Siamese Dilemmas

His wife was well into the late stages of pregnancy when the man brought her to the United Kingdom.  They came from a far-away country with strange customs.  There were complications and the woman gave birth to Siamese twins.

The couple were distraught, trying to read meaning into this disaster.  How had they offended their god to be punished in this way?  How would they cope when they went back to their village?  The doctors were sympathetic, but said there was little chance that the twins would survive for more than a few months.  And it was impossible that both twins could be saved by an operation to separate them.  "Which twin would die?" asked the father.  "The girl twin would die," said the doctors, "her brother possesses all the vital organs."  "And would the boy twin survive?" asked the father.  "It would be a difficult operation but there is a good chance that the boy would survive," said the doctors.  "Then you must operate and kill the girl baby to save my son," announced the father.

Of course, this case is hypothetical, but it poses difficult questions.  Unfortunately, the real case is just as difficult.  In the hypothetical case I have presented the solution as one in which the undervalued girl baby is sacrificed.  Most people in the west would find it hard to justify the motive behind the action.  In the real case the parents do not want the operation to take place, as a result of which the doctors accuse them of negligence.  It seems likely that the court will allow the doctors to act against the parent's wishes, and that an operation resulting in the certain death of a baby will take place.  The motive here is to save a life, which most people in the west would find acceptable.  In both instances, however, the result is the same.

Does this make us hypocritical, or are we more concerned with motive than consequence?  Should we always strive for survival at any cost, or do other factors come into play?  Should we value quality of life over life itself? 

Psychologists will tell us that survivors of disasters are often consumed by guilt.  In this case, the medical experts are proposing acting against the parents' wishes to attempt to save the life of one twin.  We know from other case studies that twins have their own shared identity, and that the death of one often results in severe trauma for the survivor.  But here we are giving one sister the ultimate guilt trauma ~ responsibility for the death of her twin.  Is this outcome so desirable that our best medical and legal experts are prepared to over-rule the parents and authorise the killing of a disabled baby?

There are no easy answers.  Sometimes parents might not be acting in the best interests of their children, and outside agencies must intervene.  Sometimes the issues are clear and unequivocal.  But where the shades of gray are almost indistinguishable surely we should attempt to support the parents in their ordeal, whatever their decision.

ã Harvey Tordoff
3rd September 2000