Bioethics III Case Study #4: Siamese Twins

*Disclaimer - I am sorry if I offend anyone. Everyone is entitled to their opinion including myself. I can take criticism but remember that I recognize your right to an opinion and I hope you recognize mine. Thanks!*

The case study my group was given to discuss was about the Lakeberg Siamese twins:

Joey Lakeberg, the mother, found out after five months of pregnancy that her twins would not be normal. The twins, Angela and Amy, were fused together at the chest, they shared a liver and heart between the two of them. The twins were born on June 29, 1993 and were put on a respirator; their lungs could not function properly because of the place in which they were conjoined. The doctors at the hospital said that the twin could not be separated and both survive. There have been nine cases out of 190 where twins conjoined at the chest were separated and did not live more than three months after the operation. The mother of the twins expressed her concern that she could not live without if she couldn't at least save one of their lives. At this point, the twins were transferred to a hospital that was daring enough to attempt such a procedure. Their surgery took a total of five hours and Amy died in the process. Her sister, Angela, lived for 11 months following the surgery which broke the record for longest survivor of a separation where the two children were fused at the chest. Angela never had the chance to leave the hospital and was hooked to a breathing machine for most of her short life. The staff at the hospital took care of Angela following the surgery; her mother only held her three times after separation. Her father was in jail at the time and never got the chance to hold his surviving daughter.

Below will be questions that the member of the group were tasked with answering individually. These are the answers and opinions of myself.

Q: Do you think that a record of nine unsuccessful attempts at separating Siamese twins is enough to establish that such an operation could never be successful.
A: No, it is not nearly enough! It would be bad science to have something fail 9 times and give up. If we quit doing things just because we failed some of the time we would get nowhere technologically, scientifically or even within in our own lives, if you look at it from a philosophical perspective. There were 9 failures out of 190 tries. Those are not bad odds in my opinion. Every case is different, every pair of children are different, there are just too many variables to take into account.

Q:Some critics said that the decision to put the twins on a respirator "sentenced" Angela to life. They argue that, by putting the twins on the respirator, it was then not possible to halt the process,even though medical opinion held that the twins or even one twin could never survive off the respirator. Should this first step have been more fully evaluated before it was taken or do you think that it was the right first step to take in the Lakeberg's case?
A: The twins were unable to breath because their lungs could not probably expand with how they were joined. The two options the medical staff had were to either not put them on a respirator and let them die or put them on a respirator and keep them alive artificially. I think this decision should be up to the parents, but I understand that the medical staff may not have had time to consult the parents or acted out of instinct. This is fine but the parents should ultimately decide. If I were in that situation I would not keep the children alive artificially, had they been born with perfectly functioning lungs then I can see keeping them alive. But they are not my children and my opinion doesn't matter, what matters is what the parents think the best thing is for their kids.
Q:The Lakebergs lived in a trailer and had financial and martial problems. Do you think the instability of the Lakeberg home should have been taken into account when the decision was made to try to save Angela? Would this home environment have been adequate to meet Angela's heavy medical needs had she been able to leave the hospital? When, if ever, do you think it is appropriate for medical decisions to be made for non-medical reasons?
A: Yes  and no, I think that a social worker should have been involved in the event that one of the children lived. If the child, or both, survived the operation how does one know whether they would get the proper care? If the family cannot provide the proper care, by the sounds of it they couldn't, the surviving child/children should have been put up for adoption, put in foster care or given to relatives willing to take care of them. The father was a drug addict who used money sent to the family to help the children to buy a new truck and drugs, this family is obviously not stable. He also got in a fist fight at the one child's funeral. I'm not saying that if you use illegal substances that you are a bad person, because you are not, but the level of abuse that he would dish out really did not help his case, with me at least. I think that a social worker should have gotten involved and consulted the parents not the hospital or medical staff.

Q: Do doctors have an ethical obligation to try to save every baby?
A: No they do not and should not have that obligation, although most think they do. It would seem that most doctors have a god complex in which they feel obligated to try to save every patient, young or old, they come across and that they are infallible. I can see where they are coming from though, they see a life as a precious thing and they feel it is their duty to save the life, which that's what doctors do. This is really where the Pro-life/Pro-choice debate comes in to play. The Pro-life people would say, save the kids life and keep it alive and do anything you can to keep that child alive. Someone who aligns their philosophical values with Pro-choice would say, it is up to the parents to decide. Both groups value life but have different ways of looking at life. I look at it a bit differently which may seem harsh to some people. The reason why we care about out children and care for each other is a evolutionary adaptation. If we as a species didn't take care of our children then they would die and we would be unable to become "fit" (in a biological sense). I also understand that I may have a different way of looking at things if the situation directly involves myself, my child etc. I don't find life as valuable as some people because it isn't hard to create. People create life all the time, it is nothing new. If a child was born conjoined 1 m.y.a. when our species, or an ancestor, was living in groups of 30 to 50 people, they would not survive. That is how I feel but I can guarantee that if I was a parent I would feel much differently. Keeping a child that is brain dead or severely disabled alive artificially is doing it for the wrong reasons. To me that is selfish, the parents would keep the child alive in its suffering just so they feel better about themselves.

Q:Not all parents of Siamese twins oft for separation. There are cases where Siamese twins survive into adulthood and lead productive lives. How does their description of their lives affect your thinking about Siamese twins and the lives they lead.
A: I think that is it great that Siamese twins are able to live productive suitable lives. But once more, it depends on the case. Every case is slightly different and for some they would not be able to live fulfilling lives. It seems to me that the cases of Siamese twins that have survived into adulthood overcome their "disability" much like someone in a wheelchair would. They don't know any different. I think that in most cases, conjoined Siamese twins lead good lives.

Q:Would you make different decision for Siamese twins whose brains are normal than for those whose brains are not.
A: It would depend on the abnormalities in the brain that we are talking about. If by "normal" you mean perfectly functioning and have no brain damage I wouldn't have as much of a problem with them being separated or kept alive. If Siamese twins are born and one is brain damaged and the other is healthy I would say remove the one that exhibits brain damage. If both children had brain damage then neither should be kept alive. This goes back to the Terri Schiavo case on whether or not someone that is severely brain damaged is alive or not.