Siamese Twins— Jodie and Mary (Gracie and Rose)
THE ULTIMATE DECISION
This is the final decision made by the four of us, namely: Songjia, Huijing, Charmaine and Zuo Yue. We have decided on the decision of the court to be the best solution favouring the interest of the twins and the parents alike.
After taking into consideration the various viewpoints from the different parties involved, our group has decided that the court’s point of view would be the best solution in resolving these issues.
In consideration of the twins’ medical condition, it is best that the separation is conducted, as in the opinion of medics, it is wise to save as many lives as possible, thus it is better to save Jodie's life rather than losing both Jodie and Mary’s. Also, this surgery will create a breakthrough in the separation of conjoined twins in the future. As the doctors also serve as independent opinions, they may also possess more rational and calm mindsets comparing to that of the parents’ at that point in time as they are restricted by religious beliefs and overwhelming poignancy. Also, separation of conjoined twins by surgery will also have a high chance of success as for example, the first successful separation of conjoined twins was as early as 1689, thus the parents should be more confident in the success of the operation and that Jodie will have higher chance of survival.
On the other hand, the actual condition of the children is the crucial factor to determine the court’s decision. It is true that the court is not entitled to value to quality of human life as worth more than another, and that the court does not have any right to kill someone just to save the life of another, but the decision that the court makes has the benefits of all parties considered. Like mentioned in the previous posts, the court’s decision does not only benefit Jodie, but it would be in the best interests of Mary, as for the twins to remain alive and conjoined in the way they are would be depriving them of the bodily integrity and human dignity which is the right for both of them. The duty of the court is to put the welfare of each child paramount, and hence it will make sure that no party is shortchanged in the decision making process.
Another reason for why we have chosen the court’s decision is because religion and culture is not always rightful or legal when humanity is concerned. Many cultures, especially in the third world countries, have very primitive views on impairment and human rights. For example, in China, the rampant acts of the murdering of baby girls became a social norm. But aren’t we condemning these acts? In a similar fashion, looking from a religious viewpoint, much of the attention has been placed on the parents, who are Catholics, and believed in complying with God’s will or nature’s will. In certain cases, these forms of compliance would indeed be more humane, an example being UK mother Lisa Chamberlain, 25, also a Catholic, who is pregnant with dicephalus twins, and insisted in giving birth to a pair whom people label “freaks”. In this case, religion is in fact the life saver of the abovementioned twins. However, for Jodie and Mary’s case, if they were allowed to progress on their own according to “nature’s will”, they would both be put at risk of death. Personally, we find that parents should not be granted absolute right to the lives of their disabled children, and there should be a third party or an independent opinion to make impartial judgments on the situation if required.
In essence, we have agreed upon the decision of the court after evaluating the different perspectives of the stakeholders and most importantly the interest of the twins. Also, after the discharge of Jodie, healthy 10-month-old , following the separation, the parents were contented with the ultimate decision that one of their daughter is saved and granted a life.
Our discussion will end here, you are most welcomed to post your opinion about this topic(:
Is it right to sacrifice a life to save another?
After research on the case of Jodie and Mary, I have decided to argue from the religious viewpoint on this case. The mere fact that Jodie and Mary were recognized as separate individuals would have been able to give an indication that it would not have been morally correct to sacrifice one life for the sake of the other. Both, being separate and legal humans, would have the rights to their own lives and though Mary’s physical situation is such that it would render her dependent upon her sister Jodie for her continued existence, removing herself as a threat to her own sister’s life would have meant the disregard of the viewpoint of her as an individual person.
This decision (to undergo the potentially life-threatening separation operation to Mary) would have also been made without the consensus of the parties directly involved – namely Jodie and Mary, as they would not have (or would not be able to) developed and grow to such a point where they would have been able to make decisions for themselves. In which case, the parents’ consent to allow the medical operation would be needed, and in the case of Jodie and Mary, the consent was not given. Their reasoning was mainly based on the fact that as Catholics, they believed that God created their children in the way He wished to, and that it was also up to His wish as to how long they would be able to live. They did not wish to do anything which would harm any one of their daughters, and as the separation would have implied the death of Mary, they hence did not want to go against the natural flow of what should have been.
Apart from the two parties directly involved (Jodie and Mary), and their parents who gave them their lives, who else would be entitled to a right in deciding the fate of the children? What exactly would give the medical authorities or the court the right to decide that the continued unity of the twins would not have been the best solution to resolving the issue – even if their suggested options in resolution may have not been what the parties involved, or what the parents have wished for? These are controversies which arose from the case, and are key points when considering if it would have been right to sacrifice Mary’s life to save Jodie. Even with Jodie’s life preserved in the end, one would have to wonder about the actual causes of the separation, as this would mean a grave injustice to Mary.
There are five overarching moral considerations which govern this submission:
(a) Human life is sacred, that is inviolable, so that one should never aim to cause an innocent person's death by act or omission.
(b) A person's bodily integrity should not be invaded when the consequences of doing so are of no benefit to that person; this is most particularly the case if the consequences are foreseeably lethal.
(c) Though the duty to preserve life is a serious duty, no such duty exists when the only available means of preserving life involves a grave injustice. In this case, if what is envisaged is the killing of, or a deliberate lethal assault on, one of the twins, 'Mary', in order to save the other, 'Jodie', there is a grave injustice involved. The good end would not justify the means. It would set a very dangerous precedent to enshrine in English case law that it was ever lawful to kill, or to commit a deliberate lethal assault on, an innocent person that good may come of it, even to preserve the life of another.
(d) There is no duty to adopt particular therapeutic measures to preserve life when these are likely to impose excessive burdens on the patient and the patients' carers. Would the operation that is involved in the separation involve such 'extraordinary means'? If so, then quite apart from its effect on Mary, there can be no moral obligation on doctors to carry out the operation to save Jodie, or on the parents to consent to it.
(e) Respect for the natural authority of parents requires that the courts override the rights of parents only when there is clear evidence that they are acting contrary to what is strictly owing to their children. In this case, the parents have simply adopted the only position they felt was consistent with their consciences and with their love for both children.
(Adapted from http://www.rcdow.org.uk/textonly/cardinal/default.asp?content_ref=45)
All these point towards the fact that it would not be up to external parties to decide readily if such a sacrifice would be better. Taking into consideration the possible implications of the separation on the lives of Jodie and her parents after the separation would further amplify this point. The parents, originally against the separation, would have to take time to recover from the loss of one of their children. The separation was too made without Jodie nor Mary’s consensus, and hence Jodie may have to face a struggle in coping with the knowledge of how her twin sister was lost when she grew up, and may not also have agreed to the decision originally passed to separate.
Hence, it would not have been right, morally or otherwise, to pass a decision to sacrifice a life to save another’s, especially because the parties involved would not have been able to give their consensus to such a sacrifice in the first place. We would have never found out what would or could have occurred if a separation had not taken place, and we could not foresee how the effects of the separation would turn out now that the sacrifice had taken place. However, in considering the rights of both Jodie and Mary to their lives, and their parents’ rights over them, in this case, I do believe it is not correct to wish for a sacrifice to occur.
Labels: religious viewpoint
Regarding separation of the Siamese twins Jodie and Mary, I personally feel that the surgical separation of the twins is to the utmost benefit to both of the twins. Since both of them will die if they are not separated, and if the surgery is conducted, although Mary is going to make the sacrifice but it also brings the chance of survival of Jodie from 0% to 80%-90%. And knowing that Mary’s brain is underdeveloped and Jodie’s brain is functioning normally, it is then obvious that saving life of a capable and more useful child is better than leaving both to die. The surgery would both twins’ interest, since for the twins to remain alive and conjoined in the way they are will depriving them of the bodily integrity and human dignity which is the right of each of them.
Adding on to that, this surgery will also benefit the medical community as there are not many successful cases of separation worldwide and the medical team has never done a successful separation of Siamese twins before. I believe that the skills and knowledge acquired from surgeries like the one that separates Jodie and Mary will aid in future attempts. It is impossible for Siamese twins to stop exist in the world and it is often rare and unique cases as twins are conjoined at different body parts and different organs are often involved. Thus they have to keep practice and explore until a foolproof way is found to ensure 100% successful separations.
However, there are still questions left to be pondered upon. Should doctors use number of lives saved to decide whether to sacrifice minor for major, stronger for weaker despite strong objection of relatives? The job of doctors is to save as many lives as possible, and being the closest people of patient, the relatives should have the best interest of patient in mind. When these two principles coincide with each other which one will outweigh the other?
In this case, I choose to conduct the surgery despite of strong objection from parents. In this way, Jodie is saved but is she able to lead a happy life afterwards? Will her parents hold grudges and think that Jodie should not live on the earth without Mary hence mistreat her? Or will constantly living in self denial because her twin sister sacrificed her life to continue hers? The family including Jodie and her parents will live under the shadow of Mary, and I wonder if they can lead a happy life without constantly being reminded of Mary’s death whenever they see Jodie.
The important value here is understanding between people. The parents should understand the doctors’ profession and the doctors should also understand the parents’ stand. If they try to see the situation in another party’s standpoint, they should be able to come up with a common solution which is to the upmost benefit of both of them, and they will not live with regrets.
Fu Songjia (6)
4K
The Roman Catholic Diocese of Westminster - Cardinal
(a) Human life is sacred, that is inviolable, so that one should never aim to cause an innocent person's death by act or omission.
(b) A person's bodily integrity should not be invaded when the consequences of doing so are of no benefit to that person; this is most particularly the case if the consequences are foreseeably lethal.
(c) Though the duty to preserve life is a serious duty, no such duty exists when the only available means of preserving life involves a grave injustice. In this case, if what is envisaged is the killing of, or a deliberate lethal assault on, one of the twins, 'Mary', in order to save the other, 'Jodie', there is a grave injustice involved. The good end would not justify the means. It would set a very dangerous precedent to enshrine in English case law that it was ever lawful to kill, or to commit a deliberate lethal assault on, an innocent person that good may come of it, even to preserve the life of another.
(d) There is no duty to adopt particular therapeutic measures to preserve life when these are likely to impose excessive burdens on the patient and the patients' carers. Would the operation that is involved in the separation involve such 'extraordinary means'? If so, then quite apart from its effect on Mary, there can be no moral obligation on doctors to carry out the operation to save Jodie, or on the parents to consent to it.
(e) Respect for the natural authority of parents requires that the courts override the rights of parents only when there is clear evidence that they are acting contrary to what is strictly owing to their children. In this case, the parents have simply adopted the only position they felt was consistent with their consciences and with their love for both children
http://www.rcdow.org.uk/textonly/cardinal/default.asp?content_ref=45
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Jodie and Mary—The Parents View
Zuo Yue (28) 4K
-Should the parents let nature take its course? And not making any effort of save at least one of them?
After reading about the Siamese Twins Jodie and Mary, I’ve decided to take up the role of the parents and to give advice in their situation. According to the news, the twins’ parents have decided to let nature take its course, which is probably letting the twins die on the medical view. And their decision has incurred a lawsuit against the Hospital. I think the parents are in a very hard situation, struggling with their moral values, their love for the child and their religion. They can’t choose to let both live, and they don’t want both to die. Also, because they are Catholics, they do not support “killing” one to allow the survival of another. Due to their status, they are on a very contradicting stand, they would very much want Jodie to live, but to them it’s not morally correct. According to Catholic religion, Mary has a brain, organs( though not functioning) and the only part they are sharing is the bladder, and therefore, Mary is a person and has the right to live. Choosing the path to surgery implies that the doctors, the court are killing Mary, and only by letting things go the way they are is the right choice. The moral value that drove their decision, I believe is impartiality, in the parent’s view, the equal treatments to both children is their main reason for objecting the operation and partially due to compliance to nature. However, this will result in the death of both children as they are not able to outlive 6 months according to the medics, if not separated.
Religion should be respected, but on certain scale, the decisions of parents should not lie entirely in the hands of religion as religion sometimes give rise to prejudice such as “handicapped are better dead” 1. If the decision were to not let the pair undergo surgery, Jodie would not have survived and both of the twins would have been dead due to the incapability to sustain their life. That will be the inevitable and cruel truth but to the parents, is that the NATURE they really want? They are depriving the chance anyone of them to live, then what about the decision of the children? If people would like to say that Mary is killed by the surgery, I would rather they say that Mary has died due to failure of the surgery. In another example about Faith and Hope (see below) , another pair of conjoined twins. They might both die if operation is not performed due to deterioration of organs. They have both died 23 days apart but their parents have made an effort to save them, now, is that to say that their parents have killed them?or rather, they have done their best in SAVING them?
Personally, I do not believe that parents should have total control over the lives of their disabled child, there must be an independent opinion and I think that letting the issue to become a public affair and a legal issue. Supposing the child has Spina Bifida or was brain damaged due to premature birth, and the parents made the decision to withdraw feeding, which is to let the child starve to death, in this situation, many of us will not support the idea. And often in UK or even other countries, parents have the rights to terminate treatment or the lives of their children, sometimes pressurized by medics or religion in this case and their bias opinions (E.g. to terminate the life of the child because of brain death). Therefore, I suggest a solution that there should be independent service available to parents who have disabled children, and provide them with an impartial judgments and suggestions to allow them to “assess”. Making the issue legal and public will also facilitate in “unbiased” decisions.
Footnote
1. A quote from http://www.johnnypops.demon.co.uk/poetry/articles/jodieandmary/livewithdignity.htm by Jane Stewart
The parents travelled to the UK for the birth after learning that the expectant mother was carrying conjoined twins.
The UK is one of only a few locations with doctors experienced in dealing with the highly unusual births.
Joined at the abdomen
The sisters were joined at the lower abdomen but were capable of lying flat on their back.
At first glance they appeared as if they were one single trunk with a head and limbs at both ends.
Although their spines were fused, their legs were independently formed and criss-crossed each other.
Birth problems
At birth, Jodie was active and breathing voluntarily with a good heart and chest movement and moving all four limbs.
In Mary's case, there was a minimal response from the cardiopulmonary system before it failed.
The medical team soon realised that Mary's heart and lungs were so poorly developed that she was totally dependent on Jodie for oxygen and blood circulation.
In other words, she could not exist without Jodie.
While Jodie's system did collapse from blood poisoning shortly after birth, her heart and lungs were reported to be later fully functioning - giving the doctors hope that she could be saved. She was also said to have the same mental awareness as other newborn children.
However, Mary's mental state was unclear. During evidence given in the initial court hearings, doctors said that she was moving her limbs and had opened one of her eyes.
Because there appeared to be no distinguishing point where Jodie's body came to an end and Mary's body began, surgery effectively meant an operation on both of the babies.
One of the three law lords who heard the case, Lord Justice Ward, said: "The moment the knife goes in to that united body, it touches the body of unhappy, little Mary.
"It is in that second an assault."
Separation?
Doctors believed that Jodie could survive separation because her long-term problems were "functional" rather than life threatening.
The only threat posed to Jodie, said the doctors wishing to operate, was that Mary was sapping her strength.
Separation would lead to the immediate death of Mary.
The courts finally ruled in favour of the doctors who wished to operate and the separation took place on 7 November 2000. As expected, Mary died. The surgery means that Jodie still requires substantial surgery to reconstruct her lower abdomen, rectum and possibly her sexual organs.
While there were many doubts about Jodie's medium to long-term prospects, in the days following separation the baby rapidly improved, as predicted by the surgical team.
Unhappy precedent
In 1993, doctors in the US city of Philadelphia sought to separate conjoined twins Amy and Angela Lakeberg, knowing that one would die in the operation.
After much anguish, the parents agreed to the operation.
Amy died immediately but Angela only survived for ten months.
By Sandra Laville
Published: 12:00AM BST 16 Jun 2001
ON the Mediterranean island of Gozo, family and friends are preparing a homecoming for Jodie, the Siamese twin whose life was saved in an operation which killed her sister.
In a short hearing at the High Court yesterday, an injunction banning identification of Jodie was lifted to disclose her real name as Gracie Attard in preparation for her arrival home, which is expected today.
Named after the grandmother in Malta she has not yet met, Gracie, now 10 months old, has been given the all clear by doctors at St Mary's Hospital, Manchester, to travel to Gozo. There, Roman Catholic priests are ready to baptise the baby whose life split public opinion on the island.
The Catholic Church, supported by most of the island's people, opposed the separation of the twins, born in Manchester on Aug 8. Their parents, Michael Attard, 44, and Rina, 29, were also against the life-saving surgery which doctors knew would result in the death of Gracie's sister, Rosie.
Mounting a legal challenge to stop the operation, Mr and Mrs Attard said to choose life for one daughter and death for another "was against God's will". But the Attards lost their challenge when the Appeal Court ruled that the separation should go ahead. It took place in November in a 20-hour operation at St Mary's in which Rosie, who shared an abdomen, heart and lungs with her sister, died on the operating table.
Despite the Church's opposition to the surgery, Fr Eucharist Sultana, archpriest of Gozo, was eagerly awaiting the arrival of the family in their home village of Xaghra. He said: "I know they are coming soon. I have spoken to them. They will be welcomed back warmly I am sure but it will be a quiet welcome. People will give them privacy and then we will baptise the baby here and I am sure many people will come."
Nurses and doctors at St Mary's last night bade farewell to Gracie and her parents, who have lived in the hospital since last May. For the surgeons who carried out the complex surgery, it was a powerful moment. Adrian Bianchi, the Maltese-born surgeon who operated on the babies with his colleague Alan Dixon, said goodbye earlier in the week before flying off on holiday. He was responsible for bringing the twins' parents to St Mary's after doctors in Malta realised the unborn babies were conjoined and they did not have the expertise to deliver them.
Last May, the couple arrived to prepare for the birth of their babies but it was not until their birth by caesarean section that doctors realised the full extent of their conjoinment and of Rosie's poor condition. Since the surgery, Mr Bianchi has been reponsible for the after-care of Gracie. "It has all gone very well, the whole thing," he said. But we were always confident of Gracie's recovery after the operation. That is what we always said."
Mr and Mrs Attard have nothing but praise for St Mary's and its staff. A close friend said: "They cannot talk highly enough about them all: nurses, doctors, everyone. They feel they have been treated very well from the moment they arrived." Mr Attard, an unemployed labourer, and his wife, a chambermaid, have secured Gracie's future in a cross-media deal worth more than £350,000 - money which will be paid into a trust fund.
The couple have said they are beginning to come to terms with the operation and have told friends they are overjoyed to have "Jodie" in their lives. Just after the surgery, Mrs Attard said: "We are very happy because she likes to try to talk with us. She makes sounds like she is talking with us and she smiles at people and us. It makes us very encouraged for the future." He added: "She's going to be a real fighter."
http://www.telegraph.co.uk/news/uknews/1312094/Surviving-Siamese-twin-Gracie-goes-home-to-Gozo.html
Mary, the smaller and weaker twin, was fatally compromised. Her lungs and heart were not properly formed and her brain was primitive, although capable of sustaining life.
If the operation had not taken place, both babies would have died.
"The only way [Mary] could have survived was [by the] link to her sister who was acting as her life-support machine," neonatal surgeon Adrian Bianchi told Mary's inquest.
"Over the previous 10 days [Jodie's heart] had begun to show signs of strain, consequent to taking on two bodies."
The doctors had little doubt about what had to be done, but the parents, devout Catholics who had come to Britain to consult leading specialists in conjoined twins, were not prepared to agree to the ending of Mary's life, even though it would be the saving of Jodie's.
The case went to the high court which ordered that the separation should go ahead, and then quickly on to the court of appeal, where judges said they had been faced with an agonising decision.
In the end they came down in favour of Jodie's right to life. "Mary has always been fated for early death," said the senior judge, Lord Justice Ward. "Though Mary has the right to life she has little right to be alive.
"She is alive 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. The best interests of the twins is to give the chance of life to the child whose actual bodily condition is capable of accepting the chance to her advantage even if that has to be at the cost of the sacrifice of a life.
"I am left in no doubt at all that the scales come down heavily in Jodie's favour."
The Catholic church and other campaigners vigorously protested at the decision, but the parents decided not to take the case to the House of Lords.
In a 20-hour operation, the bones and internal organs shared by the twins were separated and neurosurgeons delicately divided the spinal cord.
When the main blood vessel connecting Mary to Josie was severed, the weaker twin died. It was an incision the two surgeons, Alan Dickson and Mr Bianchi, made together in silence and, they said, with "great respect".
Jodie - whose real name, Gracie, was disclosed after the operation - is living with her parents on their native island of Gozo and is said to be doing well. Doctors say she should be able to lead a normal life and have children of her own.
Rose - Mary's real name - is buried on the island.
http://www.guardian.co.uk/uk/2002/feb/05/sarahboseley
*Related-articles By: John Fitzpatrick is director of the Kent Law Clinic, the coauthor of Criminal Justice and the Human Rights Act 1998, Jordans, 2nd edition 2001 and a contributor to Morals of Legitimacy: Between Agent and System, Berghahn Books, 2001 Jodie and Mary: whose choice was it anyway? That Gracie, the survivor of the Jodie and Mary Siamese twins, is doing well and returning home to Gozo with her parents shows that the judges' decision in this case was right. But it does not alter the fact that judges should not make these decisions. |
The operation to separate the Siamese or conjoined twins Jodie and Mary took place in Manchester, England, in November 2000, after months of wrangling in the courts. | |||
Mary died, as it was known she would. Jodie, or Gracie, survived and is now a bright 10-month-old, returning home to Gozo with her parents. The court has spoken, the doctors are satisfied, the parents were granted a full TV interview to express their views, and Gracie has the chance of a normal life. | |||
Case closed? Hardly. The case brought into focus so many difficult and far-reaching issues in family and criminal law that the debate is likely to go on for years. One of the most important questions to emerge was one that challenged the role of the law itself: who should decide the fate of newborn children in such circumstances - their parents or the courts? | |||
Jodie and Mary were born on 8 August 2000 at St Mary's Hospital in Manchester, joined together at the lower abdomen. They each had their own head, arms, legs, brain, heart, lungs, kidneys and liver. The only shared organ was a bladder. There were severe ano-urogenital abnormalities and serious problems arising from the fusion of pelvic bones and the tips of their spines. Jodie seemed to have normal brain development, and her main organs were all working well. Mary had primitive brain function, her heart barely functioned, and her lungs did not function at all. She was surviving only as a result of Jodie's heart pumping blood around her body. This effort was expected to weaken Jodie quite quickly and lead to her death, and thus that of Mary too, in about three to six months. | |||
When the parents came to Britain seeking medical aid, doctors at St Mary's Hospital proposed an operation to separate the twins. The operation would cause Mary's immediate death, but Jodie was expected to have a good chance of surviving, and a reasonable chance, after further operations, of a full, healthy life with the ability to walk, control her bladder and bowels and have normal sexual function. The worst case scenario was that she might be wheelchair-bound with continence and sexual function problems. | |||
The parents, Roman Catholics, wanted nature to take its course, that is, to allow the babies to die. They refused their consent to an operation that would give one of their children a good chance of life but would certainly kill their other child. The Central Manchester Health Area NHS Trust applied to the court for permission to operate without the parents' consent. The High Court, and then the Court of Appeal, albeit on different grounds, declared that such an operation would be lawful. | |||
At first sight it may seem obvious that the law should play the decisive role here. Parents have the first say in treatment where their children cannot give a valid consent themselves, but doctors have a duty to their patients as well, and of course society at large has an interest. Once born, a child is recognised as a legal person, and may be protected by the law from the harmful acts of strangers, doctors or parents. So, if a dispute arises, how else is the issue to be decided, but in court? | |||
Some, however, would maintain that legal intervention in such an issue represented an intrusion into the private beliefs of the family, disrespected the moral autonomy of the parents, and was impelled by a trend that is as much about making parents conform to prevailing standards of behaviour as it is aimed at protecting their children. | |||
In any event, it would appear that the public supervision of private matters of this sort is becoming more common and more intrusive, the conjoined twins case being just the latest example. | |||
The law protects human life in different ways at different stages. The law protects the embryo from experimentation once the primitive streak has appeared or 14 days have passed, but not before. The law protects the fetus from a termination, but not during the first 24 weeks of pregnancy if medical opinion considers there to be a health risk (very broadly defined) to the mother or any of her children. | |||
Furthermore, the law allows a mother to have a termination at any time before birth if medical opinion confirms a substantial risk of a seriously handicapped child being born. It should be noted, too, that a mother suffering from post-natal depression who kills her child in its first year will face an infanticide rather than a murder charge and be treated as if she had committed manslaughter. Beyond that, of course, the laws of assault, homicide, etc protect all legal persons, adult and child alike. | |||
One situation that raises similar principles to the conjoined twins case is that of the pregnant woman who can seek a termination right up to term in cases where serious handicap is expected. The interests of the woman, as future parent with the extra burdens of caring for a seriously handicapped child, are simply given priority over those of the fetus - either because the fetus (handicapped or not) is not recognised as a person who can be wronged by a termination, or because a greater value is placed upon the self-determination of an adult than on the life of a seriously handicapped unborn baby. | |||
In either case, it is not clear what the difference is between a seriously handicapped fetus a few days before birth and a seriously handicapped neonate (newborn) a few days after birth. Nor is it clear how the physical event of birth transforms a fetus into a person or confers a value on the handicapped neonate equal to that of a healthy adult human being. | |||
However, the law confers legal personhood at birth, drawing a crucial line at this point for understandable reasons, not least the fact of separation and entry into the world. It is of course necessary to draw a line as to 'when life begins' at some point, and it may be necessary to apply it rigidly for the purpose of upholding its integrity. In any case, once the law recognised Jodie and Mary as legal persons who were children, there was only one decision to which the courts could come. | |||
Under British law, if the jurisdiction of the court is invoked to protect a legal person who is a child, then the court must give 'first and paramount consideration' to the interests of that child. There is little flexibility; the interests of the parents must come second. | |||
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This is what happened in the case of the conjoined twins. The court declared that the twins were both legal persons entitled to the full protection of the law, and that the law required the court to act in the best interests of the children, and that it was not in the best interests of Jodie that she be allowed to die, even though that is what her parents wanted, and that Mary's life should be brought to a premature end, even though that is not what her parents wanted. The paramountcy principle simply precluded the court from allowing the parental wishes to prevail. | |||
The court held that it if it acted in the best interests of Mary (allowed her to live out her natural span of about six months) then Jodie would also die after about six months, and that if it acted in the best interests of Jodie (allowed the operation, and a chance for Jodie of a normal life) then Mary would die immediately. If it could not act in the best interests of both then it had to act in the best interests of at least one, and so it chose the lesser evil - lesser because Jodie would benefit more from the performance of the operation than Mary would from its non-performance. It further found (although the reasons given by the three judges differ considerably) that the consequent intentional killing of Mary during the operation would be lawful. | |||
There is a limited analogy between the position of these parents and that of the pregnant woman actively seeking a very late termination of the pregnancy on account of the risk of a seriously handicapped child - even though the parents of the twins, as devout Catholics, of course never entertained the idea of an abortion themselves. In both cases the parents are prepared to sanction the death of their severely handicapped babies, one by termination, the other by refusing consent to an operation that could save one of the twins. One difference, however, is that the respect and mercy shown by the law to the pregnant mother is not available to the twins' parents because their children have actually been born. Of course human beings who are born must have the protection of the law, although whether that protection has to be both full and immediate is less clear, as indeed the law on infanticide indirectly indicates. | |||
The analogy is limited, especially because in the case of the conjoined twins the parents did not see themselves as sanctioning the death of Jodie by withholding consent from the operation, they saw themselves as refusing to sanction the death of Mary. They saw operating as actively killing one of their children in order to save the other. This they were not prepared to do, and they were also very worried at how they would cope financially and personally with a seriously disabled child (which they feared Jodie might be), especially in their relatively impoverished homeland. | |||
In 1997 the Court of Appeal had reversed a High Court order that a transplant operation take place on a child a few weeks old against the mother's wishes. Medical opinion was that the child would die within two and a half years without transplantation surgery, and the prospects of a successful transplant were good and in the patient's best interests. In determining the best interests of the child the court gave special weight to the strong and reasoned parental objections - based on risk of failure, knowledge of pain and suffering involved, and the effect on the mother's future care of the child were she made to bring him up against her wishes. This case was mentioned by the court in the conjoined twins case but not followed. | |||
In a sense that is understandable. The law has to fix its lines somewhere, and the courts cannot afford to show much flexibility in matters of life and death without undermining the certainty of the law and the safety that bestows. We insist that the law protect the lives of human beings with special firmness and care. The strict formulations of the law can serve to restrain both errant individuals and also institutions such as government, the police or the national health service which might be tempted to adopt practices that hold life cheap. Both parents and hospitals are subject to the law. | |||
Nevertheless, the law can be a blunt instrument. It is quite handy to have such an instrument to hand, but foolish to make use of it at every opportunity. Many people feel that this was the mistake the hospital made in this case. The parents were faced with the gross abnormalities of their conjoined children, the prospect of the certain early death of one and the survival of the other with a risk that she be seriously handicapped. Worse still, the survival of that child depended upon their agreeing to an operation that would cause the immediate death of the other. | |||
On any account this was a deeply personal and private matter. Only the parents themselves would have to live with the consequences of their decision. It was a terrible situation, but their statement to the court, understandably anguished as it was, does not in fact show that they found it difficult to arrive at a decision. Their religious beliefs were strong, and their concerns about their own situation clearly articulated. They were certain that nature should be allowed to take its course. | |||
The striking feature of the case is that the hospital authorities insisted on invoking the law. They were not prepared to let the parents have their way, but sought to impose their own view as to what should happen to the children. Their action bespeaks a boldness among healthcare professionals about the propriety of interfering in the private lives of their patients, and a readiness to resort to law rather than to accommodate the judgment of others. | |||
In the court of appeal, Lord Justice Ward said that the hospital authorities were entitled to seek the Court's ruling. He went out of his way, however, not to endorse the view that the hospital authorities were under a duty to refer the matter to the court, and he also said, 'Other medical teams may well have accepted the parent's decision. Had St Mary's done so, there could not have been the slightest criticism of them for letting nature take its course in accordance with the parent's wishes'. Later in his judgement, however, he said 'if this court were to give permission for the operation to take place, then a legal duty would be imposed on the doctors to treat their patient in her best interests, ie, to operate upon her'. | |||
It is an interesting position: it would have been lawful for the doctors to have accepted the parents' decision and let the twins die; the doctors were entitled, but not bound, to seek a court ruling; having done so they were bound in law to accept the court's decision - which was contrary to that of the parents. | |||
He seems to be saying in effect that not everything has to be referred to the court, even those matters of life and death that the court would be constrained to decide differently. Something of the same diffidence about the role of the court is also evident in his opening comment on this topic: | |||
'There has been some public concern as to why the court is involved at all. We do not ask for work but we have a duty to decide what parties with a proper interest ask us to decide.' | |||
Of course the judiciary protest too much as they extend their remit. They are however well placed to see the limits of the law and the limits of judicial activism. There are many problems that are best left to people to sort out among themselves, and the people most concerned with those problems should be trusted to sort them out and their judgement respected. It has come to something when it is the judges who are hinting that this is so. http://www.spiked-online.com/Articles/00000000540E.htm |
Siamese Twins, Jodie & Mary |
posted on 14 September 2000 A SUBMISSION BY ARCHBISHOP CORMAC MURPHY-O'CONNOR, ARCHBISHOP OF WESTMINSTER, TO THE COURT OF APPEAL IN THE CASE OF CENTRAL MANCHESTER HEALTHCARE TRUST V MR AND MRS A AND RE A CHILD (BY HER GUARDIAN AD LITEM, THE OFFICIAL SOLICITOR) 1. I am grateful to the Court for this opportunity to make a submission. My reason for doing so is to offer some reflections based on principles of morality which the Catholic Church holds in common with countless others who value the Judeo-Christian tradition. It is my hope that these reflections may be of some assistance to the Court of Appeal judges in deciding this tragic and heartrending case in which everyone involved is clearly trying to discern, and to do, what is for the best. 2. The arguments presented in this submission stem from the belief that God has given to humankind the gift of life, and as such it is to be revered and cherished. Christian beliefs about the special nature and value of human life lie at the root of the western humanist tradition which continues to influence the values held by many in our society and historically underpins our legal system. 3. There are five overarching moral considerations which govern this submission: (a) Human life is sacred, that is inviolable, so that one should never aim to cause an innocent person's death by act or omission.(1) (b) A person's bodily integrity should not be invaded when the consequences of doing so are of no benefit to that person; this is most particularly the case if the consequences are foreseeably lethal. (c) Though the duty to preserve life is a serious duty, no such duty exists when the only available means of preserving life involves a grave injustice. In this case, if what is envisaged is the killing of, or a deliberate lethal assault on, one of the twins, 'Mary', in order to save the other, 'Jodie', there is a grave injustice involved. The good end would not justify the means. It would set a very dangerous precedent to enshrine in English case law that it was ever lawful to kill, or to commit a deliberate lethal assault on, an innocent person that good may come of it, even to preserve the life of another. (d) There is no duty to adopt particular therapeutic measures to preserve life when these are likely to impose excessive burdens on the patient and the patients' carers. Would the operation that is involved in the separation involve such 'extraordinary means'? If so, then quite apart from its effect on Mary, there can be no moral obligation on doctors to carry out the operation to save Jodie, or on the parents to consent to it. (e) Respect for the natural authority of parents requires that the courts override the rights of parents only when there is clear evidence that they are acting contrary to what is strictly owing to their children. In this case, the parents have simply adopted the only position they felt was consistent with their consciences and with their love for both children. 4. Against this background, this submission, on which I have received legal advice, now turns to the specific arguments adduced. It respectfully invites the Court to reverse the judgment of Johnson J. and not to grant a declaration that it would be lawful to separate the conjoined twins Mary and Jodie. It seeks to assist the Court by analysing the judgment of Johnson J. and by outlining the main considerations which, it is submitted, ought to govern the resolution of this case. 5. The following seem to be the case: 1) Mary is a distinct individual, giving some evidence of a distinct life, even if conjoined to another and with seriously defective organs. 2) The life that Mary has is, because of abnormal development, dependent on Jodie's blood supply. 6. The first consideration - implicitly and rightly accepted by Johnson J.(2) - is that each of the conjoined twins is a live-born human being or, in the ancient terminology of the common law, a 'reasonable creature in rerum natura'.(3) Mary and Jodie have been wholly born alive and enjoy an existence physically independent of their mother. Their parents and the hospital staff rightly consider them to be two individuals.(4) 7. Mary exists as a legal person in spite of the fact that her continued existence may depend on her sister's heart and lungs. Physical independence from the mother is not to be confused with an existence independent from anyone or anything else. Many live-born children are dependent on mechanical ventilators for their hope of survival: they are nevertheless legal persons. 8. As Mary is a legal person, she enjoys the same right to bodily integrity, and the same legal protection from assault and homicide, as other legal persons. 9. Although Mary and Jodie are two seriously abnormal human beings, they remain fully entitled to the protection of the law relating to assault and homicide. The law protects Mary from lethal conduct just as it would protect, say, an anencephalic infant. In Re J (A Minor), Lord Justice Taylor noted that the court's high respect for the sanctity of human life imposes a strong presumption in favour of taking all steps to preserve it, save in exceptional circumstances. He added: 'it cannot be too strongly emphasized that the court never sanctions steps to terminate life. That would be unlawful. There is no question of approving, even in a case of the most horrendous disability, a course aimed at terminating life or accelerating death'.(5) 10. A child may not normally be subjected to medical treatment without the consent of her parents. As Lord Donaldson MR observed in Re J (A Minor), although the doctors owe a child patient a duty to care for it in accordance with good medical practice recognized as appropriate by a responsible body of medical opinion: 'This duty is, however, subject to the qualification that, if time permits, they must obtain the consent of the parents before undertaking serious invasive treatment'.(6) 11. In Re F (Mental Patient: Sterilization), Lord Brandon stated that treatment would be in the best interests of incompetent (adult) patients 'if, but only if, it is carried out in order either to save their lives, or to ensure improvement or prevent deterioration in their physical or mental health'.(7) The proposed operation would confer no benefit, therapeutic or otherwise, on Mary. It would serve only to accelerate Mary's death and, therefore, far from being in her interests, would be against her interests. It is the parents' right to withhold consent to such lethal conduct. 12. In Re T(8) the Court of Appeal held that it would not be in the best interests of a child to undergo a liver transplant operation, despite unanimous medical evidence that with the operation the boy would enjoy many years of normal life and that without the operation he would die. The Court held that the High Court judge had failed to assess the matter more broadly and had overlooked several factors including the relevance or the weight of the mother's concern as to the benefits to her child of the surgery and post-operative treatment, the dangers of failure both long term and short term, the possibility of the need for further transplants, and the likely length of life and the effect on her child of all those concerns.(9) As Butler-Sloss LJ observed, the practical considerations of the mother's ability to cope with supporting the child in the face of her belief that the operation was not right for him, the requirement to return from their distant Commonwealth country for further treatment, possibly leaving the father behind and losing his support, were not put by the judge into the balance. She added that the prolongation of life was not the sole objective of the court and that to require it at the expense of other considerations may not be in the child's best interests.(10) If the Court respects the parents' refusal of consent because they do not think that a life-saving operation is in their child's best interests, then the Court should a fortiori respect parents' refusal of consent because they think a life-taking operation would not be in the best interests of one of their children, Mary, as being a grave injustice to her. 13. I understand that the primary reason for the parents' refusal of consent to the procedure for separating the twins is that it will cause Mary's death. But there is also the question whether, were Jodie to survive separation, subsequent surgical and other care for her would impose excessive burdens both on Jodie and on the parents. When prospective burdens likely to be caused by a therapeutic procedure are reasonably judged to be considerable and the benefits very uncertain, one is justified in declining that procedure. (11) So, though the Court should recognise the lethal consequence for Mary of separation surgery as a decisive reason for respecting parental refusal of consent to it, weight should also be given to the likely burdensome consequences of surgery for Jodie and her parents. 14. Johnson J. stated that 'In considering the consequence for Mary of what is proposed, I must, and I do, focus only upon the interests of Mary herself'.(12) His Lordship proceeded to reason that it was in Mary's interests for her life to be intentionally terminated and to find a basis upon which that termination could lawfully be justified. In other words, His Lordship declared the operation lawful precisely on the ground that it was 'a course aimed at terminating life or accelerating death'.(13) 15. His Lordship stated: 'I conclude that the few months of Mary's life if not separated from her twin would not simply be worth nothing to her, they would be hurtful' and that 'to prolong Mary's life for those few months would, in my judgment, be very seriously to her disadvantage'.(14) He invoked the distinction drawn by the House of Lords in Airedale NHS Trust v Bland(15) - to justify the withdrawal of tube-feeding from a patient in persistent vegetative state - between intentionally terminating life by an act and by an omission. Drawing an analogy between the withdrawal of tube-feeding and the proposed operation, Johnson J. ruled that the operation causing Mary's death would also be an omission: 'I have concluded that the operation which is proposed will be lawful because it represents the withdrawal of Mary's blood supply'.(16) 16. His Lordship construed the 'interests' of Mary in such a way that the bringing about of her death is justified precisely as a desirable objective. The implications of such a line of reasoning are alarming, and in no way mitigated by the penultimate sentence of his judgment: 'It is of course plain that the consequence for Mary is one that most certainly does not represent the primary objective of the operation.'(17) For his reasoning sought to show not that the 'consequence for Mary' would be, say, a tolerable side-effect(18) but rather an appropriate objective of the procedure envisaged. And that is why he thought it necessary to invoke Bland. 17. Johnson J.'s reasoning invites several criticisms: 1) It is seriously unreasonable to seek to justify the ending of someone's life on the grounds that that human being's life lacks value or worth,(19) so that he or she would be better off dead. Judgements of that kind should not be admitted as justifications of intentional killing since they are both arbitrary and admit of no principled way of containing their extension to a variety of other conditions, and so are incompatible with the justice which the law should uphold. The indispensable foundation of justice is the basic equality in worth of every human being. 2) The distinction drawn in Bland between deliberately ending someone's life by a positive intervention (held to be impermissible) and by a course of conduct classifiable as an omission (held to be permissible) should not be relied on. To aim at ending an innocent person's life is just as wrong when one does it by omission as when one does it by a positive act.(20) 3) In any event, the analogy between the proposed operation and ceasing tube-feeding is strained and unpersuasive. While it is reasonable to classify the latter as an omission, the former is clearly a major surgical intervention. 18. There are those - including no doubt many Catholics - who would argue that one might embark on such an operation without having Mary's death as part of one's aim, and that her death would then be a foreseen but unintended consequence of a morally justifiable operation aimed at saving Jodie. But what is not possible is that one could embark on such an operation without foreseeing that it would do Mary no good(21) but only lethal harm. And even if her death were merely foreseen, the invasion of her bodily integrity is nevertheless intended. The process of separation cannot be thought of with any plausibility as one of cutting into Jodie's body alone; Mary's body is necessarily cut into. And that violation of her bodily integrity is in the nature of the case lethal for her. It therefore cannot be justified. 19. It is submitted that Ward LJ was right to observe: 'The moment the knife goes into the united body, it touches the body of unhappy little Mary. It is in that second an assault. You fiddle about, rearrange the plumbing. An hour later you put a clamp on the aorta. You cannot pretend that is not actively engaged in assaulting her integrity. For what justification? None of hers.'(22) 20. It is also submitted that the further comment reportedly made by Ward LJ is right: 'If what you propose is the murder of Mary, I cannot see how you can trade off one against the other. My conclusions in the middle of the night were, if the court comes to the view that the operation is contrary to the interest of Mary, there is no jurisdiction to say that the parental refusal was wrong - and the parental refusal bites.'(23) 21. The considerations which, it is submitted, should govern a just resolution of the case are: (1) Mary should be acknowledged to be an individual human being with, as the parents have asserted, a right to life. It is clear that those who have dealt with Mary apart from her parents - the doctors and nursing staff - see Mary as an individual human being. The fact of her dependence should not be allowed to count against her right to life. 2) Mary's right to life should be respected because (a) she possesses the same basic worth and dignity which belongs to every human being, and (b) she has done nothing which could justify killing her. Any attempt (as in Johnson J.'s judgement) to justify intentionally ending her life on the ground that her life is without any value - indeed, has negative value - should be rejected as incompatible with the truth which should govern all our dealings with each other, viz. the basic equality in worth of every human being. So the argument advanced before the Court of Appeal by counsel for Jodie that Mary's life is 'futile'(24) should be rejected. The right not to be unjustly killed is the core of the doctrine of the sanctity of life, which the criminal law has historically upheld, and which it is essential that the law should continue to uphold.(25) 3) The doctrine of the sanctity of life does not entail any absolute requirement that human life is to be preserved wherever and whenever this may seem physically possible.(26) There can, moreover, be no obligation to prolong a person's life when doing so involves something which should be regarded as morally wrong. Thus in the case of Jodie, if what is required to prolong her life involves doing grave wrong to Mary then one is obliged to refrain from that attempt to prolong life. Even if the attempt to save Jodie's life does not require that one has as part of one's aim (as recommended by Johnson J. and, at least implicitly, by counsel for Jodie) ending Mary's life, it will nonetheless amount to an invasion of her body which will in no wise benefit her and do her nothing but lethal harm. It will therefore amount to an unjust invasion of Mary's bodily integrity. So the attempt to save Jodie's life at the expense of Mary's should be regarded as morally impermissible. 4) The law should not stretch the concept of an 'unjust aggressor' to include human beings incapable of entertaining aggressive intentions. Dependence which has resulted from developmental processes, however abnormal, is not aggression. 5) No part of the judgement should rely on the distinction drawn in Bland between, on the one hand, deliberately ending someone's life by a positive intervention (held to be impermissible) and, on the other, by a course of conduct classifiable as an omission (held to be permissible). To aim at ending an innocent person's life is just as wrong by omission as by a positive act.(27) 6) Respect for the natural authority of parents requires that the courts override the rights of parents in the care of their children only when there is clear evidence that the parents are acting contrary to what is owing to their children. The refusal by the parents of Jodie and Mary to consent to surgery to separate them involves no injustice towards either of their children and is indeed wholly reasonable on the grounds they have advanced.(28) In particular, respect for the rights of both their children makes any other choice on their part morally impossible. The Court should respect their refusal and allow the parents to take up, if they wish, the offer of care in Italy, which seems to be the type of care that is consistent with the moral principles they rightly uphold.(29) Archbishop Cormac Murphy-O'Connor Archbishop of Westminster |
The crucial issues considered by the three judges were;
Conjoined twins are usually classified by the point at which they are joined (the Greek word pagos , meaning "that which is fixed.") There have been as many as three dozen separate types identified in the last century. The following basic classifications can be combined to more closely define individual cases.