If Saving One Means Losing Another, What Would You Do?: Jodie and Mary’s Conjoined Twins Case

Written by Crystal Kong and Chloe Cherng, Founders of Code of Cures Bioethics Blog

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In 2000, conjoined twins named Jodie and Mary were born in Manchester, England. Joined at the abdomen and pelvis, doctors determined that Mary, the weaker twin, had no functioning lungs and a poorly developed heart; her life depended on oxygenated blood pumped through Jodie. Without separation, doctors believed both girls would die soon. However, through a separation operation, Jodie would be able to have a chance at a relatively normal life–at the cost of Mary’s life. These twins became the subject of a famous UK court case where judges authorized their separation surgery against their devout Catholic parents' wishes. This brings up the question: If you knew that keeping two babies conjoined would kill them both, but separating them would inevitably kill one to save the other, what would you do?

Background

The twins’ parents, from Golta, had opposed the operation. They expressed their desire for nature to take its course (Dyer 2000). They argued that all human life has equal value and that it was not their role to decide which child should live or die. To them, the idea of separating the twins at the cost of one of them was morally unacceptable. 

This case went to a High Court judge in August who ruled that the operation could go ahead despite the parents' objections. Three appeal court judges upheld the ruling in September, and an eleventh-hour attempt by the ProLife Alliance to take the case to the House of Lords for a final appeal failed in the High Court and the appeal court. Ultimately, the court reasoned to act within the best interest of Jodie, the stronger twin, because of the likely outcome of both twins dying if no operation was performed. This case established a scenario where the judge’s assessment of medical decisions outweighed parental refusal of consent.

Ethical Questions

1. Can We Think in Terms of “Lesser Evils”?

Medical and legal ethicists utilize the principle of “the lesser evil” to make tricky decisions. In the course of caring for patients, where some type of harm seems inevitable, we are morally bound to choose the lesser of the two evils (McCormick, n.d.). In addition, it is also important to note that this determination has to be made by the patient or the patient’s guardian if underage. They serve as the authority on the interpretation of the "greater" or "lesser" harm for the self. In Jodie and Mary’s case, the courts ruled that saving Jodie’s life rather than losing both was the “lesser” of the two evils. But should we ever treat one life as exchangeable for another? And can interpretations of which is the “lesser evil” be ruled by the court instead of the parent?

2. What Role Should Parents Play?

Parents are typically viewed as the best decision-makers for their children, but what happens when their views conflict with medical evidence about life and death? The court’s decision to override parental wishes highlights the tricky balance between parental rights, religious beliefs, and the state’s responsibility to protect children.

If You Were the Decision-Maker

Imagine being Jodie, Mary, the parents, a surgeon, or a judge, what would you do? Would you let nature take its course, even if it killed both children? Or would you go through with the procedure knowing one child would not make it? How can you balance medical evidence with the parents’ religious views against the procedure?

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Works Cited

Dyer, Clare. “Conjoined Twins Separated after Long Legal Battle.” BMJ : British Medical Journal, vol. 321, no. 7270, 11 Nov. 2000, p. 1175, pmc.ncbi.nlm.nih.gov/articles/PMC1118951/.

McCormick, Thomas. “Principles of Bioethics.” UW Medicine, 2018, depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/articles/principles-bioethics.