Discussion: End-of-Life Issues at the Beginning of Life

Dr. Fadel’s response: Conjoined twins is a serious problem, and it is also very variable one. There are many different degrees of conjoined twins. Some of them can be easily separated, while others are very difficult or impossible to separate. Success depends on the particular way they are conjoined; therefore, there is no one answer to this question. Successful separation depends on the extent of fusion and which organs are shared. For example, is it the heart that is shared? Is it the liver? If the twins do not share vital organs and their case seems to be operable after delivery, that is very good. But if it seems from the imaging studies – ultrasound or an MRI – that the twins cannot be separated, then this will be like addressing a lethal malformation, and you have to deal with it depending on the gestational age and other factors. One may counsel termination of pregnancy or offer palliative care.