Should babies fused at the head be aborted?

Conjoined twins (previously known as Siamese twins) are identical twins whose bodies are joined in utero. Conjoined twins occur when a single fertilized ovum doesn't separate properly. A rare phenomenon, the occurrence is estimated to range from 1 in 50,000 births to 1 in 100,000 births, with a somewhat higher incidence in Southwest Asia, India and Africa. Approximately half are stillborn, and a smaller fraction of pairs born alive have abnormalities incompatible with life. The overall survival rate for conjoined twins is approximately 25%. The condition is more frequently found among females, with a ratio of 3:1

The question that is very difficult to answer is; “Should lives doomed to hardship be aborted?”

On November 15, 2008, a subscriber to a magazine wrote the following statement in a newspaper.

“Recently, I read in a national magazine the story of Krista and Tatiana, the conjoined twins in B.C. who are fused at the head. The picture with the article broke my heart – such sweet little two-year-olds, doomed to spend their whole lives as freaks, being stared at, unable to do any of the things normal people do. I don't understand how any mother – especially one who already has older kids – could bring children like that into the world. I don't doubt she loves her kids, but ethically wouldn't it have been better for everyone if the pregnancy had been aborted? And if the mother couldn't make that decision, shouldn't her doctors have made it for her?”

In the same newspaper, Felicia Simms, the mother of the conjoined twins had a simple answer for the woman who suggested that she should have aborted her twins. "Kiss my butt." I guess she was saying was that any decision she made is nobody’s business. She is absolutely right.

There can be no doubt that these most unfortunate girls, Krista and Tatiana are in for a life experience most of us can't even imagine. It starts with the idea that neither of them will ever, for even one moment, be alone – and it spins out from there. It is not a life most of us would choose, and they didn't choose it either. But are we going to abort every baby who has a life we wouldn't choose for ourselves? Babies are born every day into hunger, abusive homes, war zones – into a thousand difficult circumstances. Are we going to abort them all because we've decided their lives aren't as perfect as ours?

A London appeals court on the other hand ruled on September 22, 2000, that doctors could operate to separate 45-day-old conjoined twins against the wishes of the parents. Justice Ward, reading the court’s decision said in part;

“I freely confess to having found it truly difficult to decide this difficult case because of the scale of the tragedy for the parents and the twins, difficult for the seemingly irreconcilable conflicts of moral and ethical values and difficult because the search for settled legal principle has been especially arduous and conducted under real pressure of time”

The twin girls, joined at the lower abdomen, were born on August 8 at St. Mary’s Hospital in Manchester. Doctors said the girls, identified only as Jodie and Mary, will both die within months if they remain together. However, Jodie is a relatively strong, healthy baby and stands a good chance of living a normal life if the two are separated.

Craniopagus (6% of conjoined twins) means fused skulls, but separate bodies. These twins can be conjoined at the back of the head, the front of the head, or the side of the head, but not on the face or the base of the skull. Many conjoined twins have been successfully separated but I only know of two children who where fused at the head being separated. Trishna and Krishna from Bangladesh were born around December, 2006, joined on the tops of their skulls, and sharing a small amount of brain tissue. They were found in an orphanage, and their surname is not clear. On 16–17 November 2009, they were separated in Melbourne, Australia, in a 32-hour operation involving a surgical team of 16 led by Wirginia Maixner, director of neurosurgery at the Royal Children's Hospital in Melbourne. Doctors had not only to separate shared brain tissue, but perform plastic surgery to close up the girls' skulls. A series of earlier operations had been performed to separate shared blood vessels and to insert tissue expanders in preparation for the final separation.

In their case, it was possible to separate them because they only shared a small amount of brain tissue. But what can be done if the twins’ heads are fused so close together, that separating them would invariably result in their immediate deaths? And what about conjoined twins who have one body and their own heads? Which head will be separated from the body they both shared? Imagine if you will, the guilt the survivor will feel when she realizes that her twin’s head was removed so that the surviving twin can live.

In 1961, the Schappell Twins were born as Lori and Dori. Dori, an aspiring country singer, took the name Reba for a while after her idol Reba McEntire. I can’t find a reason why, but Dori/Reba now prefers to be called George. Lori and George are joined at the head and as such, face each other. Dori/Reba doesn't always go by the name of George, just sometimes when she is role playing and pretending to be Lori's son rather than her sister. Apparently Dori's need to be separate from Lori takes the form of creating new personas for herself sometimes. They share 30 percent of their brain matter. Even so, they have very different personalities and live different lives as much as possible. While Dori is trying her hand at singing, Lori works at a laundry and schedules her shifts around George’s performances. The two of them were 24 before they were able to declare their independence and go to college – prior to that they lived in an institution in Reading, Pennsylvania. Unfortunately, when one of them dies, the other twin will die almost immediately thereafter. They are both well aware of this so it follows that they each wish the best of health for their twin sister.

I'm not, incidentally, arguing that it would necessarily have been ethically wrong for a mother to make a decision to abort her pregnancy if she is aware that she is going to give birth to conjoined twins who cannot be separated after birth. If they take that step, knowing their own limitations and being realistic about the life ahead for their kids, it would be right to respect their decisions. Nonetheless, if they choose not to abort their twin babies, that is a noble choice.

There will be those who scream at me for saying this, but however hard the decision to end a pregnancy such as this might be, the decision to raise, love and defend kids like this is even harder and nearer to the heart of God. Some will criticize such mothers for being naïve by not aborting their conjoined twin babies. As for the notion that the doctor should somehow have forced a termination to this pregnancy, don't even think about it. No doctor would do it without the consent of the mother.

Those of us millions of parents who were blessed with the birth of normal children and whose own children were born as normal children should truly be grateful for the blessings we have received. I do not think that we should be dictating to those less fortunate than us as to whether or not they should abort their twin babies when it is apparent that they cannot be separated after birth. Only when we are walking in their shoes should we propose what direction they should take.