British Surgeons Begin Separation of Twins
Both risk death, but operation will kill weaker girl
T.R. Reid / Washington Post 7nov00

Twins Die After Separation  - NYT Article

London -- A 20-member surgical team in Manchester, England, began a marathon operation yesterday that will almost certainly kill an infant girl -- in order to save the life of her conjoined twin.

The operation, the latest and possibly last chapter in a moral and legal battle that has drawn extensive international attention, was expected to take about 18 hours. There was a clear risk that both the 3- month-old twins could die on the operating table.

But doctors felt they had a good chance to save the stronger one, known in court papers as Jodie. Both she and her sister, known as Mary, were likely to die within months if they were not separated, the doctors said.

The girls are joined at the hips, with normal arms but small legs. The stronger twin has functioning organs that provide life support for herself and her sister.

The distraught parents of the twins had vigorously opposed the operation. They said their Roman Catholic faith taught them that the girls' fate was up to God and that human beings should not be in the business of choosing one life at the expense of another.

But in British law, the parents' opinion has little impact in such cases. Accordingly, an appeals court ruled last month that the operation should proceed despite the parents' objections.

``Though Mary has a right to life, she has little right to be alive,'' Lord Justice Alan Ward said, summarizing the unanimous judgment of the three-member panel. ``She is alive because and only because -- to put it bluntly but nonetheless accurately -- she sucks the lifeblood of Jodie, and her parasitic living will soon be the cause of Jodie ceasing to live.

``Jodie is entitled to protest that Mary is killing her. Nobody but the doctors can help Jodie. Mary, sadly, is beyond any help.''

On Friday, judges rejected a last- minute appeal by the Pro-Life Alliance, an anti-abortion group that wanted the case to be decided in the House of Lords.

The surgeons' goal yesterday was to separate the weaker child, which would cut off her blood supply and kill her. They then planned hours of reconstructive surgery on the stronger girl to build her a body as close as possible to normal -- if she survived the operation.

The parents, from the island of Gozo, part of the independent Mediterranean state of Malta, came to Britain for specialized treatment last spring after an ultrasound examination showed the mother was carrying conjoined twins. After the birth, British doctors went to court demanding the right to separate the twins, despite the objections of the parents and their church.

The case became an international cause celebre and one of the most complicated cases in British history. When it reached the appellate level, separate lawyers were on hand representing the doctors, the parents, the stronger twin, the weaker twin, the hospital, the National Health Service and government prosecutors.

British media have reported that the parents have agreed to sell their story on an exclusive basis to a British TV network for about $225,000, to get the money to raise Jodie if she survives. Their small island has minimal medical services, and they are worried about providing the specialized care their daughter could need.

Cases of conjoined twins are very rare -- around one in every 100,000 live births.

Twin Dies After Separation Procedure

WARREN HOGE / New York Times 7nov00

LONDON, Nov. 7 — British doctors today separated three-month-old twin girls joined together since birth in a court-approved operation that knowingly sacrificed the life of one infant to save the other.

Surgeons and medical teams at St. Mary's Hospital in Manchester worked for 20 hours in what a statement called a "complex procedure" to separate the girls, known by the false names of Jodie and Mary to protect their anonymity.

"Jodie is currently in a critical but stable condition," the brief statement said. "Unfortunately despite all the efforts of the medical team, Mary sadly died."

"As with all major surgery," it continued, "the first few days following an operation are the most critical, and our thoughts remain with Jodie and her parents."

The parents, an unidentified couple from the Maltese island of Gozo, had opposed the operation in an unsuccessful legal action that cited religious objections. They said their goodbyes to Mary on Monday morning before the surgery began, doctors said.

Mary, who had primitive brain functions, was said to have been "draining the life" out of Jodie, who is thought to have normal mental abilities. Jodie was reported to be bright and alert, Mary passive and unresponsive. Since Jodie's heart and lungs were keeping both girls alive, it was known that removing Mary would cause her death.

Were they left joined, doctors said, there was an 80 percent expectation that both girls would die within six months.

The legal battle to save Mary began shortly after the twins were born Aug. 8 at St. Mary's with fused spines, joined at the abdomen and with arms and legs at right angles to their upper bodies. The mother had been brought to the Manchester hospital because it has a medical unit that specializes in operating on joined twins.

Though the High Court and a three-judge panel of the Court of Appeal turned down the parents' appeal, the case raised vexing questions for the judges, some of the most senior on the English bench, and prompted several of them to say they found it one of the most testing of their careers.

Five days of hearings in September ranged over questions of law, ethics, morality, parental rights and the nature of "God's will." The case aroused concern and dismay as it weighed arguments over whether it is ever lawful to permit the taking of life.

Lord Justice Ward, himself the father of two daughters, said it was "an agonizing and difficult case" and expressed sympathy for "this family blighted by disaster."

The parents, both Roman Catholics, said their religious faith compelled them to let nature take its course, with no medical intervention, even though it could result in the deaths of both their daughters. In a statement to the court, they said, "We cannot begin to contemplate that one of our children should die to enable the other one to survive. That is not God's will."

In issuing the verdict Sept. 22, Lord Justice Ward said of Mary, "The sad fact is that she lives on borrowed time, all of it borrowed from her sister. She is incapable of independent existence. She is designated for death."

Jodie will now need extensive skin grafts and additional surgery, but doctors say she could be of normal intelligence and be able to walk, have children and enjoy an average life expectancy.

Professor Lewis Spitz, consultant pediatric surgeon at London's Great Ormond Street Hospital for Children, said she would need minute-by-minute monitoring because of the extreme instability of infants after such extensive surgery.

"Little tricks", he said, could help Jodie's chances of survival and suggested that one of them would be placing a mirror beside her to lessen the stress of losing Mary.