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One into two will not go: conceptualising conjoined twins
  1. M Q Bratton1,
  2. S B Chetwynd2
  1. 1The Chaplaincy, University of Warwick, Coventry, UK
  2. 2Department of Philosophy, University of Warwick, Coventry, and School of English and Philosophy, Keele University, Staffs, ST5 5BG, UK
  1. Correspondence to:
 Revd M Q Bratton
 The Chaplaincy, University of Warwick, Coventry, CV4 7AL, UK; cpsadcsv.warwick.ac.uk

Abstract

This paper is written in response to controversial judicial decisions following separation surgery on conjoined twins “Jodie” and “Mary”. The courts, it is argued, seem to have conceptualised the twins as “entangled singletons” requiring medical intervention to render them physically separate and thus “as they were meant to be”, notwithstanding the death of the weaker twin, “Mary”. In contrast, we argue that certain notions, philosophical and biological, of what human beings are intended to be, are problematic. We consider three compelling conceptualisations of conjoined twins and advocate a model that conceives them as two psychologically separate individuals who happen to share a body, the sharing of a body being integral to the individuality of each twin. While we reject an “essentialist” view of the conjoined state, a view which might render separation surgery unthinkable in all cases, we nevertheless argue against an “adversarial” interpretation of conjoined twins’ respective best interests. We maintain that the physical entanglement should be regarded as a shared problem rather than one posed by one twin to the other. And if, after deliberation, separation surgery is deemed the “least detrimental alternative” or the “lesser of two evils”, then there should be recognition of what conjoined twins will lose, as well as gain, through separation. The current drive to separate twins at all costs may evince a deeper unease with bodily configurations that appear to threaten the premium that the Western ethical and legal tradition places on personal sovereignty, and the physical circumscription that such sovereignty assumes.

  • body
  • conjoined twins
  • defect
  • individuality
  • person

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Footnotes

  • * In the context of conjoined twins, by “sustaining independent existence” we mean sustaining life independent of their mother, not of each other.

  • Later in the paper we will attempt to clarify in what sense conjoined twins might be thought of as “separate” and where that might be inappropriate. For now, we are using the term in a non-contentious way.

  • “Mary may have a right to life, but she has little right to be alive. She is alive because and only because to put it bluntly, but none the less accurately, she sucks the lifeblood of Jodie and she sucks the lifeblood out of Jodie. She will survive only so long as Jodie survives. Jodie will not survive long because constitutionally she will not be able to cope. Mary’s parasitic living will be the cause of Jodie’s ceasing to live. If Jodie could speak, she would surely protest, ‘Stop it, Mary, you’re killing me.’ Mary would have no answer to that. Into my scales of fairness and justice between the children goes the fact that nobody but the doctors can help Jodie. Mary is beyond help” (Re A,1 1010 h-j).

  • ** Thomson’s violinist analogy concerned a hypothetical famous violinist who is, for life saving purposes, surreptitiously attached to the healthy kidney of a dormant, unsuspecting surrogate. Thomson uses this analogy to sketch out the relationship between pregnant woman and fetus in essentially contractual terms.

  • †† This observation is also cited by Dreger (Dreger,12 p 5).

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