Medical, religious values clash over conjoined twins

The parents of a pair of conjoined (Siamese) twins have decided not to appeal a court ruling in a case whose legal, religious, and ethical dimensions might tax the powers of the biblical King Solomon.

The case focused on when, or if, it is justifiable to take one life to save another, and who gets to make the choice; whether parents, doctors, or judges should have the final say in determining medical treatment for children; and how much religion, culture, and "quality of life" should factor in to decisions on whether to perform complex procedures.

On Sept. 22, a panel of three senior appeals-court judges decided to allow doctors to separate the infant girls, identified in court under the pseudonyms "Jodie" and "Mary."

Doctors acknowledge that Mary, the weaker of the two, could not survive on her own. But without separation, medical experts say both will die within a few months.

The parents, deeply religious Roman Catholics from the Maltese island of Gozo in the Mediterranean, argued that their faith does not allow them to sanction killing one daughter even in order to save the other. The parents told the appeals court, "We cannot begin to accept or contemplate that one of our children should die to allow the other to survive. That is not God's will."

They added that the expert medical care the surviving girl would need is not available in their remote village. Further, the parents said, they feared the local social stigma attached to the disabled.

The parents had been considering whether to appeal to the House of Lords. The upper house of Parliament is Britain's final court of appeals.

But Official Solicitor Laurence Oates, who represents minors in court cases, said yesterday that the parents had notified him that they did not wish to make a further appeal.

"I am satisfied that the decision will not set a precedent, which would undermine the principles of law deriving from and supporting the respect for the sanctity of life and the belief that all life has equal value, which I have been most concerned to uphold," Mr. Oates said in a statement released to the media.

Roman Catholic and other religious leaders have spoken out in support of the parents' right to reject a medical procedure that would result in death for one child, a subject that generated heated debate in Britain.

The depth and character of the dilemma posed by the case was stressed last week by Lord Justice Alan Ward, who presided in the appeals court.

Delivering a judgment that he termed "excruciatingly difficult," Mr. Justice Ward said, "It is in the best interests of Jodie that separation takes place." He noted, "[Mary] is incapable of independent existence. She is ... living on borrowed time." Ward added that permitting the operation was the "least detrimental choice."

Another appeals judge said he had consulted the writings of Aristotle and Cicero in an attempt to make up his mind and had finally decided that separation was justified.

On Gozo, the court's decision had caused deep dismay. In Xaghra, the parents' village, people immediately gathered in church to pray for the twins.

The twins' paternal grandmother told London's Daily Telegraph: "The judgment was wrong. It is up to the parents to decide. To them and to us, it is God's will."

Archbishop Cormac Murphy-O'Connor, head of the Roman Catholic Church in England and Wales, has said separating the twins would be "morally impermissible," because Mary had "done nothing which could justify killing her."

In a submission to the appeals court, he wrote: "Respect for the natural authority of parents requires that the courts override the rights of parents only when there is clear evidence that they are acting contrary to what is strictly owing to their children.

"In this case, the parents have simply adopted the only position they felt was consistent with their consciences and with their love for both children."

Most other mainstream British churches have had little to say on the case, calling it a private matter. But David Goldberg, senior rabbi at London's Liberal Jewish Synagogue, says the appeal court judgment took "scant account of what constitutes personality, feelings, or the spiritual essence of a human life."

A spokesman for the East London Mosque told Britain's Sunday Telegraph, "The general view of Islam is that life and death are in the hands of the Almighty alone.... On that basis, you could say that perhaps it is better to leave things as they are rather than take any decision to intervene."

The ruling has divided medical opinion. John Harris, professor of medical ethics at Manchester University, says the appeal court was "trying to force the parents to violate their fundamental beliefs."

Harvey Marcovich, a senior physician at the London-based Royal College of Paediatrics and Child Health, says it was "right that the law should make the final decision."

Los Angeles surgeon Harry Applebaum, who has separated conjoined twins, also backs the court's decision. "I would hate to see both twins die when one could be saved," he says.

Jodie and Mary were born on Aug. 8 at a hospital in Manchester, in northern England. Their parents came to Britain because their homeland was ill-equipped to provide medical services for the complex birth. The parents refused the hospital's offer of an abortion.

The hospital then decided to ask the courts to approve the twins' separation and to declare that surgeons performing the operation would not be guilty of the unlawful killing of Mary.

Surgeons describe Jodie as "bright and alert," but they concede that there is no guarantee that she would survive an operation.

Lewis Spitz, of London's Great Ormond Street Hospital for Children, says that if she survives, Jodie would require further reconstructive surgery.

Professor Spitz has helped to separate several pairs of conjoined twins.

There was no immediate word on when the surgery might take place. Medical experts say the "ideal time" would be in about two months, but it could be brought forward to October if the girls' condition deteriorates.

(c) Copyright 2000. The Christian Science Publishing Society