The Maltese Conjoined Twins: Two Views of Their Separation

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Two Views of Their Separation

Four months into their mother's pregnancy, an ultrasound scan of the twins publicly known only as "Jodie" and "Mary" revealed that the girls were conjoined, and it quickly became clear that the modest facilities near their family's home on the Mediterranean island of Gozo would be ill equipped to handle the complicated birth.[1] With the financial support of an existing arrangement between the Maltese government and the British National Health Service, their parents sought medical help in the United Kingdom, where further testing revealed that one of the twins might not survive the birth. As devout Roman Catholics, the parents refused to contemplate the possibility of abortion and on 8 August 2000, Jodie and Mary were born at St. Mary's Hospital in Manchester.

Lying on their backs, the girls' heads and upper bodies emerged at opposite ends of a torso that was joined from the base of the pelvis to the lower abdomen. Their spines were fused at the base, and their legs extended to the sides at right angles. Each twin had her own brain, heart, lungs, liver, and kidneys, and they shared a bladder that lay mostly in Jodie's abdomen.

Jodie was described as surprisingly bright and alert. She moved her limbs, squirmed, and appeared to have developmentally normal responses for her gestational age. Her brain appeared to be anatomically and functionally normal, and the same was true of her liver, lungs, kidneys, and heart, with one exception: Jodie's aorta fed into Mary's, circulating blood through Mary's body and back into Jodie though a united inferior vena cava.

Mary's condition was less hopeful from the start. Her brain was described by physicians as "primitive" because of reduced cortical development, an incomplete corpus callosum, and a malformation in the hindbrain. Although her eyes were open and she was capable of reflexive movements, she could not cry because her lungs were severely underdeveloped and virtually devoid of functioning tissue. As a result, she was incapable of breathing on her own. Her heart was also abnormally large and had difficulty functioning properly. It was estimated to contribute less than 10 percent of Mary's circulatory requirements. Because of these circulatory incapacities, Mary relied entirely on Jodie's heart and lungs to oxygenate and circulate blood through both of their bodies.

In the days after their birth, specialists at St. Mary's were grim about the prognosis of the twins in their current condition. They estimated that Jodie's heart would fail under the excess strain in as little as six months. They also estimated that Mary had a 75 percent chance of developing hydrocephalus, which would be very difficult to treat in light of her abnormal abdominal cavity and cardiac abnormality. The prospect of persistent hypoxia in Mary increased the likelihood of further damaging her brain, and specialists also thought it could promote similar cell destruction in Jodie as well. Surgeons were very optimistic, however, that Jodie would have only a 5 to 6 percent chance of not surviving surgical separation, and they were confident that she would then be able to live out a normal life span with the most serious foreseeable complications limited to possible difficulties walking without support and controlling her bowels. They were certain, however, that Mary could not survive independently of her sister, and that separation would therefore directly cause her immediate death.

The twins' parents refused to consent to separation. They maintained that they loved each of their children equally, that both of their daughters had an equal right to life, and that they could not possibly kill one in order to allow the other to survive. They affirmed that they were content to place their faith in God and let His will decide the twins' future. Contemplating the possibility that the surgery would go ahead without their consent, they worried deeply about their ability to care for Jodie, both financially and personally, if she were to survive with serious disabilities. …

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