MEDI7231 Study Guide - Final Guide: Trilobite, Parasitic Twin, Conjoined Twins
CONJOINED TWINS
Gillett G. When two are born as one: the ethics of separating conjoined twins. JLM. 2009;17:184-189
Introduction
Conjoined twins pose a serious challenge to medical ethics because most legally informed ethicists recognise
the need to respect sanctity of life for all children
Important to evaluate the ethics of treatment for conjoined twins carefully
Radica & Doodica Neik
Conjoined twin girls, 1888 born
1901 - one twin developed TB
Dr Eugene-Louis Doyen stepped in to separate the twins
Help treat TB twin & prevent spread of TB to other twin
TB twin, and the other twin contracted - they both died
Abby & Brittany Hensel
Conjoined girl twins
They have their own organs except for urinary organs
They have half a body each
Run, ride in perfect coordination
Due to their torso, it would be impossible to separate the twins
They appear to adjust well, and live happily joined together
Nolan case
Alyssa Grace & Bethany Rose Nolan
Conjoined craniopagus twin girls; extremely complicated surgery with low survival rate
Joined at the head with separate brains, however they share the cranial draining veins - this has enabled
Bethany to survive
No separation - B was imminently dying, and would’ve also resulted in death of A
Separation – A would survive, however B would have a hastened death
Standard cases and responses
Three possible situations of conjoined twins
o1 = A and B have a chance of life, either separated or together
o2 = A and B have a chance of life together; separated A has a chance of life & B will die
o3 = No chance of life together; separated A has a chance of life & B will die
Welfare principle
oDo no decide final decision by comparing respective worth of two lives
oInstead, evaluate outcome to be expected (wholeness of each twins life) if various approaches are taken
Substantial benefit principle
oClinical medicine should undertake only those interventions the outcome of which, now or in the future,
the patient would think worthwhile
oConsider whether the children will be able to live a fulfilling life, or will remain in a (near) vegetative
state
oAlso consider the financial and emotion costs involved to keep this barely sentient child alive
Psycho-social individuality
oDisregarding anatomical individuality, each twin may desire psycho-social individuality to aspire to
achieve their own goals on different pathways
Case 3
Best interests of the child Both twins are dying; despite hastening B’s death, it seems a necessary step to
separate in order to save A’s life
Potentiality principle Consider whether the future life of any child will give them a chance of a
meaningful human form of life; have the capacity to love and be loved;
important criterion for saving an infant’s life
B appears to not have a meaningful life, whether together or separated; A can
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Document Summary
Gillett g. when two are born as one: the ethics of separating conjoined twins. Conjoined twins pose a serious challenge to medical ethics because most legally informed ethicists recognise the need to respect sanctity of life for all children. Important to evaluate the ethics of treatment for conjoined twins carefully. Dr eugene-louis doyen stepped in to separate the twins. Help treat tb twin & prevent spread of tb to other twin. Tb twin, and the other twin contracted - they both died. They have their own organs except for urinary organs. Due to their torso, it would be impossible to separate the twins. They appear to adjust well, and live happily joined together. Conjoined craniopagus twin girls; extremely complicated surgery with low survival rate. Joined at the head with separate brains, however they share the cranial draining veins - this has enabled. No separation - b was imminently dying, and would"ve also resulted in death of a.
