Should these Siamese twins be separated?

I don't know...that's a hard decision.

Why would the parents want to keep both, what sort of lives would they have being stared at like a freak show? They can't survive together; one heart is made for one body...

The parents should make the decision.

I just don't get the wig thing.

I couldn't be bothered to read the link. I don't know what to think. I don't believe that it should be up to the doctors. I would tend to side with the parents. I'm not sure about the courts.

parents should make the decision, the government shouldn't decide what is right for a family's medical decisions.

Goodness, I just don't know. What a wrenching situation.

My instinct is to save the sister who can be saved, given that both will very likely die if that doesn't happen. But I am not someone who values religion as much as these parents do. I don't know if I can put my belief system above theirs.

Zang - Did you realize that both will likely die if the operation isn't done?

I got the gist of that, yeah. I think the operative word is "likely". I'm sure the doctors aren't the least bit swayed in their medical opinions by the fact that there is an lucrative operation involved. It sounds to me like one thing is sure though, one of them will definitely be dead if the operation is performed. I really don't have a strong opinion. I just don't generally trust doctors, that's all.

Best to have one stay alive then the both die...but shouldn't it be the parents decision?

It has less to do with god's will than with natural selection. If the parents want them to remain how they were born because that is natural, then that is how it should be.

The operative word is closer to "almost certainly" rather than "likely". I don't think that the doctors are being swayed by financial considerations - if the operation goes ahead, it will be at a specialist hospital, not the one where the twins are currently being cared for and not by the doctors who have made the diagnosis.

If these were my children, I would have them separated. If they remained attached, what kind of life would they lead, even if they did survive? However, I do think it should be the parents' decision.

I think doctors are often wrong.

It should be up to the parents. They want the doctors to butt out, but in this age of "medical miracles" society just can't stand to leave nature alone. It makes me sick. Just because doctors have the ability to perform the procedure doesn't mean that it is the right thing to do.

*applauds*

I think that the parents should make the decision, but I also think that it's better to save one than risk losing both, which is what I'd probably do if it were my choice. But it's not.

Thank you, thank you. No applause, please...just throw money.

I feel I can't decide for them.

This is so complicated! Good question.

I think the parents should get to choose

No opinion

If I were the parents I would probably go for the surgery. But I'm not the parents, and I don't they should be forced into it.

I am surprised that so many people think that the parents should choose. The reason that they courts have said that the doctors should carry out the operation is that British Law considers what's in the best interests of the children. It was a hard-won change in the law in the late 80's early 90's and works extremely well. Everyone's views are taken into account but the interests of the children are paramount.

Overall I think the question in this specific case is easy - the twin without heart or lungs is not going to survive and the other twin should be helped. To suggest the doctors are looking for some extra cash is insulting, and in any case irrelevant as these are NHS (state) doctors who are paid a salary and don't get commission.

I feel bad about the kids, but I think probably the parents should make the decision.

I just argued the other way but now that you mention it you're probably right. I think part of the reason people are answering the way they are is that the children are very young. The older they get, the more likely (I bet) people would be to vote in their interests rather than those of the parents.

That's a very interesting point. Our rules take no account of age until the subjects are no longer children - at the age of 16 generally speaking. That ties in with many other laws for which 16 is the age cited. Some rules still stick at 18 but there are anomalies like paying taxes at 16 but not being able to vote until 18 and stand for office until 21. The joys of an unwritten constitution!

Guthrie, what makes you think that the courts are better able to discern what's in the best interest of the child than the parents are??

They may not be, but I am sure that there are cases where the parents deliberately put other factors - like adherence to religion - above the best interests of their children. That is, in summary, what is happening in this case.

Anyway in practical terms it isn't the court that is better able to discern, as it is for the court to decide the balance of opposing views based on the agreed framework. In this case the court looked at the framework ("Children's best interests come first") and balanced the views of the parents and the views of the doctors. The judge ruled that the Doctors' view was closest to the framework required.

How do you think this should be handled?

My personal view? I think rights and responsibilities should correspond. I think a party who will bear little responsibility for the consequences of a decision (in this case, doctors and lawyers/judges) should also have little right to make that decision.

While the individual doctors and lawyers have little responsibility, the state does in fact have quite a lot of responsibility, especially in what for lack of a better term I will call a "welfare state" like Britain where this is taking place.

Really? Did the state endanger its life by carrying the child for nine months and then delivering it? Can the state be sent to jail if the child doesn't behave properly? Is the state responsible for continuing its family name/genes?

I guess you are talking about financial responsibility; perhaps the state does bear a lot of financial responsibility there, I don't know much about England.

Does the fact that someone has given birth to a child give them the right to decide that the child should die? If so, when does that right stop, and the right of the child to live become more important?

So death to both twins then? That seems to ignore their futures entirely.

You guys are deliberately missing my point.

No, I'm not missing the point. Parents have a lot of rights over their children, and this is the way it should be - they conceived them, carried them, brought them into the world and are expected to care for and nurture them for as long as it takes. But there must be limits to those rights, otherwise parents would be able to harm their children without anything being done to stop them. The question is, where do the parents' rights end and those of the child begin? I would argue that no parent has the right to decide that their child will die, even if the parents genuinely believe that that's the right thing to do. You seem to be suggesting that if the parents in this case want both their children to die instead of saving one of them, then that's what should happen.

The parents should make the decision under the advice of the doctors and their according to their faith in God.

I believe that the presumption that a doctor or lawyer is better able to protect a child's rights is extremely flawed.

I believe many doctors may be better able to, simply because they have the advantage of additional knowledge about the children's medical needs. I certainly don't think it's inherent in doctors, as some may not be interested in the child's interests at all. Those who take their oath seriously should be able to put the children's needs first though.

Is it really in the best interests of these children to perform the surgery? Will the surviving child be able to live a full, healthy life, without a barrage of health problems?

msgman - You ask if giving birth to a child gives someone the right to decide if the child should die. What about the child who won't survive the surgery?

So do I, which is why I wasn't presuming it. I'd still appreciate an answer to the question I asked though: Where do the rights of the parents end and the rights of the child begin?

One of the twins is going to die no matter what happens. The other one will also die if they are not separated. From what I've read of the news reports, no-one involved in the case disputes that.

The problem is that under English law, it isn't legal to kill someone even if you know they are going to die (ie, euthanasia is banned). So the argument rests on whether or not the doomed twin is really "alive" in any meaningful sense. If she is, then they can't be separated. If she isn't, then they can. Some of the arguments to suggest that she isn't alive are:

* She is not breathing
* Her heart is not pumping blood
* Her brain activity is almost non-existent

but, on the other hand:

* She is growing
* She has reflexes

The other twin is expected to be able to live a relatively normal life if separated, although she will need plastic surgery to rebuild the conjoined area. She appears to have normal brain activity and she has a full set of internal organs. There is a possibility that the operation to separate them may leave her with a deformed spine and unable to walk, but the doctors are hopeful that they can avoid this.

However, this isn't really relevant to the decision. Just as the law forbids killing someone even when they are going to die, it also forbids allowing someone to die if there is a reasonable chance of saving them. So it all comes down to the decision on whether or not the doomed twin (the one with no lungs and a non-beating heart) is alive. If she is, then the doctors cannot operate, as they are not allowed to save one twin by murdering the other. But if she is not alive, then the doctors must operate, as failing to do so would be causing the death of the other twin by negligence.

Thanks for clarifying some of that for me. I understand why other people feel differently, but I still think that if the parents want to turn down surgery that should be their choice. Many years ago there wouldn't have been any chance of successful surgery for these twins. Just because science has progressed, I don't see why it should be forced on people. What if the one twin is saved and has a miserable life feeling like a part of her is missing?

That's a really good question. The problem is, how will we ever know, unless we give the twin a chance to live and answer for herself?

msgman: I think the child always has rights, but it's difficult to determine what the child would want until it can speak for itself. Until then, someone else has to make decisions for it. IMO, a parent both has more of a right to make that decision, and is more likely to have the best interests of the child at heart. Where there is disagreement between doctors & lawyers and the parents, the parents should prevail.

I'm divided between it being the parents choice and that they should at least try to save one.

No one knows how the parents are feeling. Those are their children and it should ultimately be only their decision.

For those that are interested, the court of appeal has just ruled that the twins should be separated. http://news.bbc.co.uk/hi/english/health/newsid_937000/937449.stm