Conjoined Twins

IronDuke

Ancient Mariner
Yesterday a set of twins were born in Vancouver, British Columbia. The little girls are joined at the head and they apparently share brain matter, making it extremely difficult to seperate them safely.

Is it morally right to perform the operation? Who decides which twin would get which parts of the shared brain tissue? Can they lead a normal life without being seperated? Is it right to perform drastic surgery like this without letting the girls themselves decide?

What social pressures do you think are on the mother, and eventually the grls, to look "normal"? Even if they are seperated, it's been noted that it'll be hard to reconstruct their bodies physically.

What's everybody's take on this kind of thing?
 
Oh dear. This is a pretty hard one, Iron Duke. I remember a few years ago (or it might have been a year?) there was a case where two twin girls joined at the head underwent surgery in India (I believe). They were quite old (not newborn or anything, I think in their twenties) and they said that they had rather undergo surgery and face the risk of dying, than to continue living as they did because it was degrading to them (imagine having to go to the toilet with someone attached to you!). They underwent surgery and died. This case is different because the girls involved are infants. They can't be asked their opinion because they can't even talk yet. What we don't know about the situation is whether it is life threatening to the twins to continue to be attached to each other. We can infer from the case I described earlier that it is life threatening to perform this type of surgery. We don't know either whether it would make a huge difference to separate them now, or when they're 20 and have their own opinion. It probably does matter, especially since you say brain tissue is involved. You also say, though, that separating them now would hamper their development. It's really a tricky situation and it depends on so many factors. It depends on the family situation (on multiple levels: religion, beliefs, pressure, money), it depends on the mother, on the advising doctors, on the values of society in Canada...

Anyway, you were asking whether it is morally right to separate them. Well...if its between death and death then yes, its morally ok (in my opinion). However, if its not, then I think they shouldn't be and they should wait until the twins can form their own opinion. Who knows, in 20 years technology and our understanding of how the body works may have improved so that such a surgery would be possible and the death factor reduced by a lot.

P.S. Isn't this sort of thing normally referred to as siamese twins?
 
Yes, but Conjoined is the 'proper' medical term, methinks.

I agree with Natalie, you can't really ask for their opinions - they dont know what is happening or will happen to them, they are much to young. Its not even a case of flipping a coin to see who lives and who dies: there are one or both their lives at risk here if they undergo the op., but if they dont, they wouldn't be happy being stuck together for all their life. I care about my older brother, we are so alike, but I would never bare being stuck to him ALL the time.

You've brought a nice issue up here,  a real thinker.
 
Um, I don't see what the issue is hear. Conjoined twins have been born ever since humankind has been walking, shiting and fucking. Also, the separation of such twins has been going on for a LONG time without controversy. Twins sharing hearts, livers, stomachs, and, of course, brains. Many of them as I understand don't live for long anyway and they rarely share an organ 50/50, thus usually the little fella with 60% or more gets a go at life.

There is a famous case of conjoined twins at the head that weren't separated because, well, it's impossible, both would die, and they grew up. One of them is a midget and sits in a special chair while her sister (both are women) walks around hunched over. Get this, The one that isn't a "little person" is a country singer AND... ready? She DATES....
 
They should be separated ASAP. If they don't survive, my condolences; however, humans are not meant to exist in that type of conjoined state. It's the biological equivalent of a train wreck, and needs to be fixed. Waiting until the twins are old enough to form their own intelligent opinion makes the operation less likely to succeed, for two reasons:

1. For all their fragility, newborn babies actually have tremendous healing and growth potential. Doing the operation while they are less than one year old actually gives them a better chance of healthy recovery than if you wait until they're teenagers.

2. If the brains have to be separated, then it's better to do it before all the neural pathways have been mapped out, so the brains can reprogram themselves. Again, a maximum age of one year seems to be called for - if possible, a max age of 6 months is even better.

Finally, though it's not as strong a reason: Most people, as adults, remember little from before they were 4 years old, and absolutely nothing from before they were 2 years old. Major surgery and recovery like this is something that no one should have to remember, if it can be avoided.

And to any who might reply, "Who are we to decide how other people should live their life? Who are we to judge a conjoined state as unacceptable?", I say: We're the adults, and adults have always been entitled to make decisions in the best interest of children. We can foresee the innumerable severe difficulties that these twins would be subjected to. I understand that any parent would be rightly hesitant to do anything that would endanger the life of their children. But a responsible parent should consider the alternative: an extremely difficult and abnormal life for their children.

My harshest reason for advocating separation: not all babies are meant to survive. Just because we now possess the medical technology to circumvent natural selection doesn't make it a good idea. From the perspective of biology, this is a mistake; it should be corrected if possible.
 
SinisterMinisterX said:
They should be separated ASAP. If they don't survive, my condolences; however, humans are not meant to exist in that type of conjoined state. It's the biological equivalent of a train wreck, and needs to be fixed. Waiting until the twins are old enough to form their own intelligent opinion makes the operation less likely to succeed, for two reasons:

1. For all their fragility, newborn babies actually have tremendous healing and growth potential. Doing the operation while they are less than one year old actually gives them a better chance of healthy recovery than if you wait until they're teenagers.

The main reason I survived my accident and subsequent surgeries...
 
Onhell, the case you're referring to was in Pennsylvania (they interviewed them on CBC Radio yesterday about the ethics behind all this). They were enthusiastically in favour of letting the girls make their own choices, and seemed to love the way they were born and wouldn't give it up for anything; it's part of who they are.

SMX, while I agree with you I feel like I must play devil's advocate:
How do we know we're "meant" to be born in any form? Doesn't that imply some higher power designing our lives? Furthermore, it seems to be that if they seperate them, they share so much brain that one of them will most certainly die. All things being equal, which would you pick: Leftie or Righty?
 
IronDuke said:
SMX, while I agree with you I feel like I must play devil's advocate:
How do we know we're "meant" to be born in any form? Doesn't that imply some higher power designing our lives? Furthermore, it seems to be that if they seperate them, they share so much brain that one of them will most certainly die. All things being equal, which would you pick: Leftie or Righty?

I don't think it should be up to any parent to decide which of their children dies and which one lives.  If there is a high risk that the twins (one or either of them) will die during the operation, I believe it is up to the parents to make the best choice-however, I feel that if at all possible these twins should be separated at this stage, as SMX said.  If it did come to a choice between one of them, I think that the doctors in charge of them should make a decision based on the chances of one of the twins surviving; if twin A has a better chance of surviving than twin B, and there is no way to save them both, they might as well at least try to save one of the twins.  Quality of life over quantity.

This topic is especially pertinent in the U.K., due to a case, not of conjoined twins, but of a similar child, called Charlotte Wyat.  I don't know the full details of her case, but she was born extremely prematurely, with extensive complications and damage to several of her organ systems, including her renal system.  She has spent 2 years in hospital on permament care, in constant pain and has only been home once in her short life-for Christmas.  Her case was the subject of a long court battle, based around a DNR (Do Not Resuscitate) order the doctors had put on her-they saw that her quality of life was miserable, and if she went down, they would not try to revive her.  Her parents, however, want her to have as long a life as possible, and want the doctors to do everything they can to try and save her.  However, we have to weigh up her quality of life over the quantity of life.  She can't make the decision, so where does such a choice lie?  With the doctors, or with the parents?  It's a very sad case and an interesting thought.
 
On a similar line of digression, I read an article in the newspaper last week about a case similar to the one Raven has explained. A boy was born four months prematurely and after spending months in intensive care he survived and now has no lasting disability other than slight hearing loss. The question arises over how far doctors should go to try to save premature babies. This child only survived by undergoing much painful surgery and had a 89% chance of lasting disability. Also interesting to note is that this baby was born at 23 weeks, yet the legal time limit on abortion is 24 weeks, so theoretically while one child is being resuscitated, down the hall an older baby may be being terminated.
 
SinisterMinisterX said:
And to any who might reply, "Who are we to decide how other people should live their life? Who are we to judge a conjoined state as unacceptable?", I say: We're the adults, and adults have always been entitled to make decisions in the best interest of children. We can foresee the innumerable severe difficulties that these twins would be subjected to. I understand that any parent would be rightly hesitant to do anything that would endanger the life of their children. But a responsible parent should consider the alternative: an extremely difficult and abnormal life for their children.

Somehow, I get the feeling this was partly pointed at me, because I'm always the loser who makes statements that begin with "who are we to decide", but on this one, I'm totally and completely with you, SMX.
 
No Perun, that was not pointed at you or anybody else. I simply thought that it was a likely response; if I had read the same words posted from someone else, I would have thought of that reply. Duke's question is somewhat similar:

IronDuke said:
SMX, while I agree with you I feel like I must play devil's advocate:
How do we know we're "meant" to be born in any form? Doesn't that imply some higher power designing our lives? Furthermore, it seems to be that if they seperate them, they share so much brain that one of them will most certainly die. All things being equal, which would you pick: Leftie or Righty?

It is, in my opinion, reasonable to assume that gross deviations from the typical human form are not intended by nature. Conjoined twins are a particularly clear example of this. Natural evolution occurs by subtler means, such as mutation or natural selection of specific traits. Conjoined twins are the result of a pregnancy malfunction. If this type of malfunction were advantageous to the species, why is it so rare?

If one of the twins would have a significantly greater chance of survival than the other, then it could be argued that this twin is the "primary" child, and the other must serve the needs of the primary. Since that sounds superficially harsh, allow me to provide some historical examples.

Consider the notorious case of Frank Lentini, whose physical form was the result of non-separating triplets. His most obviously unusual feature was his third leg, but he also had other notable oddities. Or consider Margarete Clark (I can't find a web reference for her, but I have a book with extensive documentation about her). She had an entire twin whose rudimentary head was inside her abdomen. To an observer, she had an entire second body (minus a head) growing by the neck out of her stomach. This twin was obviously not "alive" as a separate person, but part of Margarete's body.

So it may be a reasonable point of view to say that one twin is the primary, and the other apparent twin is simply part of the same physiological system. How can we tell if it's really two independent twins, or one person with an extra body? Simple: personality.

In virtually all documented cases of conjoined twins who grew to adulthood without separation, the twins had significantly differing personalities; they were truly two people. Anyone who has ever had children or even just observed newborns knows that they start to exhibit simple personalities within days of birth, and have very clear personalities by the time they're a few months old. So if these twins reach the age of three or four months, and both of them display similar levels of activity and intelligence (i.e. both bodies are fully functional) and their personalities are noticably different, then it may be required by ethics not to attempt a separation if one would die.

But, if one of those twin bodies turns out to have a lack of functionality - physical or mental - then that body should be considered an incompletely formed human, and thus not entitled to the same right to life as a full human. I mean this in the sense that if an incomplete twin is holding back a functional twin, and the functional twin can survive the separation, then the operation should be attempted.

And in an unusual rhetorical maneuver, allow me to quote something I just said:
But, if one of those twin bodies turns out to have a lack of functionality - physical or mental - then that body should be considered an incompletely formed human, and thus not entitled to the same right to life as a full human.
Let me make something absolutely clear: I am NOT saying that disabled persons have less of a right to life than normal people. I detest such Hitler-esque ideas. I am saying that conjoined twins are a special case where one twin might turn out to be genuinely subhuman. If that is true, then the subhuman can be sacrificed.

Let's say both twins are functional, and truly two different people. I've done a bit more research on dicephalic twins. While rare, such cases have had decent lives. I've also learned that all sets of conjoined twins develop, by pure instinct, the ability to completely block out their awareness of the other twin. While the exact mechanism remains unknown, it is believed that this ability develops because a person would literally go stark raving mad if they could never believe they were alone. So it may not be necessary to separate these twins for the sake of giving them decent lives.

However, I reiterate my position that such an operation is preferable if possible, and that the best chances for success likely lie in infancy. Waiting to give the twins their own choice may actually make such a choice moot, because they are less likely to survive the operation when they are older.

So now the main issue is: what is the chance of both twins surviving the operation? And are the parents willing to take that chance? Do they consider a newborn baby to be a full person, or just "meatwith great potential"? An argument could be made that if the parents are young and healthy enough to have many more children, risking losing these twins may not be so bad. (I am not making that argument; I'm just saying I can envision its articulation.)

That's really the bottom line: "Good day, Sir and Madam; may I interest you in a game of chance?"


Hey oldtimers: Does this qualify as LooseCannon-long?
 
SinisterMinisterX said:
Hey oldtimers: Does this qualify as LooseCannon-long?
Close man....but nobody is that long-winded!

I must say, SMX, I think you've won me over to your case. Well done.
 
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