Intended for healthcare professionals


Conjoined twins separated after long legal battle

BMJ 2000; 321 doi: (Published 11 November 2000) Cite this as: BMJ 2000;321:1175
  1. Clare Dyer, legal correspondent
  1. BMJ

    A 20 hour operation to separate the conjoined twins Jodie and Mary at St Mary's Hospital in Manchester ended at 5 am on 7 November with Jodie, the stronger twin, surviving but her sister Mary dead. The operation, carried out by a team of 20 doctors and nurses, followed a three month legal battle watched by the world to decide their fate after their birth at the hospital in August to parents from the Mediterranean island of Gozo.

    The twins' parents, whose identities were protected by an injunction, had opposed the operation, wanting nature to take its course. Without an operation the prognosis was death for both twins, who were joined at the abdomen. But whereas surgery gave Jodie the chance of a reasonable life, her sister, who had a primitive brain and no functioning heart or lungs, faced an inevitable death. A High Court judge ruled in August that the operation could go ahead despite the parents' objections. Three appeal court judges upheld the ruling in September, and an eleventh hour attempt by the ProLife Alliance to take the case to the House of Lords for a final appeal failed in the High Court and appeal court last Friday.

    Six hours after the operation ended, the hospital said in a statement that Jodie was in a “critical but stable condition.” Although it had been certain that Mary would die—indeed the central issue in the Court of Appeal was whether it was lawful to kill one twin to save the other—the statement went on: “Unfortunately despite all the efforts of the medical team, Mary sadly died.” The twins were joined at the abdomen with fused spines, and arms and legs at right angles to their torso. Jodie has a normal brain, heart, lungs, and liver, but she shared a bladder with her sister.

    Jodie's degree of disability is uncertain, but doctors hope she will be able to walk, have children, and have a normal life span. She will have to undergo further surgery in the future. Mary was said to have been “draining the life” out of Jodie, whose heart and lungs had kept both babies alive. In the last 10 days of October, there was some deterioration in Jodie's heart function. Last Friday Bruno Quintavalle, director of the ProLife Alliance, asked the High Court to let him replace the Official Solicitor, Laurence Oates, as Mary's guardian, to allow him to appeal to the law lords. The appeal court had granted permission for a further appeal but Mr Oates had decided not to take it up after learning that the parents had become resigned to the operation. The president of the High Court's family division, Dame Elizabeth Butler-Sloss, rejected Mr Quintavalle's application, ruling that Mr Oates had acted with “complete propriety.” Two appeal court judges refused permission to appeal against her decision. The parents have agreed a six figure deal with Granada TV for an interview on the Tonight programme with Trevor MacDonald, to provide a fund for Jodie's future medical care.

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