Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-23T09:21:23.725Z Has data issue: false hasContentIssue false
  • English
  • Français

Separation of Craniopagus Twins

A Clinical, Legal, and Ethical Conundrum

Published online by Cambridge University Press:  20 January 2016

REUBEN JOHNSON  and
PHILIP WEIR
Get access Rights & Permissions [Opens in a new window]

Abstract:

Separation of craniopagus twins is fraught by ethical issues. The surgery is high risk and may involve the sacrifice of one twin. We review surgical successes in separation of craniopagus twins and consider ethical and legal concepts affecting the decision to undertake such procedures. Our discussion considers how Gillett’s potentiality principle and the concept of moral permissibility may be used to arrive at fair and realistic decisions.

Keywords

craniopagusneurosurgeryethicsconfidentialityautonomypotentialitysacrificemorality
Type
Special Section: The Best Interests of a Child: Problematic Neuroethical Decisions
Information
Cambridge Quarterly of Healthcare Ethics , Volume 25 , Issue 1 , January 2016 , pp. 38 - 49
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Stone, JL, Goodrich, JT. The craniopagus malformation: Classification and implications for surgical separation. Brain 2006;129:1084–95.CrossRefGoogle ScholarPubMed

2. Rutka, JT, Souweidane, M, ter Brugge, K, Armstrong, D, Zuker, R, Clarke, H, et al. Separation of craniopagus twins in the era of modern neuroimaging, interventional neuroradiology, and frameless stereotaxy. Child’s Nervous System 2004;20:587–92.CrossRefGoogle ScholarPubMed

3. Browd, SR, Goodrich, JT, Walker, ML. Craniopagus twins. Journal of Neurosurgery Pediatrics 2008;1:1–20.CrossRefGoogle ScholarPubMed

4. Winston, KR, Rockoff, MA, Mulliken, JB, Strand, RD, Murray, JE. Surgical division of craniopagi. Neurosurgery 1987;21:782–91.CrossRefGoogle ScholarPubMed

5. Calagan, JL. The conjoined twins born near Worms, 1495: Woodcut by an unknown artist, from a pamphlet by Sebastian Brant: New Haven, Yale Medical Library, Clements C. Fry Collection. Journal of the History of Medicine and Allied Science 1983;38:450–1.CrossRefGoogle Scholar

6. Cameron HC. II.—A craniopagus. The Lancet 1928;211:284–5.

7. Grossman, HJ, Sugar, O, Greeley, PW, Sadove, MS. Surgical separation in craniopagus. JAMA 1953;153:201–7.CrossRefGoogle ScholarPubMed

8. Franklin, AW. Paediatric care of craniopagus twins. British Medical Journal 1964;1:1342–4.CrossRefGoogle ScholarPubMed

9. Voris, HC, Slaughter, WB, Christian, JR, Cayia, ER. Successful separation of craniopagus twins. Journal of Neurosurgery 1957;14:548–60.CrossRefGoogle ScholarPubMed

10. Todorov, AB, Cohen, KL, Spilotro, V, Landau, E. Craniopagus twins. Journal of Neurology, Neurosurgery and Psychiatry 1974;37:1291–8.CrossRefGoogle ScholarPubMed

11. Krauthammer, C. A doctor’s duty. Time 2003;162:80.Google ScholarPubMed

12. See note 10, Todorov et al. 1974.

13. See note 4, Winston et al. 1987.

14. Harvey, D, Totonchi, A, Gosain, A. 15-year assessment of craniopagus twins: What factors increase the likelihood of successful separation? Plastic and Reconstructive Surgery 2011;128:15. doi:10.1097/01.prs.0000406225.00299.1aCrossRefGoogle Scholar.

15. Al Rabeeah, A. Conjoined twins—past, present, and future. Journal of Pediatric Surgery 2006;41:1000–4.CrossRefGoogle ScholarPubMed

16. See note 4, Winston et al. 1987, at 785.

17. Annas, GJ. Siamese twins: Killing one to save the other. Hastings Center Report 1987;17:27–9.CrossRefGoogle ScholarPubMed

18. Dyer, C. Twins’ lawyers may demand change of venue for operation. British Medical Journal 2000;321:853.CrossRefGoogle ScholarPubMed

19. See note 3, Browd et al. 2008.

20. Wise, J. Conjoined twins are separated in four stage operation. British Medical Journal 2011;343:d6033.CrossRefGoogle ScholarPubMed

21. See note 4, Winston et al. 1987.

22. Swift, D, Weprin, B, Sklar, F, Sacco, D, Salyer, K, Genecov, D, et al. Total vertex craniopagus with crossed venous drainage: Case report of successful surgical separation. Child’s Nervous System 2004;20:607–17.Google ScholarPubMed

23. See note 20, Wise 2011.

24. See note 3, Browd et al. 2008.

25. Bucholz, RD, Yoon, KW, Shively, RE. Temporoparietal craniopagus: Case report and review of the literature. Journal Neurosurgery 1987;66:72–9.CrossRefGoogle ScholarPubMed

26. O’Connell, JE. Craniopagus twins: Surgical anatomy and embryology and their implications. Journal of Neurology, Neurosurgery and Psychiatry 1976;39:1–22.CrossRefGoogle ScholarPubMed

27. Winston, KR. Craniopagi: Anatomical characteristics and classification. Neurosurgery 1987;21:769–81.CrossRefGoogle ScholarPubMed

28. Guttmacher AF, Nichols BL. Teratology of conjoined twins. Birth Defects 1967;3:3–9.

29. See note 3, Browd et al. 2008.

30. Gillett, G. When two are born as one: The ethics of separating conjoined twins. Journal of Law and Medicine 2009;17:184–9.Google ScholarPubMed

31. Queensland v. Nolan, Supreme Court of Queensland: Chesterman J. [2001].

32. See note 10, Todorov et al. 1974, at 1298.

33. See note 4, Winston et al. 1987, at 785.

34. O’Connell, JE. Surgical separation of two pairs of craniopagus twins. British Medical Journal 1964;1:1333–6.CrossRefGoogle ScholarPubMed

35. See note 4, Winston et al. 1987, at 786.

36. Paris, JJ, Elias-Jones, AC. “Do we murder Mary to save Jodie?” An ethical analysis of the separation of the Manchester conjoined twins. Postgraduate Medical Journal 2001;77:593–8.CrossRefGoogle ScholarPubMed

37. Re A (Children) (Conjoined Twins: Surgical Separation). All England Law Report 2000;4:961–1070.

38. Re A (Children) [2000] EWCA civ254 (22 September 2000), at I.13; available at www.baillii.org.

39. Himma, KE. Thomson’s violinist and conjoined twins. Cambridge Quarterly of Healthcare Ethics 1999;8:428–35; discussion 435–9.CrossRefGoogle ScholarPubMed

40. Thomson, JJ. A defense of abortion. Philosophy & Public Affairs 1971;1:47–66.Google Scholar

41. See note 39, Himma 1999, at 430.

42. See note 11, Krauthammer 2003.

43. See note 10, Todorov et al. 1974.

44. Bratton, MQ, Chetwynd, SB. One into two will not go: Conceptualising conjoined twins. Journal of Medical Ethics 2004;30:279–85.CrossRefGoogle Scholar

45. Re F. (Mental Patient: Sterilisation) [1990] 2 A.C. 1.

46. Re T. (Adult: Refusal of Treatment) [1993] Fam. 95, 102.

47. Waisel, DB. Moral permissibility as a guide for decision making about conjoined twins. Anesthesia Analgesia 2005;101:41–3.CrossRefGoogle ScholarPubMed

48. Re M.B. (Medical Treatment) [1997] 2 FLR 426, at 439.

49. Re A (Male Sterilisation) [2000] 1 F.L.R. 549, at 555.

50. See note 30, Gillett 2009.

51. Re A (Children) (Conjoined Twins: Surgical Separation) [2001] 2 WLR 480, at 588.

52. See note 30, Gillett 2009.

53. See note 47, Waisel 2005.

54. Annas, GJ. Conjoined twins—the limits of law at the limits of life. New England Journal of Medicine 2001;344:1104–8.CrossRefGoogle Scholar

55. Drake, DC. One must die so the other might live. Nursing Forum 1977;16:228–49.CrossRefGoogle ScholarPubMed

56. See note 17, Annas 1987.

57. Rex v. Bourne [1939] KN 687.

58. Leiter et al. 1932, cited in Winston et al. 1987, at 785 (see note 4).

59. Campbell, T, McMahan, J. Animalism and the varieties of conjoined twinning. Theoretical Medicine and Bioethics 2010;31:285–301.CrossRefGoogle ScholarPubMed

60. See note 15, Al Rabeeah 2006.

61. Pearn, J. Bioethical issues in caring for conjoined twins and their parents. Lancet 2001;357:1968–71.CrossRefGoogle ScholarPubMed

62. See note 44, Bratton, Chetwynd 2004.

63. Dreger, AD. The limits of individuality: Ritual and sacrifice in the lives and medical treatment of conjoined twins. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 1998;29:1–29, at 25–6.CrossRefGoogle Scholar

64. See note 44, Bratton, Chetwynd 2004.