Ethical Challenges in Separating Conjoined Twins
Professional ethics is based on the notion abiding by a certain code of ethics by profession in making judgments when applying their skill. Every profession has a specific code of ethics that is largely based on the moral obligation of such professionals. Relevant to this case-study is the Hippocratic oath that doctors take and are bound to adhere to in order to preserve the integrity of the profession (American Medical Association, 2016). This case-study will examine the challenging aspects of making medical decisions on the grey medical issued that cannot be clearly governed by codes of conduct. Such issues require the doctor’s autonomy to make difficult decisions based on his or her own interpretation of what is morally required of a professional faced with such challenges.
The case-study involves analysing how doctors make decisions when faced with difficult questions during procedures that require the separation of conjoined twins (Firger, 2017). In a scenario where the procedure of separation of this twins is necessary to ensure their survival but if such a procedure is done, one of the twins has to die, how will the doctor decide on whether or not to conduct such a procedure given his duty to preserve life? What about when the outcome of the procedure has a fifty percent chance that one of the twins might survive? This problematic questions form the basis of this case study owing to the fact that there is no clear cut procedure of making such decisions.
John is a doctor in a certain well-funded private hospital. Mary and Joseph, the parents of two conjoined infants, heard of the expertise of John in carrying out separation procedures and decided to consult John for advice on the possibility of saving their twin daughters by conducting a separation surgery. A preliminary analysis of the condition reveals that the sisters are fused at the pelvis and abdomen and have only three legs one of which has a deformed foot. The internal structure of the twins is such that they share certain vital internal organs such as the liver and the bladder. The twins also share a single set of lower intestines and reproductive system. However, each child has their own spinal cord, brain and heart. One of the twins appears to be larger, more active and alert while the other appears less active and more difficult to engage.
From this tests, it is clear that the smaller twin is living off of the larger twin’s blood supply through an artery that is shared between the two twins and the only reason that she is still alive is because she is attached to the larger twin. The test also reveals that as the smaller twin gets bigger, her chances of survival become slimmer as her lungs continue to deteriorate. It therefore becomes very clear to John that in order to ensure that the larger twin survives, the separation is necessary and this means that the smaller twin will have to die. Upon receiving this news, the parents are uncertain of what decision to make due to the love they have for both their daughters. John is faced with the question of whether or not to advice the parents to go ahead with the procedure or to wait it out (Cummings, et al., 2017).
From this case study, a number of issues arise. One of the main issues revolves around the duty of the doctor to do all he can to preserve life. Carrying out the procedure will lead to the loss of life of the smaller twin. The question therefore is, what is the place of the doctor in deciding who lives and who dies and whether he should let nature decide. Another issue arising from this scenario is that the existence of two sets of brains means that these twins have two different sets of personalities. It is not simply one organ surviving off another but rather two different people. The question, therefore, arises as to whether it would be inhuman to procure the death of the smaller twin. In order to deal with this issues, John should only give professional advice to the parents who then, being informed of the possible outcomes, can make a decision. John cannot decide on whether or not it would be best to perform the procedure due to the autonomy granted to the patient.
In such a case, the duty of John to advice the parents would only be so much as to enable the parents to make a decision by providing them with his expert opinion. The ultimate decision on whether or not to go ahead with the procedure lies with them. In this situation, the risk of losing both daughters outweigh the risk of losing one, John should therefore advise Mary and Joseph as such. This difficult professional decisions form part of everyday life and as such, professional ethics and values should continuously be instilled in professionals to prepare them for such situations.
American Medical Association. (2016). AMA Code of Medical Ethics. American Medica Association.
Cummings, B., Gee, M., Benavidez , O., Shank, E., Bojovic, B., Raskin, K., & Goldstein, A. (2017). Case 33-2017 22- Month-Old Conjoined TWINS. The New England Journal of Medicine, 1667-1677.
Firger, J. (2017, October 26). Conjoined Twins Ethical Dilemma: When Parents Need to Sacrifice One Life For the Other. Retrieved from Newsweek: http://www.newsweek.com/conjoined-twins-ethical-dilemma-separation-surgery-death-693562