Freethought & Rationalism Archive

Kuu · 07-20-2002, 08:39 PM

I want to raise a topic that I am discussing on another board to see if people here feel differently.

Quote:

Mohamed and Ahmed Ibrahim are siamese twins. The two little Egyptian boys are connected at the crowns of their heads. A good portion of each brain is separate but the attachment in their heads in extensive and includes the connection of blood vessels.

The boys are a year old. If left as they are the boys can live indefinately but the whole year they have lived so far has been spent on their backs. They appear eager to get up but are unable to do that so far.

They are now in Texas to see if they should be separated. This might be successful if attempted but it could also could end in death of one or both babies or brain damage to one or both.

One medical ethicist has said 'To perform the surgery is to make the judgment that the quality of life attached is so poor that it's not worth living to preserve it'

My opinion is that the twins are healthy and can live a normal lifespan so it isn't right to expose them to an operation that might kill them ao give them brain damege.

There are other conjoined twins who are living, ot have lived worthwhile lives while joined. This includes Yvette and Yvonne Calder who were joined at the top of the head like these boys. They learnt to walk and do most things that other people do. There is also Reba and Lori Schappell who are joined at the front of the head and who say that they are happy and do not want to be separated.

tronvillain · 07-20-2002, 09:35 PM

Well, I would really want to know the estimates of their chances, but if they were my kids I would definitely consider such an operation.

rebelnerd · 07-21-2002, 12:26 AM

If it were my childeren, I would definitely consider separation. The main mitigating factor would be the chances for a successful (meaning little brain damage or death) separation. The reasons I would opt for separation would be quality of life and independence.

The earlier they are separated, the better chances their brains will have to adapt to modified structure. If I remember correctly from my psych classes, the brain is in a state of flux in early childhood and new neural pathways are easily created. Given this, even if there were minor damage to their brains, the possibility is good that they would adapt and show little, if any diminished function.

Now this is easy for me to say as they are not my children and I am not faced with this choice to make. If there was a poor chance of success, I would leave them as they are and be happy that they are my childeren and alive. In this day and age of computers allowing people to work from home they would also be able to support themselves (providing that was how they wished to do it.)

Filo

[ July 21, 2002: Message edited by: Filo Quiggens ]

Kuu · 07-21-2002, 01:32 AM

I don't think doctors can really estimate the boy's chances easily. This condition only occurs in about 2% of conjoined twins and not all of those are connected at the crown.

I believe that two set of twins connected at the head have both survived (Nepali girls separated in Singapore, girls seperated in Australia), boys separated in South Africa are believed to have brain damaged, in two other cases one child died. I think all other cases either it was decided not to separate of which teo sets have survived into adulthood, or else both babies died during or after separation.

echidna · 07-21-2002, 05:25 PM

Ideally it largely comes down to a risk assessment exercise. We take risks every day, many involved with enjoyment, many involved with improving our standard of living. Even in driving to work each day, we risk life to earn money. Despite what our politically correct lawyers would have us believe, risk is with us every day.

Most people are willing to take these risks, only the degree varies. It is fair to say that their lives will be difficult & also that their life expectancy will be significantly shortened without such an operation. More difficult that the operation is largely pioneering & the risk sounds almost impossible to estimate, although it does sound significantly higher than 2%. More like the roll of a die.

I understand that such Siamese Twin surgery is best performed when the twins are younger. In older twins the operation complicates dramatically as does the risk.
Being only a year old, parents must only make the best guess by asking what they would want if in the babies� situation.

Recently my brother in law had corrective eye surgery to remove his need for glasses. Although the benefits were purely convenience, he was willing to accept a small but important risk that he could also lose his eyesight. People are often willing to take these risks.

At the same time I do not believe one can simplify or understate the problem. If I were faced with 50 / 50 life or death odds, or a loved one, I�m not at all sure how my reaction would change. It�s much easier to make the decision about a complete stranger though.

Although I do disagree with the ethicist. I would rephrase : �'To perform the surgery is to make the judgment that the quality of life attached is so poor that it is worth a significant risk to their lives to improve it�.

Not an easy decision. I hope I�m never faced with it, and I certainly wouldn�t judgementally condemn anyone who was.

abe smith · 07-22-2002, 05:21 AM

As every incidence of conjoined-twinning appears to be absolutely-unique (= totally-unlike any other instance), it is/wd be IMPOSSIBLE to formulate a general rule (except possibly "Do nothing."). Hence those who pitiably have the deciding to do, must take any advice they can get; grit their teeth; and DO the deciding. Sometimes it is/wd be possible to wait & let the twins themselves decide, when they are old enough to do that.

RogerLeeCooke · 07-22-2002, 06:16 PM

Quote:

Originally posted by abe smith:
As every incidence of conjoined-twinning appears to be absolutely-unique (= totally-unlike any other instance), it is/wd be IMPOSSIBLE to formulate a general rule (except possibly "Do nothing."). Hence those who pitiably have the deciding to do, must take any advice they can get; grit their teeth; and DO the deciding. Sometimes it is/wd be possible to wait & let the twins themselves decide, when they are old enough to do that.

The theological implications of this interest me more than the moral ones. There is/are a two-headed girl (perhaps one of those mentioned on this list---I'm not sure) alive at this very moment. Besides the pronoun difficulties (she or they?), the theological difficulty is huge. Is this one soul or two? What about the opposite case of a human organism with one head and two torsos? One soul or two? (Again, there was an actual case of a woman who gave birth to different children from two different uteri.) Seriously, doesn't this make dualism totally absurd? We count personalities by heads and brains, and I'm sure anybody would say the two-headed girl is really two people, whereas the two-uterused woman was one person.

Kuu · 07-22-2002, 11:45 PM

I think the children you are referring to are Abigail and Brittany Hensel who are mentioned at this website

<a href="http://phreeque.tripod.com/hensel_sisters.html" target="_blank">http://phreeque.tripod.com/hensel_sisters.html</a>

One interesting point mentioned at this site is

Quote:

While separation at birth was an option, the Hensels decided against it, as one or both of the twins would probably die. Even if both survived, they would each only have one arm and one leg and would be confined to prostheses or wheelchairs, rather than running around in the snow or riding a bicycle

It also says

Quote:

They can swim, bicycle, ride a horse, ice skate and run and walk with remarkable ease and grace, though each girl controls only the leg and arm on her own side.

I realise that the Egyptian twins would not have the same amount of mobility as these girls I still think IF the chance of brain damage or death is too high than it is better to leave them as they are.

Boro Nut · 07-23-2002, 08:14 AM

Quote:

Originally posted by Kuu:
Siamese Twin Dilemma.

I've often pondered this one. If one of them pinched something, but they share the same arse, would you be jutified in smacking? Could you send one to jail for murder if the other one knew nowt about it? To be fair to the other children, should they be banned from the three legged race on school sports days?

Boro Nut

mattmattmattmattv · 07-24-2002, 12:54 AM

It seems painfully obvious to me that they should try to separate the two, even if the chances that they will survive are extremely small. Heck, if I grew up like that, I'd wish that they'd have aborted me. Of course, sometimes I wonder whether the high cost of living is really worth what you get for it even for me, and I am a perfectly normal person (that is, I have no brother that is attached to my head), so maybe I am not the one to ask.

P.S. - so how do the people in the other forum in which you brought this up feel about it?

[ July 24, 2002: Message edited by: mattmattmattmattv ]

07-21-2002, 12:26 AM	#3
rebelnerd Senior Member Join Date: Apr 2002 Location: 47°30'27" North, 122°20'51" West - Folding@Home Posts: 600	If it were my childeren, I would definitely consider separation. The main mitigating factor would be the chances for a successful (meaning little brain damage or death) separation. The reasons I would opt for separation would be quality of life and independence. The earlier they are separated, the better chances their brains will have to adapt to modified structure. If I remember correctly from my psych classes, the brain is in a state of flux in early childhood and new neural pathways are easily created. Given this, even if there were minor damage to their brains, the possibility is good that they would adapt and show little, if any diminished function. Now this is easy for me to say as they are not my children and I am not faced with this choice to make. If there was a poor chance of success, I would leave them as they are and be happy that they are my childeren and alive. In this day and age of computers allowing people to work from home they would also be able to support themselves (providing that was how they wished to do it.) Filo [ July 21, 2002: Message edited by: Filo Quiggens ]</p>

07-24-2002, 12:54 AM	#10
mattmattmattmattv Junior Member Join Date: Mar 2002 Posts: 36	It seems painfully obvious to me that they should try to separate the two, even if the chances that they will survive are extremely small. Heck, if I grew up like that, I'd wish that they'd have aborted me. Of course, sometimes I wonder whether the high cost of living is really worth what you get for it even for me, and I am a perfectly normal person (that is, I have no brother that is attached to my head), so maybe I am not the one to ask. P.S. - so how do the people in the other forum in which you brought this up feel about it? [ July 24, 2002: Message edited by: mattmattmattmattv ]</p>

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07-20-2002, 09:35 PM	#2
tronvillain Veteran Member Join Date: Oct 2000 Location: Alberta, Canada Posts: 5,658	Well, I would really want to know the estimates of their chances, but if they were my kids I would definitely consider such an operation.

07-21-2002, 01:32 AM	#4
Kuu Senior Member Join Date: Jul 2002 Location: Tasmania Posts: 710	I don't think doctors can really estimate the boy's chances easily. This condition only occurs in about 2% of conjoined twins and not all of those are connected at the crown. I believe that two set of twins connected at the head have both survived (Nepali girls separated in Singapore, girls seperated in Australia), boys separated in South Africa are believed to have brain damaged, in two other cases one child died. I think all other cases either it was decided not to separate of which teo sets have survived into adulthood, or else both babies died during or after separation.

07-21-2002, 05:25 PM	#5
echidna Veteran Member Join Date: May 2001 Location: Melbourne, Australia Posts: 2,832	Ideally it largely comes down to a risk assessment exercise. We take risks every day, many involved with enjoyment, many involved with improving our standard of living. Even in driving to work each day, we risk life to earn money. Despite what our politically correct lawyers would have us believe, risk is with us every day. Most people are willing to take these risks, only the degree varies. It is fair to say that their lives will be difficult & also that their life expectancy will be significantly shortened without such an operation. More difficult that the operation is largely pioneering & the risk sounds almost impossible to estimate, although it does sound significantly higher than 2%. More like the roll of a die. I understand that such Siamese Twin surgery is best performed when the twins are younger. In older twins the operation complicates dramatically as does the risk. Being only a year old, parents must only make the best guess by asking what they would want if in the babies� situation. Recently my brother in law had corrective eye surgery to remove his need for glasses. Although the benefits were purely convenience, he was willing to accept a small but important risk that he could also lose his eyesight. People are often willing to take these risks. At the same time I do not believe one can simplify or understate the problem. If I were faced with 50 / 50 life or death odds, or a loved one, I�m not at all sure how my reaction would change. It�s much easier to make the decision about a complete stranger though. Although I do disagree with the ethicist. I would rephrase : �'To perform the surgery is to make the judgment that the quality of life attached is so poor that it is worth a significant risk to their lives to improve it�. Not an easy decision. I hope I�m never faced with it, and I certainly wouldn�t judgementally condemn anyone who was.

07-22-2002, 05:21 AM	#6
abe smith Veteran Member Join Date: Apr 2001 Location: springfield, MA. USA Posts: 2,482	As every incidence of conjoined-twinning appears to be absolutely-unique (= totally-unlike any other instance), it is/wd be IMPOSSIBLE to formulate a general rule (except possibly "Do nothing."). Hence those who pitiably have the deciding to do, must take any advice they can get; grit their teeth; and DO the deciding. Sometimes it is/wd be possible to wait & let the twins themselves decide, when they are old enough to do that.

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