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KembaraXtra-Case Law- (Children) (Conjoined Twins: Surgical Separation) (2000)
I. Facts of the Case
Parties: Conjoined twins, Jodie and Mary; their parents; and the hospital.
Issue: Whether to surgically separate conjoined twins when one twin (Mary) is severely compromised and dependent on the other (Jodie), where separation would cause Mary's immediate death but give Jodie a chance at a normal life.
Twin's Condition:
Mary: Non-functioning lungs, severely abnormal heart (10% function), completely dependent on Jodie for oxygenated blood.
Jodie: Healthy, would likely survive separation with a reasonably normal life.
Prognosis:
Without separation: Both twins would die within 3-6 months.
With separation: Jodie would likely survive; Mary would die immediately.
Parents' Stance: Refused consent based on religious beliefs, not wanting to choose between their children, and believing the situation should be left in God's hands.
II. Court Decision (Court of Appeal)
Overturned Previous Decision?: No, the Court of Appeal dismissed the parent's appeal thus agreeing with the judge's original declaration that the operation would be lawful.
Grounds for Dismissing the Appeal (allowing the operation):
Inherent Value of Life: Every life has equal value, regardless of disability. Quality of life should not determine the value of a life.
Positive Act, Not Omission: The operation is a positive act (separation), not a passive omission of care.
Best Interests (Conflicting): The operation was in Jodie's best interests, but not necessarily Mary's (Walker LJ dissented, arguing it was in Mary's best interest to avoid prolonged suffering).
Conflict of Duty: The court faced a conflict between its duty to prioritize the welfare of both twins.
Lesser of Two Evils: The court had to choose the "least detrimental course" through a balancing exercise. Jodie's potential benefit from the operation far outweighed Mary's value in not operating, given Mary was beyond medical help and causing harm to Jodie.
Lawfulness: The operation would kill Mary, potentially constituting murder unless justified. Mary was causing a strain on Jodie's organs, effectively killing her. The operation was justified as "quasi self-defense" to save Jodie's life.
III. Commentary and Key Legal Principles
Necessity: The court argued that the operation was justified by necessity, fulfilling three requirements:
(i) Needed to avoid inevitable and irreparable evil (death of both twins)
(ii) No more done than reasonably necessary (only separating the twins)
(iii) Evil inflicted (Mary's death) not disproportionate to the evil avoided (death of both twins and harm to Jodie)
Balancing Act: The "least detrimental course" approach is only appropriate when there is a conflict between two legal duties, not when one duty is merely moral.
Legal Personhood: Conjoined twins are considered two distinct legal persons.
Intention (Human Rights Act): "Intention" in Article 2 of the European Convention on Human Rights (right to life) refers to the ordinary meaning (purpose), not the criminal law definition (where death is a virtually certain consequence). Since the purpose of the operation was not to kill Mary, it did not violate the Human Rights Act.
Limited Precedent: Ward LJ emphasized the decision was limited to "unique circumstances". The precedent can only be applied if all conditions are satisfied:
Impossible to save X (Jodie) without causing the death of Y (Mary).
Y's (Mary) continued existence will inevitably kill X (Jodie) within a short period.
X (Jodie) is capable of independent life.
Y (Mary) is incapable of viable independent existence under any circumstances.
I. Facts of the Case
Parties: Conjoined twins, Jodie and Mary; their parents; and the hospital.
Issue: Whether to surgically separate conjoined twins when one twin (Mary) is severely compromised and dependent on the other (Jodie), where separation would cause Mary's immediate death but give Jodie a chance at a normal life.
Twin's Condition:
Mary: Non-functioning lungs, severely abnormal heart (10% function), completely dependent on Jodie for oxygenated blood.
Jodie: Healthy, would likely survive separation with a reasonably normal life.
Prognosis:
Without separation: Both twins would die within 3-6 months.
With separation: Jodie would likely survive; Mary would die immediately.
Parents' Stance: Refused consent based on religious beliefs, not wanting to choose between their children, and believing the situation should be left in God's hands.
II. Court Decision (Court of Appeal)
Overturned Previous Decision?: No, the Court of Appeal dismissed the parent's appeal thus agreeing with the judge's original declaration that the operation would be lawful.
Grounds for Dismissing the Appeal (allowing the operation):
Inherent Value of Life: Every life has equal value, regardless of disability. Quality of life should not determine the value of a life.
Positive Act, Not Omission: The operation is a positive act (separation), not a passive omission of care.
Best Interests (Conflicting): The operation was in Jodie's best interests, but not necessarily Mary's (Walker LJ dissented, arguing it was in Mary's best interest to avoid prolonged suffering).
Conflict of Duty: The court faced a conflict between its duty to prioritize the welfare of both twins.
Lesser of Two Evils: The court had to choose the "least detrimental course" through a balancing exercise. Jodie's potential benefit from the operation far outweighed Mary's value in not operating, given Mary was beyond medical help and causing harm to Jodie.
Lawfulness: The operation would kill Mary, potentially constituting murder unless justified. Mary was causing a strain on Jodie's organs, effectively killing her. The operation was justified as "quasi self-defense" to save Jodie's life.
III. Commentary and Key Legal Principles
Necessity: The court argued that the operation was justified by necessity, fulfilling three requirements:
(i) Needed to avoid inevitable and irreparable evil (death of both twins)
(ii) No more done than reasonably necessary (only separating the twins)
(iii) Evil inflicted (Mary's death) not disproportionate to the evil avoided (death of both twins and harm to Jodie)
Balancing Act: The "least detrimental course" approach is only appropriate when there is a conflict between two legal duties, not when one duty is merely moral.
Legal Personhood: Conjoined twins are considered two distinct legal persons.
Intention (Human Rights Act): "Intention" in Article 2 of the European Convention on Human Rights (right to life) refers to the ordinary meaning (purpose), not the criminal law definition (where death is a virtually certain consequence). Since the purpose of the operation was not to kill Mary, it did not violate the Human Rights Act.
Limited Precedent: Ward LJ emphasized the decision was limited to "unique circumstances". The precedent can only be applied if all conditions are satisfied:
Impossible to save X (Jodie) without causing the death of Y (Mary).
Y's (Mary) continued existence will inevitably kill X (Jodie) within a short period.
X (Jodie) is capable of independent life.
Y (Mary) is incapable of viable independent existence under any circumstances.
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