What are Moral Issues in the Separation of Conjoined Twins
Mary and Jodie are conjoined twins who share a circular pelvis. They also share Jodie’s heart and lungs because Mary’s heart and lungs do not function. Therefore, Mary relies on Jodie’s heart and lungs to supply her with blood and oxygen. Providing for two bodies causes extra strain on Jodie’s organs, which her doctors predict will lead to both twins’ deaths within three to six months if they are not separated. Their doctors would prefer separating the twins because it would give Jodie a very great chance for survival, but it would also mean losing Mary because she doesn’t have her own functioning heart and lungs to provide and survive for herself. Even with all the extra strain on Jodie’s body she is still a very lively, healthy, and active baby whereas even now though Mary does have a functioning brain it is very underdeveloped and she can only suck with her mouth, kick her legs, and open one eye; she may not even have consciousness. In this case, it is important to look at the main principles of utility and beneficence along with Singer’s moral principle as described by Beauchamp and Childress which states that “if it is in our power to prevent something bad from happening, without thereby sacrificing anything of comparable moral significance, then we ought to do it”. Based on these principles, Jodie and Mary’s parents have a specific moral obligation in beneficence to have the twins separated.
Those who oppose the separation of the twins may question whether or not it would be morally acceptable to violate peoples’ rights or to use people to promote the greater good. Kantian deontology would argue that no matter what the consequences are, certain acts are morally right, and certain acts are morally wrong. It would not be considered justifiable to act however we wanted, just because the overall results end up being worthy. In other words, the ends do not justify the means. We should not even act out actions that are wrong, simply because the overall consequences are desirable. Kant’s second version of the categorical imperative as Beauchamp and Childress explain, states that we should act in ways so that we are always treating humanity as both a means and at the same time as an end, but never only as a means. With regards to this imperative, human beings should, always, be treated with dignity and respect. They should be treated as holding fundamental value, and not just an expendable mechanism to achieve another end. Within the context of this case, Kantians would believe that while separating the twins would in fact bring about the greatest overall good (because it would save one life over none), it is still wrong to separate them because it would involve using Mary as merely a means towards saving Jodie’s life.
Jodie and Mary’s case may lead others to use a utilitarian perspective because it values producing the best outcome overall. This meaning that saving even just one twin is better than the alternative of letting them both just die. A utilitarian would consider a person to be equally responsible for their actions as well as their decisions to not take actions because a utilitarian focuses only on the end results. In this case, a utilitarian would argue that it is essentially the same as killing both girls by not separating them and letting them die due to the strain on Jodie’s organs. But, if their separation resulted in one living and only one dying, it would be good and morally justified. An act can only be justified up to the point that it is beneficial to oneself or others, once it is no longer helping anyone the action is no longer justified. The same thing goes for unjust actions; they can only be considered unjust to whatever point that they are causing harm. Beauchamp and Childress’ definition of utility says, “…we ought always to produce the maximal balance of positive value over disvalue- or the least possible disvalue, if only undesirable results can be achieved”. The definition of utility in conjunction with Singer’s principle, allow me to argue that if we are in a position to act in any way that is beneficial, then we are also obligated to do so.
Along with our responsibility to promote virtuous actions as moral humans, it is also important to fully assess the context of each situation. Specifically, in Mary and Jodie’s case we need to address the question of whether there are two babies or just one. Because Mary does not have her own individual working heart and lungs to support her, it could be determined that she is not actually living. Mary does still have a somewhat functioning brain of her own, which some would claim is enough to classify her as a person, but it is very apparent that without being attached to her sister Jodie, she would not be alive, and her doctors’ evaluations only solidify that. For Mary, no matter what actions are taken, there is no chance she will continue to live for any extended period of time. This now allows us to see Jodie as the only living baby to show major concern for. Without being able to regard Mary as a living person, she would more so be viewed as a hindrance to Jodie’s health and wellbeing. It would be similar to a parasite that is attached to Jodie and just using and putting more strain on her heart and lungs to be able to stay alive without doing her own work. For these reasons, Jodie would be considered the only living human being in this case, and Mary is a life-threatening condition to her.
In Singer’s moral principle, he says, “…as long as we do not sacrifice anything of comparable moral significance, then we ought to do it”. In relation to this case, we are asking the question, is there a sacrifice of something that is of comparable moral value to the life of a human? With the previous argument, we no longer consider “Mary” to be living, so we can now refer to the twins as just one baby: Jodie. If the “twins” is now just Jodie, then we would look at Mary as being synonymous to a deadly parasite. This case then becomes much less debatable and more like a case in which a life-saving operation is done to remove a harmful parasite. “Mary” is at this point just a hindrance and impediment to Jodie and her healthy survival. Because of this, Mary is not a sacrifice of comparable moral value, so separating the twins can be justified.
The parents of Mary and Jodie have a moral obligation to separate their daughters. We know that if the twins stay joined together both Jodie and her “parasite” Mary will die, which would be the worst possible outcome. We also know that their doctors are able and in favor of preventing Jodie’s death while also not having to sacrifice something that has a morally equal value. We as moral beings should, if we are able, prevent harm as long as it does not risk harming something morally comparable. Any person dying is bad so, if we are able, we should prevent the death of a living person (Jodie), as long as we do not have to sacrifice anything that is considered comparable to that life (Mary). All of these statements satisfy the conditions that warrant prima facie obligation of beneficence, and therefore a moral obligation to separate Mary from Jodie in order to prevent Jodie from dying.
The morally correct thing to do in this case is to separate the twins, and both Utilitarians and Kantians would agree with this. Kantians would at first disagree though, saying that due to that second categorical imperative it is wrong to use “Mary” solely as a means to save Jodie. But, once it is determined that “Mary” is not living, Kantians would agree that separation is the right thing to do. By viewing “Mary” as the parasite threatening Jodie’s life, Kantians would not be able to argue that it is wrong to have the “threat” removed from Jodie’s body. Utilitarians however would have always been in support of the girls’ separation because it would have satisfied their utility principle of doing the greatest good.
Overall, according to Utilitarianism, Beneficence, Singer’s principle, and even Kantian deontology, “if it is in our power to prevent something bad from happening, without thereby sacrificing anything of comparable moral significance, then we ought to do it”. With this case specifically, the doctors are able to save Jodie’s life, without having to sacrifice anything that has morally equal value because Mary is not living and would not continue to live no matter if the girls were separated or not. Having the twins separated, also brings about the greatest good- saving one life. For these reasons, the girls’ parents have a specific moral obligation in beneficence to separate their twin daughters.
