Siamese twins to be separated against parents' will

Siamese twins born in England can be separated—against their parents' wishes—to save the life of the stronger baby, even though the operation will kill the weaker twin, a High Court judge ruled last week.

In the first case of its kind in Britain, Mr Justice Johnson gave the go-ahead at the High Court in London for surgeons to operate on the twin girls, born on 8 August at St Mary's Hospital, Manchester.

The twins, given the false names of Mary and Jodie to protect their identities, were born to parents from a remote community in southern Europe who came to Britain for the birth after it was realised that the fetuses were conjoined.

Doctors say both twins will die within three to six months unless they are separated. But if the operation is carried out Jodie is likely to survive to live a normal life, though with some degree of disability.

The official solicitor, who represents Mary, opposed the hospital's application at a private High Court hearing, to ensure that arguments on both sides were before the judge. As the BMJ went to press, he was considering whether to lodge an appeal.

The babies' parents asked that no operation should be carried out and that “God's will” should prevail. They said that their community did not have the facilities to cope with Jodie's disabilities and they would have to leave her in Britain.

They were uncertain whether a family could be found to foster her. If she were adopted and they lost the right to have contact with her, it would break their hearts.

The twins are joined at the lower abdomen, and Mary relies on Jodie's heart and lungs for her blood supply. Mary's face is deformed, and she is thought to be brain damaged. She cannot cry because she has no lungs of her own.

Jodie, on the other hand, was described by the judge as “a bright and alert baby, sparkling, sucking on her dummy, moving her arms as babies do—very much a ‘with it’ sort of baby.”

Mr Justice Johnson said he had “attached great weight” to the parents' wishes, but a child's interests were “paramount.” He said that the law did not allow active steps to be taken to end a life, but treatment could lawfully be withdrawn. Mary's death would result from the “interruption or withdrawal” of the blood supply from Jodie. The few months of life Mary would have without the operation would be “very seriously to her disadvantage.”