- The Washington Times - Tuesday, November 7, 2000

LONDON Surgeons operated yesterday to separate conjoined twin girls in a long and complex procedure that doctors said would kill one baby to give her sister a chance of a normal life.

The operation followed months of legal wrangling over whether the parents could refuse surgery and let nature take its course.

St. Mary's Hospital in Manchester confirmed early yesterday that the operation involving some 20 staff members had begun and was expected to take up to 15 hours. The hospital said no details about the surgery's outcome would be released until lunchtime today.

The girls, identified publicly only as "Mary" and "Jodie," were born at the hospital on Aug. 8 joined at the lower abdomen. Doctors say surgery could allow Jodie to have a normal life, but that Mary cannot survive once she is separated from Jodie's aorta.

If not separated, doctors said, both girls would die within months.

The twins' parents identified only as Roman Catholics from the Maltese island of Gozo in the Mediterranean opposed the operation for religious reasons but decided not to contest a Sept. 22 decision by the Court of Appeal that the girls can be separated.

The court had struggled with the issue of whether the surgery would amount to intentionally killing Mary, whose heart and lungs cannot sustain life. Two medical specialists appointed by the court endorsed surgery.

"The sad fact is that Mary lives on borrowed time, all of it borrowed from her sister," Lord Justice Alan Ward said in the Court of Appeal ruling. "She is incapable of independent existence. She is designated for death."

Pannone and Partners, the law firm representing the parents, said yesterday they would not be issuing a statement.

The official solicitor's office, which represents children's interests in court, had provided legal representation for both children.

On Friday, judges rejected a last-minute appeal by the Pro-Life Alliance, a group that wanted the case to be decided in the House of Lords.

The Times of London reported that the Maltese Pediatric Association had urged British doctors to delay the operation, saying it violated common practice that parents of severely disabled babies were given the final say over treatment.

"In this case, the parents have clearly expressed the wish that nature be left to take its course," it was quoted as saying.

News reports said the parents have agreed to give a paid interview to Granada TV and will use the money to care for Jodie as she undergoes further treatment. It was not disclosed how much they reportedly will be paid.

In yesterday's operation, surgeons were expected to begin by exploring the twins' anatomy, according to testimony in the Court of Appeal. The separation process would start with the pelvic bones and then go to the spines, where the twins were joined.

"Finally and eventually, we have a major blood vessel, which is the continuation of Jodie's aorta, which is bringing blood across to Mary, and similarly the vena cava, which is returning blood from Mary to Jodie. Those would need separating, dividing. It is at that point that we would expect that Mary would then die," the court's judgment said, quoting a surgeon who was not identified.

Doctors say Jodie will probably need further surgery to reconstruct some organs damaged in the surgery, including her rectum, sexual organs and lower abdomen. She is also expected to need skin grafts.

Three judges of the Court of Appeal ruled Sept. 22 that the case came down to an issue of self-defense the right of the stronger twin to be released from a sister who would eventually kill them both.

Cases of conjoined twins are very rare around one in every 50,000 to 100,000 live births when a fertilized egg does not divide completely to form two separate babies.

The Maltese family's identity has been concealed because of the huge publicity surrounding the case.

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