Kill Mary to Save Jodie?

The distraught parents visit St. Mary's Hospital in Manchester, England, almost every day, crying over and comforting a baby they fear God plans to take from them. Or is it two babies? Their child, born on Aug. 8, is conjoined twins--two lives joined at a circular pelvis. One twin, called Mary in court papers to protect the family's anonymity, has a flaccid, useless heart, no working lungs and an underdeveloped brain. She can suck, kick and open one eye but may not have consciousness. Her bodymate Jodie is "bright, alert, sparkling...very much a 'with-it' sort of baby," say doctors who testified before British high-court judge Robert Johnson. Mary's life depends on Jodie's heart and lungs, and the strain will probably give Jodie heart failure and kill them both in three to six months. Thus the agonizing dilemma: Should surgeons detach Mary, certainly killing her, to let Jodie live a relatively normal life? Or must they do nothing to harm Mary and stand by while both certainly die?

The parents know what they want. Catholics from a remote Mediterranean village who came to Manchester last May, three months before the birth, they wanted to save both twins. But when they learned it was impossible, they asked for treatment to be stopped. They told the court, "We could not possibly agree to any surgery being undertaken that will kill one of our daughters. We have faith in God, and we are quite happy for God's will to decide what happens."

Under English law, however, parents' wishes do not take precedence. On Aug. 25, Justice Johnson backed doctors at the hospital and ruled that Jodie should be saved by detaching Mary. He said his judgment was based not on Jodie's interests but Mary's, reasoning that her harsh life would only worsen as low levels of oxygen in her blood further destroyed her brain and that stopping delivery of Jodie's blood wouldn't be a positive act of killing but a passive by-product of saving Jodie, like withdrawing food and water from a terminally ill patient--which is legal in Britain and the U.S. under certain conditions.

Three appellate judges in London are now reviewing the Solomonic verdict and could rule as early as this week. The law requires them to protect the child. But which child, and at what cost to the other? At a hearing last week one judge wondered whether Mary could be viewed as a kind of unjust aggressor, sapping Jodie's lifeblood to the point of killing her, thus entitling Jodie to self-defense. That seems farfetched: it's hard to attribute aggression to a newborn or bestow the self-defense right on a third party like a doctor. The judges appeared last week to be leaning toward the grim conclusion that the doctors' plan is illegal, possibly amounting to criminal assault and manslaughter, because it would violate the fundamental prohibition against the deliberate taking of a life, even to save another. One of the justices, Sir Alan Ward, who had been up until 3 a.m. the previous night pondering the case, suggested that the hospital was asking the court to "save Jodie but murder Mary."

Such drastic action has been taken at least three times in the U.S., but in none of these cases did the parents object, and no one pressed criminal charges. In Boston last year parents asked for separation in a situation similar to that of Jodie and Mary's: twins shared one heart, and only one baby could live. The survivor is now thriving.

Conjoined twins are rare, occurring once in 50,000 to 100,000 births. They happen when the fertilized egg starts splitting into twins but the process stalls, leaving a partly separated embryo that matures into a conjoined fetus. Many are aborted or stillborn. Surgical separations often fail, depending on how many organs are shared. At a leading U.S. center for this work, the Children's Hospital of Philadelphia, 14 sets of twins have been separated since 1957. Seventeen children survived, and both twins lived in seven cases.

Ethics experts disagree about the proper outcome for Jodie and Mary, but many are uneasy at how readily the lower court disregarded the parents. "This case is really a complete conundrum," says Dr. Richard Nicholson, editor of the Bulletin of Medical Ethics in London. "Both outcomes are right, and both are wrong. That's why it seems right to pay more attention to the parents than the professionals, because they have to live with the consequences." So too must Jodie and Mary--or die from them.