The twins were successfully delivered and found to be joined between the legs. Sketches showed what seemed like a continuous body with a head and arms at each end and four legs flailing helplessly in the middle. Both twins were well formed, with one major exception. The weaker twin had no heart -- not even the rudiments of one. Instead, the bodily functions of both twins were maintained by one twin's heart and circulation system. If nothing were done, both twins would die in a few months' time. However, if the weaker twin were killed, the surviving twin could live a normal life span.
Both the media and the courts seemed to take a rather optimistic view of the quality of the surviving twin's life, although she would face a childhood of repeated surgical operations and, according to most observers, would likely always be doubly incontinent. The responsibility of caring for a child with such disabilities would of course fall on the devoted parents. After much careful thought, and possibly with the benefit of outside advice, the parents decided that no attempt to separate the twins should be made.
The hospital authorities decided to take the matter to court. Since 1989 when American-style changes in the National Health Service were introduced by Prime Minister Thatcher, hospital managers have increasingly resorted to the courts in such difficult ethical matters, perhaps to avoid the risk of litigation at a later date. Although doctors have to provide the major evidence, it should not be assumed that they necessarily initiated the decision to defy the parents' wishes. The judge in this case decided that the surgeons should intervene. The reasoning appeared to be a little confused since the judge seemed to accept that the weaker twin was indeed a full human being but at the same time a parasite that was sucking the very life out of the stronger twin.
According to English law all must act in the best interests of the child. In this case, however, the best interests of either one of the children could only be achieved at the expense of the other. The judge's decision was welcomed by the current chair of the Medical Ethics Committee of the British Medical Association (BMA), who was satisfied that at least one child would be saved. The judgement was, indeed, a classical example of utilitarian thinking: a simple summation of the harms and benefits of both courses of action with the conclusion that there would be only one death rather than two.
After some weeks the operation to separate the twins took place. The surgical team had never undertaken such a procedure before and few details were given. Instead, the hospital issued a rather disingenuous press statement noting that whilst the operation had been successful, "the weaker twin sadly died." Since this was the whole point of the operation anyway the comment was, at best, gratuitous. Many weeks later -- and at the time of this writing -- the surviving twin continues to make an excellent recovery. She is being taken outside on the hospital grounds, and it is hoped she will return with her parents to their island home in the spring of 2001.
Specialists in medical ethics (with the exception of the BMA as noted earlier) largely agreed that the parents' decision should have been respected. It remains unclear what role society as a whole has in the matter and by what right it felt able to override the parents' wishes. The evangelical Christians whom the media consulted on the matter certainly questioned the decision.
Sadly, society has to intervene from time to time to protect a child from its own parents. An abused child must be removed from a dangerous environment before further harm results. Children are sometimes denied lifesaving treatment because of misguided religious views, such as an apparently unjustified belief that "God will heal the child" or a Jehovah's Witness's denial of a lifesaving blood transfusion. This is not the case here. The operation was fraught with danger, on the very edge of current medical knowledge, and undertaken by a team with no previous experience with the procedure. Some might think the parents' failure to agree to such a risky proposal actually reflected great wisdom and maturity rather than an inability to "do the right thing."
Moreover, sooner or later, these parents will be required to fulfill the role of primary caregivers of a child with major disabilities. Whilst we are now told that they have come to terms with the decision and even to believe that it was the right one, they now face bringing up a doubly incontinent child with disabilities whose schooling will likely be frequently interrupted by further surgical interventions. Does society have the right to impose greater burdens than those all parents face? We believe that there is a God-given purpose when a disabled child is born into the world, and we expect parents to accept this responsibility as well as to face the possibility of losing a child early in its life. God will certainly use this child to His greater glory. But does it make a bad decision good if God can bring some good out of a human-created situation?
The issue of financial costs cannot be considered in this case since virtually no information has entered the public domain. A family entering the United Kingdom from outside the European Union would normally be expected to pay for medical care and, indeed, demonstrate at the point of entry their ability to do so. It would seem slightly bizarre if the family were now required to pay for treatment to which they had initially objected and that society demanded they should receive. When they finally return to their village they will incur unexpected costs that they appear previously to have decided they could not afford to pay. Readers in the United States are perhaps more competent than the author to make judgements on this factor in the ethical debate.
On a radio programme, John Wyatt, a Christian neonatologist, said that the press had presented a very sanitized version of the surgery. Naturally, one does not seek to shock laypeople with some of the horrors modern medicine occasionally involves, but it is wrong to conclude that during surgery the weaker twin simply died and was quietly removed to lie in rest. In fact the weaker twin would have been virtually dismembered before work could begin on saving the surviving twin. In effect, the surviving twin was refashioned with parts of the weaker one. Some 20 health care professionals were involved in the various surgical procedures, which took 24 hours to complete.
Undoubtedly an outstanding technological feat has been achieved, but have the two children become hidden in all this medical wizardry? At the height of the debate there was a remarkable television interview with a surgeon from a world-renowned children's hospital. He expressed surprise that the child had not been transferred to this hospital (whose experts had helped the court whilst it was considering the matter) and made it clear that the surgeons who separated the twins had not sought his or his associates' assistance with the operation, nor even their advice. One wonders whether the execution of the procedure had more to do with exalting the performing surgeons' skill than with making an effort to join the Creator God in dealing with this supremely difficult question of life and death.
Above all, this case clearly demonstrates a number of factors about Christian ethics in modern medicine. Firstly, there is sometimes no "good solution" we should be seeking. All the options in this case were bad options. Perhaps the parents chose the least bad option. Secondly, those of us deeply committed to applying biblical principles to ethical problems sometimes find that those principles do not offer the specific solutions we seek. Nevertheless, many Christians would find a clear principle in Paul's epistle to the Romans, where he specifically rejects the slanderous suggestion that we should "do evil that good may result" (Romans 3:8b). In Christian thinking it is never right to kill one person so that another person may benefit. Ends do not justify means. The increasing adoption of utilitarian philosophies in secular society, which is infecting so much of the thinking in medical ethics, must be rejected by Christians. As Wyatt has tellingly written in a journal for Christian medical students, "If by torturing one baby we can save the lives of 100 adults, there is no doubt what the utilitarian would recommend. But Christianity teaches that respect for the integrity and sanctity of every human life must be paramount."
Finally, however, Christians will not always agree on the optimum solution. We must not become judgmental towards those who approach a complex ethical dilemma differently, although we must ensure that we are all working from a Bible-based approach. I shall be astonished if there are not at least some readers of this magazine who believe the judge made the right decision. Perhaps they would care to write to the editor and tell him why? Only as we discuss these problems together in mutual Christian love shall we find help to face the even greater problems that will come in the future.
