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In 2011, surgeons at Great Ormond Street Hospital (GOSH) in London - following a four-stage operation that took several weeks and totalled 39 hours of pioneering surgery - successfully separated conjoined twins Rital and Ritag Gaboura, who had been joined at the head (‘total type-III craniopagus’).1 On 30 August 2016, The Royal College of Surgeons of England’s Facebook page carried a link to a BBC News item reporting that twins Rosie and Ruby Formosa were preparing to start school, after ‘[being]joined at the abdomen and[sharing]part of their intestine before they had an emergency operation[at GOSH]to separate them in 2012.’2
Spitz, describing the GOSH experience with 24 sets of conjoined twins managed over 20 years (1985-2004), states: ‘Cases operated on as an emergency fare less well than those managed electively - 28% survival against 85%.’3 And Andrews et al estimate that ‘about 11 or 12 pregnancies complicated by conjoint twinning would be expected annually in the UK, possibly increased in the present era because of the increased incidence of monozygous twinning after conception using assisted reproduction techniques.’4
Such data - when combined with the ongoing experience gained at centres of excellence such as GOSH, and the successes of the Gaboura and Formosa twins’ respective separations - suggest that conjoined twins who could be separated should be separated.
Is such an inference justified? Has the notion of the autonomous individual gripped our imagination to the extent that we are reluctant to accept that two individuals might lead harmonious lives inside one body?
The answer appears to be ‘yes’. For example, BBC journalist Elizabeth Blunt described the February 2004 inquest into the deaths of 29-year-old Iranian conjoined twins Laleh and Ladan Bijani, who died during surgery to separate their fused heads: ‘There was enormous sympathy for these intelligent and articulate sisters, trapped in an intolerable situation.’5 Similarly, intolerance of the conjoined state was implied by Professor Lewis Spitz when discussing ‘ethics in the management of conjoined twins’.6 Having considered the various restrictions imposed on the lives of conjoined twins by their condition, he observed: ‘Such limitations on living seem intolerable to us, but we have left the final decision to parents.’
It is perhaps worth exploring further both the apparent intolerability of...