CONJOINED OR 'SIAMESE TWINS': TO SEPARATE OR NOT TO SEPARATE?
EAST LANSING, Mich. - When conjoined twins, or what's more commonly known as "Siamese twins," are born, it's automatically assumed they should be separated. Right? Wrong, says a Michigan State University medical historian.
Alice D. Dreger, an assistant professor in MSU's Lyman Briggs School, says when it comes to cases in which one of the twins must be "sacrificed," it is ethically wrong to take one life so another may live.
"I argue that it is unethical to kill one conscious head, given that we wouldn't do that in any other case," she says. "It is unethical to treat children with unusual anatomies according to a different set of ethical guidelines than other children."
Dreger makes her comments in a soon-to-be published article in the journal Studies in History and Philosophy of Biomedical Sciences.
"You can't do anything you want to in order to separate twins," she says. "I also challenge the assumption that a life joined is no life worth living and that any risk in terms of separation is worth it. These people clearly deserve to be treated as fully human and deserving of the same ethical care as anyone else."
In her paper, Dreger cites many examples of conjoined twins who lived full, productive lives. There were Yvonne and Yvette McCarther, born in 1949 joined at the head. Resisting urging by doctors to have the twins institutionalized, their mother took them home and raised them in what would be considered a "normal" setting. When they died at the age of 43, the two were pursuing degrees in nursing.
And then there were Chang and Eng Bunker, conjoined twins who lived in the mid 19th century and for whom the phrase "Siamese twins" was reportedly coined. Before their death in 1874 (they were in their mid-60s), they had become successful farmers and each had raised a family.
Dreger further points out that for many conjoined twins who have known no other life, separation is practically unthinkable.
"Many conjoined twins mature enough to do so have explicitly voiced acceptance of their unusual conditions and many have even expressed an inability to envision living any other way," she writes. "Yet there appears to be a willingness on the part of more and more medical professionals to attempt separation at almost any cost.
"Indeed, many twins old enough to do so express a desire never to be separated because it will result in such a profound change of identity or even the death of one's other half."
Dreger is not saying that all separations are bad. When the twins are very young and the separation surgery is simple enough that it doesn't result in the death or long-term disability of one of the twins, that is quite acceptable, she says.
From a more practical point of view, Dreger points out that separation surgeries in which one of the twins was sacrificed never are successful. At least nine have been attempted, and none has resulted in any long-term, healthy survivor.
"In all of the cases, the intentionally sacrificed twin died," she says. "But, notably, in not a single case has the twin chosen to survive ever actually survived to go home or even life free of a ventilator."
Estimates of the numbers of births of conjoined twins vary - anywhere from one in 25,000 births to one in 200,000. Some other facts: About 75 percent of conjoined twins are female; about 40 percent of conjoined twins are stillborn, while another 35 percent don't survive beyond a single day.
Contact:
Alice Dreger, Lyman Briggs School, Michigan State University, (517) 353-4628;
or Tom Oswald, Media Communications, MSU, (517) 355-2281.
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