Parents of Siamese twins appeal against separation

BMJ 2000; 321 doi: (Published 09 September 2000) Cite this as: BMJ 2000;321:589
  1. Clare Dyer, legal correspondent
  1. BMJ

    The parents of Siamese twins born in the north of England went to the Court of Appeal this week to try to overturn a High Court judge's ruling giving doctors the go-ahead to operate to separate the twins.

    As the BMJ went to press, a surgeon and a paediatric cardiologist from London's Great Ormond Street hospital were travelling to Manchester to examine the twin girls at St Mary's Hospital.

    The three appeal court judges had asked for a second opinion on the twins' life expectancy, the dangers of the surgery, the quality of life that the stronger twin can expect if she survives, and the “wholly bleak prospect” for the weaker. The specialists were expected to report back to the court by the end of this week.

    Two sets of conjoined twins have been separated at St Mary's Hospital, Manchester, which is caring for the twins. Great Ormond Street Hospital has greater experience, having treated 17 pairs.

    Lord Justice Ward said that the independent assessment had been ordered “simply to allay public concern that we might be rushing to judgment” in a complicated and difficult case. The judges gave permission for new scans if necessary.

    The parents, who are Roman Catholics and thought to be from a remote community in southern Europe, came to Britain for the birth—which took place on 8 August—because facilities in their home country were inadequate.

    On 25 August Mr Justice Johnson ruled that the operation should take place against the parents' wishes, sacrificing the weaker twin to save the stronger. Doctors from St Mary's told the judge that both twins—given the false names of “Jodie” and “Mary” to protect their anonymity—would die within three to six months unless the operation was performed, but that an operation could save Jodie's life.

    A key issue in the case is whether it would be lawful to end Mary's life to save Jodie or whether this would amount to unlawful killing. The attorney general has appointed a QC to advise the court on the criminal law implications.

    It could come down to whether Mary, who has a primitive brain, a useless heart, and non-functioning lungs and relies on Jodie as her life support system, is a person in her own right—whether the twins are in fact one baby or two.

    Lord Justice Ward said a life came into being when a fetus was expelled from the mother's womb and was capable of independent existence. “Mary isn't.” It could also be argued that Mary was an “unjust aggressor,” drawing her life blood from Jodie to Jodie's detriment, said the judge.

    The court was told that Jodie is of normal intelligence, although she would probably have some degree of disability. The parents believe that it would be against “God's will” to sacrifice one daughter for the benefit of the other, their counsel told the court. They want nature to take its course.

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