Pro-lifers ponder U.K. conjoined twins case

Pro-lifers around the world are worried about the British courts setting a precedent that appears not only to allow but to dictate the killing of a young child to save the life of her sister.

On Aug. 25, the English High Court ruled that “Jodie” and “Mary,” conjoined or “Siamese” twins born earlier that month, were to be surgically separated. The two children shared a heart and lungs and the surgery would surely kill Mary. Jodie is said to be more healthy than Mary, and able to survive on her own.

It was announced Nov. 9 that the operation had been completed, and that Mary died as expected. Jodie’s long-term prospects were not known as The Interim went to press.

Mr. Justice Johnson ordered the surgery despite the objections of the parents, devout Roman Catholics who see the surgery as a violation of God’s will. Doctors estimate that without the surgery, both twins would die within the year, although medical experts from the Great Ormond Street Hospital for Children where the surgery would be performed said it is possible that both of them could live for several years.

The family came to Britain in May because their homeland, the Mediterranean island of Gozo, off Malta, lacked the facilities to deliver conjoined twins. Ironically, the effort to have both children live has led to the entanglement of the British courts which have ruled “Mary” should not be allowed to continue to live because the hospital in which they were born applied to separate them.

Lawyers for the hospital said in the 10 to 20 per cent chance the twins did not die if left unseparated, a “permanent union” would “condemn a potentially normal Jodie to carry her very abnormal sister, Mary, throughout the life of both.”

Justice Johnson admitted, “For Jodie, separation means the expectation of a normal life; for Mary it means death.” He said the parents’ love for both their children rendered them unable to “choose life for one at this frightful cost to the other.”

Justice Johnson said “the court will never authorize any step actively to terminate a life, even to relieve misery and if the patient or a parent consents,” but included the withdrawal of treatment and nutrition as permissible steps to terminating Mary’s life. The separation surgery would end Mary’s blood supply, and thereby satisfy, to the Justice’s mind, an indirect method of killing.

In September, the parents appealed the case to the Court of Appeal, but the three-member bench ruled against them. On Sept. 28, they ended their legal battle.

Archbishop Cormac Murphy-O’Connor of Westminster, England’s leading Catholic bishop, said in a written submission to the court that separation would be “morally impermissible” because it was an act of direct killing. He expressed concern “that a precedent might be set in English law that could allow an innocent person to be killed, or lethally assaulted, even to prolong the life of another.”

Professor Joseph Boyle, principal of St. Michael’s College at the University of Toronto, toldThe Interim Archbishop Murphy-O’Connor’s statement was a condemnation of the utilitarian approach which considers some lives more worth living than others.

He criticized the hospital’s view that surgery was necessary so that Jodie could have a “normal life,” an argument perilously close making judgements about what lives are worth living and which are not. Boyle said the Catholic Church has consistently opposed such a callous view of human life. Boyle is leery of making judgement calls that some lives can be used or discarded for the benefit of others.

England’s Pro-Life Alliance went further in a Sept. 22 press release, criticizing the “judicial sanction of infanticide” on “eugenic” grounds. It said the Court of Appeals effectively stripped “the weak” of their rights. The Pro-Life Alliance failed twice to obtain a court injunction to stop the separation operation.

Archbishop Murphy-O’Connor also objected to the court’s usurpation of parental authority. “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.”

Gilbert Meilaender, professor of theology at Varaspario University and a member of the editorial board of First Things told The Interim the courts are on shaky ground, and that while he thinks this is a case of direct killing, there should be an honest description by the courts and medical community about what the separation procedure will actually involve.

Meilaender, a leading Protestant authority on ethics, said that Mary could be intentionally killed only if she was an unjust aggressor. He challenged the courts and doctors to describe how Mary might fit that description.

He said those who advocate the separation must explicitly describe what is involved in this decision, that there must no be any flinching from the truth of what is happening here. “It appears the death of Mary is the aim of the surgery,” Meilaender says. “They must explain whether or not that is the aim.”

Meilaender said “courts should be very reluctant to give precedence to the principle of actually killing a child.” He said that a public discussion might awake the moral sensibilities of the legal and medical communities to the realization of the consequences of their advocacy.

Still, because of its uniqueness and complexity, the case of Jodie and Mary has occasioned understandable debate in pro-life circles. Bridget Campion, an assistant professor of moral theology at St. Augustine’s Seminary in Toronto, told The Interim that separating the two might be considered acceptable according to the traditional ethical principle of double effect.

She listed the four conditions, based on the writings of Augustine and St. Thomas Aquinas, in which double effect comes into play. All four must be present: the act must not be intrinsically evil; the good outcome must be the intended outcome; the good outcome cannot be caused by the bad outcome; and there must be proportion between the good and bad outcomes.

Campion outlined how separating the twins might satisfy each condition. She said the act (the surgery) is not intrinsically evil because conjoined twins have been separated before and lived; the intention of the surgery is to save Jodie, not kill Mary; Jodie is saved by the separation and not the killing of Mary; and saving one life is preferable to watching both twins die, thus the good is proportionate to the evil committed.

Campion, who is a strong pro-lifer, admits the last condition is often the trickiest and involves a serious moral debate. But she said the moral quandary could be dealt with by treating Mary as a person, a fact ignored by the courts and medical establishment. She said if Mary was put on life support and treated as any other person, the separation would be morally permissible. Campion is outraged by the failure to tend to Mary’s medical needs and says it represents a “value judgement about her life.”