Conjoined Twins

Conjoined twins happen once in every 200,000 live births (Maryland). Conjoined twins are identical twins whose bodies are joined in utero. Most are stillborn and others are born with severe abnormalities that make living a normal life almost impossible. The survival rate of conjoined twins is between 5 percent and 25 percent (Maryland). The most common form of conjoined twins is thoracopagus twins. These types of twins share the same heart. Some of the other types of conjoined twins include omphalopagus in which the twins are conjoined at the lower chest but no heart is involved.
Parasitic twins are when twins are asymmetrically conjoined. One twin is dependent on the larger twin for survival. Another type of twin is the craniopagus twins in which the skulls are fused together. Surgical separation of conjoined twins is a risky procedure and requires extreme precision. Success rates have been improving but it is still rare. Surgical separation is often the only way that the conjoined twins can survive. The success rates of separation make it difficult though to make this decision. Separation often results in one or both twins deaths. This leads to the ethical dilemma on whether to separate conjoined twins.
Recent research has found that the quality of life for conjoined twins is often higher than is commonly supposed. There have been many different controversial cases regarding the separation of conjoined twins. A noted case is the “Jodie” and “Mary” judicial decision. Jodie and Mary were a set of combined twins that were brought to the court of appeals in England. Mary was dependent on Jodie for survival because many of her vital organs were within Jodie’s skeletal structure. The twins’ parents were devout Catholics and were against the separation of the twins, despite the doctors wishes.

The physicians decided to bring the matter the courts. The judicial decision was to separate the two and this ultimately led to Mary’s death. Jodie survived and is still doing well after a year (Kaveny). The case of Jodie and Mary caused many ethicists to look at the ethical and legal issues regarding surgical separation. The article “One into two will not go: conceptualizing conjoined twins” responds to the judicial decisions following the surgery. The article discusses three conceptual possibilities. One possibility is that one twin is a person and the other twin is just an extra body.
This allows for an easy decision which involves separation and the survival of one twin. Another possibility is that the two conjoined twins are two separate physical beings. A third possibility is that the twins are psychologically different people but they share the same body, so neither has rights over the body. Another article, “The Case of Conjoined Twins: Embodiment, Individuality, and Dependence,” Cathleen Kaveny analyzes the same case and discusses two different views of embodiment. The two different views are the “Bodily Distinctness View” and the “Bodily Relatedness View. Kaveny discusses both views and their role in making an ethical decision regarding separating conjoined twins. There are many reasons to keeping twins conjoined. Conjoined twins are two separate people with their own personalities. So much has been done to accommodate for their lifestyle and make it easier for them to live a normal life. The twins become close with each other along with their parents and others. If the twins are old enough, separating them can often lead to psychological issues from the separation and guilt that comes with losing a twin.
Guilt and separation issues also happen with parents and those in charge with making the decision. Losing a child is extremely devastating and that is ultimately what the parents are doing. Most often one twin can survive but the other will die. The quality of life of the twins has to bad enough that risking one life or possibly two will be worth it. There are also many reasons for surgically separating conjoined twins. Conjoined twins often need to be separated in order to survive. Separating the conjoined twins can help to save one or possibly both twins. It is also allowing for one or both to have a normal, long life.
Separation can guarantee survival for at least one twin which seems to be the most beneficent. A good quality of life for at least one person seems to outweigh a bad quality of life and possibly a shortened life of two conjoined persons. One ethical principle relating to the issue is beneficence. Beneficence means to do what is good. Beneficence is tough when it comes to the separation of conjoined twins because of the many issues that lie in the decision. The beneficent principle goes hand in hand with the utilitarian theory which is making a decision that brings about the most benefit to the most people.
Both choices have beneficent aspects. Keeping the twins conjoined is good for the parents of the children, the children, and anyone who is close with them such as family and friends. It can make them happy and help them psychologically. Separating the twins can be good for the parents and the twins if they survive and get to live a productive and good life. It also is good for the community to have someone who is productive and capable of taking care of themselves in the community. According to the beneficent principle it seems that separating the twins will do the most good for the most people.
Another ethical principle relating to the issue is autonomy. Autonomy states that people should be allowed to reign over themselves and make their own decisions. This means that making a decision to separate the twins is up to the parents or the twins according to their age. This is one of the reasons that the ‘Jodie’ and ‘Mary’ case is an ethical issue. The debate is that the decision should ultimately be the parents due to the autonomy principle. The surgical separation of conjoined twins is a much debated topic on what the best choice is and who is ultimately in charge of making this decision.
The decision will most likely never be made and it will be a highly debated topic for as long as conjoined twins are being born. Doctors, parents, and government officials will always be debating on whose decision it is to separate conjoined live twins. After doing research on the ethical issues surrounding the separation of conjoined twins, I have formulated many opinions on this dilemma. The best way to resolve the dilemma, I believe, is to leave the decision of separating conjoined twins to the parents or the twins. Taking the decision to the courts and trying to go above the parent’s choice seems ethically unfair and wrong.
Leaving the decision to the parents seems to be the most beneficent and regards the ethical principle of autonomy. I am undecided on whether the best decision would be to separate the twins or keep them conjoined. There were many ethical issues surrounding this dilemma and the pros and cons for both sides were just too complicated for me to make a complete decision. The decision would be a tough one This conclusion was reached after reading the articles about the ‘Jodie’ and ‘Mary’ case and reading research on other cases. Both articles that I have chosen bring up many points regarding both sides of the argument.
One article was focused on the choice of whether to separate conjoined twins or keep them conjoined and the other article discussed the ethical reasons on not allowing the parents to decide the fate of their own children. The success rates of separation are low but the quality of life for the separated twins is much more. Bibliography 1. Bratton, M. Q. , and S. B. Chetwynd. “One into Two Will Not Go: Conceptualising Conjoined Twins. ” J Med Ethics 30 (2004): 279-85. 2. Kaveny, Cathleen M. “The Case of Conjoined Twins: Embodiment, Individuality, and Dependence. ” Theological Studies (2001): 753-86

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