian this week in an e-mail to the BBC. ``Let the parents have the final say."
But non-intervention is not necessarily the majority view. Others argue that saving a life is paramount.
``It's an unpleasant thing to know that you're going to end the life of a child in favor of another," said a Londoner. ``But it's perverse to choose to let them both die rather than have the courage to make that decision."
Next week, three Law Lords sitting in Britain's Court of Appeal will decide whether the twins, joined at the abdomen and born almost five weeks ago, will be surgically separated.
Legal observers expect them to sanction an earlier High Court ruling and choose separation, at the cost of the life of the weaker child, Mary.
But their ruling may not end the matter. The parents, devout Roman Catholics from a remote part of Eastern Europe, have indicated that they will take the case to the European Court of Human Rights if their appeal fails. ``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," they have told the court.
So far, battle lines have tended to be drawn between the medical profession, which advocates separation, and those who like to refer to the sanctity of human life. Universally, however, the combatants agree that the decision is an agonising one.
The Roman Catholic Archbishop of Westminster, the Most Reverend Cormac Murphy O'Connor, encapsulated the dilemma: the moral principle that it was wrong to do evil, even if it resulted in good, had to be balanced against the need to save a life, he said.
But he added: ``It does seem to me that the wishes and the instinct of the parents are very, very important in this case."
The couple, whose identity has been suppressed, came to Britain to seek expert medical attention when it emerged their daughters were conjoined - a one in 50,000 occurrence.
The Law Lords this week ordered a second medical opinion from a specialist team from London's Great Ormond Street Hospital for Children, which has separated 17 sets of twins. An experienced surgeon and a paediatric cardiologist concluded the original diagnosis by doctors at Manchester's St Mary's Hospital was fair.
The city's health authority had gone to the High Court to obtain legal sanction for the separation after concluding the twins would only survive a few months without surgery.
The weaker child, Mary, was born without a heart or lungs and with an underdeveloped brain, and relies on Jodie for oxygenated blood. But the strain on Jodie's heart was telling, they argued.
In the appeal court this week, further evidence was offered about the twins' first hours of life, on August 8.
Mary gasped for breath as doctors sought to resuscitate her, but her lungs collapsed. Jodie came into the world more routinely, crying, kicking and waving her arms.
Medical notes were starkly contrasting. Of Jodie medicos wrote: ``Baby crying and active. Good HR (heart rate) and respiratory effort. Moving all four limbs." But Mary, they said, required a face mask and oxygen. ``Very stiff to ventilate. No chest movement or breath sounds."
Some consultants have argued that it was inaccurate, given her pathetic condition, for Mary to be referred to as a separate child. ``If the parents had been told at the beginning that they had a baby who had a congenital tumor attached to her resembling a baby, but in fact not a baby, would they have refused the operation?" wrote a Birmingham physician.
Lord Justice Ward, who told the court that the case was causing him sleepless nights, played devil's advocate, claiming that barristers for the doctors needed to persuade the court that it could exercise parental jurisdiction and say: ``Save Jodie but murder Mary."
``I put it starkly, but that may be what you are inviting the court to do," he added.
© 2000 The Age
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