Many, if not most, bioethical dilemmas wind up in America's courtrooms. Ardent disputes arise at the beginning and end of life, and these have been most emblematic in the cases of abortion and physician-assisted suicide. American courts have been much more successful in resolving continuing bioethical conflicts in the latter than in the former. Nonetheless, that both made their way to the U.S. Supreme Court surprised almost no one. And although America is unique in its persistent appeal to judges to resolve bioethical issues, it is not alone in looking to judges for help in their resolution. In this sense, international bioethics is mimicking American bioethics by crossing over into the territory of health law. This chapter introduces judicial decision making in the most extreme context: the separation of conjoined twins in cases in which surgery will either kill one of the twins or could kill both. The issue of separating conjoined twins forces us to confront the limits of law at the limits of life.
Conjoined twin surgery almost always involves infants, but in the summer of 2003 the world watched first in fascination and then in sorrow as surgeons in Singapore attempted the world's first separation of adult twins