Imposed separation of conjoined twins--moral hubris by the English courts?

Late last year the English Court of Appeal confirmed a lower court’s ruling that doctors could impose an operation to separate recently born conjoined twins, overriding the refusal of consent of their parents. The doctors believed the operation would probably save one of the babies at the cost of killing the other, while not operating would highly probably be followed by the death of both twins within months of their birth. The parents, said to be devout Roman Catholics, believed that it was absolutely wrong to kill one of their babies, even to save the life of the other. Undoubtedly many people, the writer included, would agree with the English courts that the “least worst” option was to separate the twins and save one at the cost of killing the other. But surely many fewer people would have imposed their own resolution of this acute moral dilemma upon parents who conscientiously chose the other limb of the dilemma, refusing to kill one baby even in order to save the other. Were the English judges right, then, to take away the parents’ normal right and duty to make health care decisions on behalf of their children and instead impose their own answer to what they admitted to be a terrible dilemma? Describing the two alternatives in terms of choosing between the lesser of two evils on the one hand, and the obligation not to kill on the other, Lord Justice Ward declared, according to The Times law report, that: “Parents who were placed on the horns of such a terrible dilemma simply had to choose the lesser of their inevitable loss [sic]”. But that surely is to beg the moral question in favour of the judges’ preferred answer to this moral dilemma. The fact is that there are—as is characteristic of all moral dilemmas—strong moral reasons for coming to two moral conclusions that are mutually inconsistent, at least in the sense that both cannot be achieved and sometimes in the sense, as here, that they are mutually contradictory. Thus there are strong moral reasons for not killing one baby to save the other even at the cost of the tragedy that both will die; and there are strong moral reasons for saving one baby’s life rather than allowing both to die, even at the cost of the tragedy that one will be deliberately killed. Neither of these alternative positions are eccentric, peculiar to a small group or sect of believers, and rejected by society as permissible justifications for parents to deny life-saving interventions to their children. Christian Scientists, for example, or Jehovah’s Witnesses, while they, like all competent adults, may refuse life-prolonging medical interventions for themselves on the basis of their beliefs, including their religious beliefs, are not permitted to impose those beliefs upon their children when to do so severely threatens those children’s welfare. Why then, it might be asked, should the parents of these conjoined twins be treated diVerently? Were not their religious views threatening the life of one of their babies? That certainly seems to have been the reasoning of the English courts. Meticulously considering the interests of each child if the operation were carried out or not, the judges concurred that while it was in the best interests of Mary, the weaker twin, not to be killed by the operation, it was also in the best interests of Jody, the stronger twin, that the operation should be carried out. In such a conflict of interests “there was no other way of dealing with it than by choosing the lesser of the two evils and so finding the least detrimental alternative”. But this assertion simply aYrms one limb of the moral dilemma, ignores the other, and begs the moral question as to which is “the lesser of the two evils”. For there is another way of dealing with the dilemma, notably the parents’ way, which is to reason that not killing an innocent baby is the lesser of the two evils, since it is absolutely morally prohibited, even if the baby would in any case die in a matter of months and even if such killing saved the other baby’s life. This alternative way of dealing with the moral dilemma does not result from an eccentric religious position held only by a small group or sect; on the contrary it results from a standard line of moral reasoning common not only to Roman Catholicism but to many, probably most, societies, both secular and religious. In its most obviously relevant form it forbids (under English law, for example) the killing of one innocent infant, even if already dying, to save another. Consider the following thought experiment. Two identical twins are born. One will incurably die within a few months, but has healthy lungs and a healthy heart. The other has a feeble heart and poor lungs, and will also soon die unless she is Journal of Medical Ethics 2001;27:3–4