A Moral Precedent for the Siamese Twins Case

The situation gripping British national attention seems unprecedented. Five-week-old Siamese twins Jodie and Mary share but one heart. Doctors believe both will die if not separated soon; Jodie, the stronger twin, would get the heart, and Mary would perish, deliberately killed by the surgery. A British court has ordered that the operation proceed. The parents, devout Catholics, oppose any surgery because they cannot bear the idea of Mary being killed.

According to British news reports, the Rev. Cormac Murphy-O'Connor, the archbishop of Westminster and England's highest-ranking Catholic, has advised the courts that it would be better to do nothing at all, letting both girls die, than to kill one in order to save the other. Yesterday, Lord Justice Ward, who is reviewing the legal appeal, declared that he is "on the horns of an irreconcilable dilemma" and can find no similar case to guide him.

In fact, an almost identical case occurred in the United States in 1977 and was just as morally wrenching but decisively resolved by the chief surgeon--C. Everett Koop, later to be surgeon general and renowned as an extremely dedicated pro-life proponent. In that case Koop, pro-life in every way, killed one twin to save the other.

Here was the background. First, it is important to know that long before Koop became politically prominent--initially as an opponent of abortion, later as an opponent of cigarette smoking and proponent of AIDS action--he was celebrated within the medical community as the founder of modern pediatric surgery.

Beginning his work at Children's Hospital of Philadelphia in the late 1940s, Koop made pediatric surgery much safer and more effective by pioneering surgical and anesthetic techniques meant for small bodies and metabolisms, and by championing pediatric surgery as a subspecialty. He developed many basic children's operations still used today, and as a research clinician, established the existence of and therapies for childhood cancer. Until Koop, the medical community believed that only adults could contract cancer, with the result that many children died of undiagnosed cancer. Koop also saved numerous infants born with extreme birth defects, ones other doctors had given up on and whom utilitarians might claim would be "better off" expiring. Not one of them, Koop later said with justified pride, ever returned to him as an adult and complained about being saved.

And Koop learned how to separate Siamese twins, once thought impossible. In 1957, Koop became an international sensation when he separated two female twins. One died nine years later of heart failure, but the second thrived, and Koop has said that his most prized possession in life is a picture of himself with the twin on her wedding day.

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