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The Ethical Pain of Separating Conjoined Twins

A pair of conjoined twins were born with a shared pelvis, liver, and blood supply, but each had their own heart, lungs, and stomach. The one-year-old girls had three legs between them. Would it be possible to separate them? Pediatric surgeon Allan Goldstein at Massachusetts General Hospital in Boston agreed to examine them and consider the possibility. He discovered that one of the girls had a congenital heart defect. And then while she was in Boston, she developed a respiratory tract infection, which endangered not only her life, but her sister's. 

But what did that mean for the upcoming operation? For one girl, her seriously ill sister posed a life-threatening danger. If she died, the other would live only a few more hours. For the other, however, the healthy sister was a life support. The 3-D model we made of the skeleton and the blood vessels of the twins clearly shows the artery running from one body to the other right across the lower chest, supplying it with oxygen-rich blood. We knew that if we separated them, we would have to cut that lifeline.

We sought advice from the pediatric ethics committee of our hospital. In many extensive conversations, I learned how important it is how to frame such a situation: Our intent was not to end the life of one girl, but rather to save the other's. The difference is subtle, because the result would be the same: We would push two living children into the operating room and leave it with only one.

Not all of us followed the argument. Three doctors -- two surgeons and one anesthesiologist -- stepped back. They said they could not participate in such a thing. The idea that our intervention would likely lead to the death of the weaker girl seemed unfathomable to them. We respected this decision.

Goldstein said the separation surgery was the first time he cried in the operating room. Read about the heartbreaking decisions involved in separating the twins at Der Spiegel. -via Damn Interesting

(Image credit: The New England Journal of Medicine)

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