Conjoined twins posed ethical dilemma for Massachusetts hospital

[October 26, 2017] By Scott Malone

BOSTON (Reuters) - Doctors at the MassGeneral Hospital for Children faced an ethical challenge when a pair of conjoined twins born in Africa arrived last year seeking surgery that could save only one of them, according to a medical journal article due out Thursday.

The twins were connected at the abdomen and pelvis, sharing a liver and bladder, and had three legs.

An examination by doctors at the hospital determined that only one of the girls was likely to survive the surgery, but that if doctors did not act, both would die, said Dr. Brian Cummings, chairman of the hospital's pediatric ethics committee.

"It really is one of those exotic cases in bioethics, because you have two individuals with different rights and claims and you have parents with different rights and claims," Cummings said in a phone interview. "Most of the time our ethical conversations are simpler."

The girls were 22 months old when they were brought to Boston for surgery from an east African country where their family faced religious persecution.

The hospital withheld further details on the family's identity.

The smaller twin, as expected, died following the 14-hour surgery conducted in mid-2016, but the survivor, now 3 years old, is recovering, Cummings said.

"She's actually doing amazingly well," Cummings said. "The family came in for questions and when she walked in everyone applauded."

The case had posed the hospital with the challenge both of ensuring that the parents understood the risks of the procedure and that the hundreds of medical professionals needed to perform the complex series of operations to separate the children were comfortable with the ethics of the situation.

"For some people, it's an act of killing and others see this as the only way I can help," Cummings said. "We don't want to put people in a place where they don't think they're doing good care."

It was not the first time the hospital had treated conjoined twins, a rare condition seen in about one in 200,000 births. The hospital chose to publicize the case in Thursday's edition of the "New England Journal of Medicine," in part to highlight a difficult case where doctors knew both children would not survive.

Just a third of conjoined twins survive a single day after birth, according to the University of Maryland Medical Center.

(Reporting by Scott Malone; Editing by Bernadette Baum)

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