The management of severely malformed newborn infants: the case of conjoined twins

The birth of 'Siamese' twins in August 2000 whose parents refused to consen t to surgery for separation required English courts to decide whether the t wins could lawfully be separated despite that refusal when one twin would c ertainly die as a direct surgical result. The Court of Appeal unanimously u pheld the trial judge's decision to authorize surgery, taking account of pr inciples of family law, criminal law and human rights law. Parental duties to the viable twin were found consistent with the justification of allowing , without intending, natural death of the non-viable twin. The right to hum an dignity of both twins supported the justification of separation surgery. The decision did not elevate physicians' choices over parents', but subjec ted both to the law. The hospital was found entitled to bring the case to c ourt, but not obliged; it could have declined surgery in conformity with th e parents' wishes. (C) 2001 International Federation of Gynecology and Obst etrics. All rights reserved.