Conjoined twins and separation surgery: bioethical aspetcs

19 July 2013


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The Committee addresses the bioethical issue of conjoined twins. While recognizing the complexity and variability of individual cases, it discusses two main situations, in relation to newborns/ minors.
A first condition is that in which the life of the twins is not in imminent danger, while the separation surgery, although technically possible, results highly risky for the life of one or both. The document outlines two prevailing lines of thought: the line of those who, referring to the value of human life, believe that in so far as the surgery is not necessary, it is not ethically justified and the line of those who, on different grounds, consider ethically lawful even a highly risky surgical separation as long as it delivers, even though slender, successful hopes.
A second condition is one in which, on the basis of an objective clinical assessment supported by empirical data, the certainty of an imminent and serious danger for the life of both twins comes to the forth. Even in this area different lines of thought arise: some believe that the choice of non-intervention on the part of the parents is justifiable on the basis of several lines of argument; the vast majority of the Committee believes that given an appreciable and reasonable anticipation of a saving outcome for one of the twins, the separation surgery is a must, even if it results in the death of one of the twins.
In the conclusions, the document outlines some guidelines as a reference framework for promoting ethically complex decisions at the clinical level, that recall the promotion of research and training of health personnel, the importance of adequate information and psychological support to parents, the duty not to intervene in case of relentless trials, the role of ethics committee, the duty of confidentiality.
The Committee believes that in the case of adults, the twins’ will has to be considered as every competent adult’s will, also with regards to the choice of undergoing experimental treatments or treatment refusal.

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