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Conjoined twins dillema

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Medical ethics can be a very tricky, subjective, delicate issue, encompassing many angles. Yet also cut and dry in some cases. Abortion and euthanasia can be polar opposites, depending on one’s life or theological/philosophical viewpoint, but if one removes the position of the individual and look solely from a neutral position, if such exists, then the puzzle changes.

If one takes the position that life is created, sacred and only the creator should intervene, then a polarizing position can be taken, and rightly so, if one’s position is correct.

If one assumes everything is entirely natural, then one can begin to define life and when it begins, and what it is prior to that, and what value it holds.

There are of course people who believe in a god and yet accept abortion and vice versa of course. There are variations.

But life and events and circumstances are fluid and not always so easy, no matter how extreme ones views are on a spectrum. Here’s one.

These form of twins are quite rare. It’s largely two people from the midriff and one below. In itself, it is not impossible to separate them, and it has been done before.

An extreme view which holds that there should never be interference or anything artificial done, then one pretty much has to reject medicine, vaccines, artificial respiration, re-starting hearts etc. I doubt anyone holds this view in theory or practise, although it does seem consistent with the idea that only God decides when it’s time. Others may take the view that it is our responsibility, given the gift of intelligence, to sustain or even extend life as much as possible.

To be fair, an alternate, naturalistic view might be similar (no interference) or the opposite, that we can or should sustain or extent life at all costs, and seek technology to do so, whilst perhaps simultaneously trying to create the defect-free, perfect lifeforms.

In the case of these twins, whilst they each have a head, brain, heart, lungs and a spine, they share 3 kidneys and only one liver, spleen and digestive tract (and one assumes, share genitalia and waste  exit.

In itself, if separated, this would mean having to introduce new body parts, necessary for life, as well as how to share/split the pelvic bones. Having only one leg would be trivial by comparison.

But one of the twins has a week heart and the other is weak, as the other parasitically draws additional blood and other functionality from the other. So, separation would almost certainly end in the imminent death of one twin, but (despite the high risks of an operation) give the remaining twin a much better chance of living a long time, albeit with a significant disability. To do nothing, will result in the very short life expectancy of both, and it if one died, it would be too late to save or separate the other.   

There are no clear answers here, and to use the excuse of doing nothing can be compared to the trolley dilemma (https://en.wikipedia.org/wiki/Trolley_problem) which the relatively new law of gang culpability - if one is merely present, you are guilty, shows.

To what extent, if any, do we consider the view of the parents, the patient(s), whether the patient(s) is able to communicate or not, one’s beliefs, one’s culture, the law of the land etc.?

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