- The Washington Times - Wednesday, November 8, 2000

LONDON The stronger of 3-month-old conjoined twins struggled for life yesterday after being separated from her sister, who died as a result of the 20-hour operation.

The surviving girl, known only as Jodie, was in "critical but stable" condition, St. Mary's Hospital in Manchester said. "As with all major surgery, the first few days following an operation are the most critical," the hospital said.

Her sister, known as Mary, died following surgery to separate the two, St. Mary's said.

Experts said the case was the first in Britain where judges had to choose whether to accelerate the death of one person to save another. The Court of Appeal allowed the operation after doctors said both girls would have died within months without it.

The next 48 hours are critical, experts say.

"The process is by no means over," said Dr. Lewis Spitz, a pediatric surgeon at London's Great Ormond Street Hospital for Children. "You have to remember that a huge body mass has been taken from them of between at least 45 percent to 50 percent."

Much depends on the function of Jodie's bladder, bowel and lower limbs, he added.

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.

The hospital provided no details of the complicated procedure, which began Monday and lasted until early yesterday. But according to testimony at the Court of Appeal, doctors said one of the main problems was that Jodie's aorta, her main artery taking blood away from the heart, was feeding blood to Mary and that her vena cava, the main vein bringing blood back to the heart, was handling Mary's blood as well her own.

Both those blood vessels would need to be separated and divided, to give Jodie the best chance of surviving, and severing those connections would kill Mary, an unidentified doctor was quoted in court records as saying.

The legal battle began shortly after the twins were born at St. Mary's in August with fused spines, joined at the abdomen and with arms and legs at right angles to their upper bodies.

Doctors had said surgery might allow Jodie to have a normal life, but that Mary's heart and lungs did not work and would not survive once she was separated from Jodie. Without surgery, both would surely die, doctors said.

The twins' parents identified only as Roman Catholics from the Maltese island of Gozo in the Mediterranean refused to allow the operation for religious reasons, and the hospital went to court to override them.

The courts struggled with the issue of whether the surgery would amount to intentionally killing Mary. Two medical specialists appointed by the court endorsed surgery.

The court heard that Mary had primitive brain function and was "draining the life" out of Jodie, who was thought to have normal mental function.

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

Their parents did not contest the ruling.

It is not the first time the wishes of parents have been overridden on the medical treatment of their children. But what made this case unique was the moral dilemma of accelerating the death of one person to offer another a better chance, said Simon Woods of the Institute of Medicine, Law and Bioethics at the University of Manchester School of Law.

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