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Ethics briefings
  1. Veronica English,
  2. Gillian Romano-Critchley,
  3. Ann Sommerville,
  4. Jessica Gardner
  1. Medical Ethics Department, British Medical Association

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    Conjoined twins

    On 8 August 2000 conjoined twins, known as Mary and Jodie, were born to Maltese parents at St Mary's Hospital in Manchester. Cases of conjoined twins are rare, affecting around one in every 100,000 live births. Mary and Jodie were joined at the lower abdomen. Jodie, the stronger twin kept Mary alive since Mary's vital organs were too damaged to sustain her. Had she been a singleton, Mary would not have survived. Mary's brain was described as having only primitive function whereas Jodie's appeared normal. They shared Jodie's aorta so that Jodie's heart supplied blood to Mary, which was oxygenated in Jodie's lungs. In sustaining Mary's life, considerable strain was exerted on Jodie's heart which, according to expert opinion, would fail within three to six months, resulting in both their deaths. To withdraw that life-line through separation would inevitably lead to Mary's death but give hope of survival to Jodie. The parents, however, said they could not consent to separation if this would result in Mary's death. The twins were equally precious to their parents who felt that it was “not God's will” for them or anyone to choose death for one. They could not agree to kill one even to save the other. Furthermore, it was uncertain that Jodie would survive surgery. If she did, she would require considerable care and further operations to build a vagina and anus. She might never be able to walk and her parents were uncertain that they would be able to look after her.

    Doctors sought a declaration from the High Court as to whether the operation was lawful in the light of the parents' refusal to consent.1 The doctors considered that they should try and save one twin rather than allowing both to die. The High Court authorised the doctors to …

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