Law Paper Example: The Legal and Ethical Dilemma of Conjoined Twins

In the recent years, there have been related reports appearing in the news media about conjoined twins. Conjoined twins have been the theme of medical study, scientific exhibition, human inquisitiveness and sometimes showbiz. Conjoined twins result from a rare pregnancy phenomenon when the human ova fails to completely separate during pregnancy resulting in united identical twins like the famous Siamese brothers Chang and Eng Bunker. Chang and Eng Bucker were bone in Siam (as referred to then) in 1811. Conjoined twins provoke fascination in both the scientific and legal worlds. The ethical dilemmas and legal battles surrounding conjoined twins have been so significant in the recent years. The primary question in this regard is whether conjoined twins should be viewed as one or two identities. This paper delves into the legal personality of conjoined twins and the relevant laws that focus on the rights and obligations of conjoined twins.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Order now

Chang and Eng Bunker were connected at the Sternum but possessed separate organs and limbs. They lived active lives up to the age of 63 and fathered 21 children by rotating weeks with their respective wives. They toured the world with Barnums circus and referred to them as Siamese twins while promoting them. Siamese is what is currently referred to as conjoined and conjoined twins are individuals physically joined during conception for reasons that are not yet medically understood. They occur very rarely at a birth rate of 1 in 200000 survival births with approximately 60% of conjoined twins being stillbirth and 35% die within 24 hours of birth. Girl Siamese twins also outnumber boys by three to one, but in all cases, each twin has a different personality from the other. They are linked by flesh, bone or ligaments and can be joined at the chest, abdomen, head or hip. With the recent medical advances, it is possible to separate conjoined twins. However, most twins possess more complex interdependency of limbs and organs which make it difficult to separate them. In most cases, one of the siblings ends up dying after the separation.

An ethical dilemma results when the siblings do not equally contribute resources, but rather one is considered parasitic by the fact of total dependency on the sibling. In this regard, the main legal and ethical question has always been, should doctors be allowed to sacrifice one of the Siamese twins to save the other. It is the life and death demand that most families with conjoined twins face. They go to the medical specialist with the hope of relief, yet they meet bewilderment, heartaches, and uncertainty. Making that decision of whether to separate the conjoined twins has never been an easy one. In most cases, it hinges on the balancing the survival projections if the twins are left unseparated against the prognosis if detached. The decision-making is left in the capacity of parents and doctors to determine the fate of the conjoined twins. The resolution to detach conjoined twins is mostly hard due to the strain in matching the contending, legal, ethical and medical rights of the kids deprived of bias towards any of them while staying compassionate and rational at the same time. In this perspective, the operating process is as difficult as the legal and ethical features surrounding such scenarios.

The Plight of Twin Sacrifice: Biologically Essential Detachment

A biologically essential separation is needed once there is a sound substantiation that if the twins stayed conjoined, it would lead to the death of both primarily due to the biological functioning of one, ensuing in a physiological botch of the other because of the shared circulatory mechanisms. In such situations, there is a deep-seated intuition to save life where conceivable, even if this may be at the price of quickening the death of the other twin. In this regard, biologically essential detachment openly contradicts the two twins right to well-being and life which therefore necessitates ethical and legal justification for the involved sacrifice.

Case Studies

Queensland v. Nolan case

In this case, the conjoined twins Bethany and Alyssa shared a draining vein but has separate brains. Bethany lacked an operational renal tract to eliminate waste products from her circulation thus absolutely reliant on Alyssa for existence. Ultimately, Bethany got pulmonary edema and cardiac failure which reduced her death to a span of 24 hours. There was substantial evidence indicating that if she dies her twin also dies and surgical separation was the only option remaining for survival with a 20% to 40% possibility of surviving the surgery for Alyssa, but for Bethany death was inevitable. Therefore, in this circumstance, the projection for Bethany, the fragile twin was dreadful just within hours with or without separation. Thus, only Alyssa would benefit from the surgery.

When it comes to the detachment of Siamese twins surgically, various ethical principles are employed. For instance, In planning separation it is unacceptable to sacrifice a priori one twin on behalf of the second. The parents must be informed of the risks of an operation and the possibility that one or both twins may die during it. If they consent to the operation, it is then for the neurosurgeon to decide the best possible management. Undoubtedly, conjoined twins present a deviance from the structural standard, however, does this nonconformity oblige adjustment, or it is a feature that ought to be acknowledged as an uncommon deviation of the ordinary? Undoubtedly, recognizing the conjoined twins has remained the utmost feasible choice in almost all scenarios. However, this is only practical in scenarios that do not entail a countdown biologically to death or functional failure. In such scenarios, researcher pose, is it acceptable to sacrifice one twin? Some families decide on the surgical separation once they realize that that is the only reasonable decision for the survival of the other twin. In such regard, twin sacrifice is considered tolerable, and the detachment must be considered if either of the twins will get a chance to live an independent, normal life. In this case, it was agreed upon that the dangers of detachment should be recognized if there was substantial evidence demonstrating that the surgery would enable one of the twins to have an ordinary life experience.

Re A (Conjoined Twins) [2001] 2 WLR 480

The legal and ethical dilemma surrounding twin sacrifice was also evident in the separation of the Siamese twins, Mary and Jodie from Manchester who were linked at the pelvis with four legs and united spinal cords. The weaker twin, Mary was entirely dependent on her twin Jodie for survival and was almost viewed to possess anomalous brain and cardiorespiratory systems with a narrow life period even as a Siamese twin. By performing surgical separation, it would mean Mary dies, and Jodie survives. The parents did not consent to the separation arguing that, Everyone has the right to life, so why should we kill one of our daughters to enable the other to survive? In this regard, the twins eventually dying without separation was considered as a natural course of their lives. This case was quite a challenge for the Lord Justices of the Court of Appeal as they tried to decide on the contradicting principles of the welfare of children, preservation of life and the essentiality of finding some rationale for the legal murder of one of the twins in an attempt to safeguard the other. In as much as all the three judges agreed with the High Courts pronouncement to detach the twins, their reasoning was dissimilar. Lord Justice Ward employed the concept of self-defense in the regard that Mary was attacking Jodie since their connection had significant effects on Jodies survival chances and if they are separated, it will be considered as Jodie finding assistance to defend herself from Jodie, thus, aiding the guiltless victim. He further reasoned that the twins were confronted with only two options yet, both had adverse effects for Mary but probable advantage for Jodie. Therefore, it would be prudent for the Court to select the lesser evil between the two choices. On the other hand, Lord Justice Brooke, idealized necessity as a rationale for authorizing detachment whereby lawfully killing Mary was defended by necessity since it was the only way Jodies life would be saved. Lord Justice Robert Walker abridged his outlook as, The proposed operation would not be unlawful. It would involve the positive active surgery, and Marys death would be foreseen as an inevitable consequence of the surgery which is intended, and is necessary, to save Jodies life. But Marys death would not be the purpose or intention of the surgery, and she would die because tragically her body, on its own, is not and never has been viable.

The intricacies, in this case, were so complex and complicated including the fact that should Jodie stay alive after the operation; then she would be left with substantial incapacities which would necessitate complex continuing therapeutic necessities for which treatment is unavailable in their home country. There was a possibility that her parents would have to leave her in a foster home or under the care of the state. The underlying question in this regard is, if the Court orders intervention against the wishes of the parents and oblige them to take care of the surviving child for what may be many years with potentially significant emotional, financial, medical, practical and social effect on them, other family members and the child itself. Does the court or the state have any responsibility to provide ongoing care to the child? What if the parents disregard their responsibility of taking care of the child since their moral, religious, and parental views were not considered, will they be justified? It was a landmark twin separation case, and clearly, the Court of Appeal grappled with determining the contending opinions of the welfare of children, preservation of life and the need to find rational to authorize the killing of Mary to save Jodie.

Siamese Twins: The Bounds of Law at the Limit of Life

Until 2000, during the determination of the case of Mary and Jodie, Siamese twins had never been subjected to the legal battle. This case illustrated the struggle of employing legal principles to the extraordinary life-and-death decision encompassing recommended medical intervention for twins whose parents and doctors differ on the best thing to be done. If this case was presented in the United States, the parents judgment would be ultimate except if the state or physician proved to the judge that it was an act of child neglect. The U.S still operates on the provisions used in the 1993 American case of the two Siamese girls who unfortunately did not survive the surgery. In England, the applicable law is dissimilar since once the judge is presented with such a case, the judge needs to resolve in what is the best interest or welfare of the child by employing objective and independent judgment. The judge only considers the parents decision as one piece of evidence to be used in the determination of the case. The legal reasoning of the different judges on the panel was conflicting which can be explained by the extraordinary characteristics of the case as well dependence on legal correlations that were impractical in this case.

Lord Justice Alan Wards Opinion

Lord Justice Ward began his breakdown by acknowledging the exceptionality of Mary and Jodies case. He broke down the details of the case by stating that it involved killing Mary, the fragile twin who would still have been feasible as a singleton and to offer Jodie a worthwhile life. After providing the medical intricacies of the case, Lord Justice Ward notes that while every instinct of the me...