Question:
Can Siamese twins who share the same heart and part of the liver be surgically separated?
Answer:
The question refers to the case of the twins Amy and Angela Lakeberg, born June 29, 1993, at Loyola University Medical Center near Chicago. It was briefly analyzed by Wm.B. Smith, in ‘Homiletic & Pastoral Review’, March 1994, pp. 68-69).
They were united from chest to navel, they shared a malformed six-chambered heart. In such a state they had a life expectancy of 6 to 7 weeks. Doctors at the Children’s Hospital of Philadelphia offered to operate on them: the idea was to separate them, resulting in the death of one of the twins and a less than 1% chance of survival for the other.
Several Theologians were consulted. Many of them affirmed that this was an extraordinary case of the principle of double effect. What seemed, however, not to justify recourse to this principle were the excessive expenses (more than 1 million dollars).
What should we say?
1) In the best case, if it were a case of double effect, then we would be in a non-obligatory case, among other things because of the enormous expenses.
2) But, still hypothesizing that it falls under such a principle, there is the difficulty of the minimum success: the certain death of one of the girls and the 1% chance of survival of the other. With such an outcome, is it therapy or experimentation?
3) But are we dealing with a case of double effect? This seems to be the most doubtful:
a) Intention: there is no difficulty since it is a question of saving one of the twins.
b) Proportionality: there seems to be a proportion between the good and the bad effect, since the death of one is allowed in order to save the life of another; in other words, it is not to achieve an economic good, but a life (it would be similar to when one gives one’s life for another person: it is justified because it is worth giving one’s life so that another does not lose it).
c) The problem: It seems to be the moral object of the act to be performed. This seems to be neither good nor neutral, because it is a matter of assigning the heart and the connecting vessels to the one who has the best chance of survival; this deprives the other girl of the right to the only heart they share, so that the very act produces death. This death will not be wanted as an end, but is foreseen and intended as a necessary condition for the hope of success in giving the other life.
d) For this same reason, it is doubtful whether there is not a certain nexus of causality between the two effects, that is, that the life of one is produced by killing the other. Some consider that this condition (that there is no causal link between the bad effect and the good one, i.e. that the good one is not caused by the bad one) is not the problem here (e.g. Smith, the author of the article).
The most reasonable solution (if not the only morally admissible one) is therefore the one put forward by the Dominican Albert Moraczweski: ‘it is morally better, even if not from the sentimental point of view, that both twins die by natural death, in this case from the defective heart, which is inadequate to support both lives, and not to deprive one of life in order to give it to the other’ (Cf. ‘Ethics & Medics’, v.18, 11 [November 1993], p.2).
Fr. Miguel A. Fuentes, IVE
Original Post: Here
Anothe Post: Immediate Animation & Identical Twins: A Catholic Bioethics Resolution
