Friday, May 20, 2005

This Little Girl...

...can thank God that surgeons in our day can fix things like this. But the bizarre variety inherent in our physical frailty is emotionally exhausting to behold. And what a cute kid at that.

Update: A "reader" (apparently named 'Racheal') writes - Hey dude. found your blog. you should read this: http://www.jimmyakin.org/2005/02/ethical_questio.html

Okay, dudess, I read it. Mr. Akin is inclined to think that the separation amounted to murder of the undeveloped twin. This is possible, I suppose. I did a quick google and read a number of the articles, all of which are extremely (one might almost say purposely) sparing in detail. Several say that the undeveloped head was capable of "blinking and smiling, but not of independent life." Well, a baby in the womb isn't capable of independent life either, so you can see where Mr. Akin is going. The developed twin, Manar, suffered from a condition called craniopagus parasiticus, in which the process of twinning in the womb fails to complete itself. It's an extremely rare condition, and the undeveloped twin is "usually considered parasitic." Of course, once something is labeled parasitic, the necessity of having it removed becomes immediately, and conveniently, apparent.

It seems to me that the decision to attempt surgery would have to depend on a very precise medical diagnosis: did the 'parasitic' head have a brain and any sort of consciousness, however rudimentary? Did this undeveloped 'other' give any evidence, even on the level of animal sentience, that it was truly alive, or perhaps I should say 'awake'? Should this other be considered a being with a separate (as opposed to independent) existence? In other words, was someone in there?

Blinking and smiling could be reflexive. Could be. The dearth of medical details makes it impossible to know.

Could the separation fall under the principle of double effect, in which (as in the case of ectopic pregnancy) the surgery might be deemed necessary to save the life of the developed twin, with the death of the other an unintended side-effect? Mr. Akin says no, inasmuch as Manar's life was not threatened.

Don't hold your breath waiting for the desired biological revelations. Most people will simply assume (as did I) the lifelessness of the extra head and the medical necessity of the operation, that Manar not be condemned to a life of lugging it around. Even now she cannot sit up and crawl around like a normal kid because of the extra weight.

Some might wonder whether Manar's parents ever gave the undeveloped twin a name. If so, no mention is made of it.
_______________

Comments:
My initial reaction to this was the same as yours -- that it was the right thing to do. Mr. Akin makes some good points, but I'm still not convinced that the separation was wrong.
One thing that Mr. Akin said that left me flabbergasted was this: "As far as I know, they could live a normal life while remaining conjoined." Huh? He's kidding, right? How on earth could the fully formed girl live any kind of a normal life? With all due respect to Mr. Akin, I find that ridiculous.
Posted by susan b. email at February 21, 2005 06:21 PM


I agree and disagree, Susan. Agree that, like you, I'm still not convinced that the separation was wrong. Disagree with your "How on earth could the fully formed girl live any kind of a normal life?" Obviously she could not. But to allow this as the reason for separation is the same thinking that allows abortion in the cases of rape, incest and fetal deformity. In short, the hard case exceptions. I think by 'normal' Akin meant that she could make a go of it, however difficult. There's really only one question to be answered: is the undeveloped conjoined twin a person?
The abortion parallel is instructive in another way. Neither the unborn nor the undeveloped twin are capable of "independent life." But an unborn baby possesses the potential for such, whereas the twin does not. Would this allow us to kill it? Suppose we had (as has happened numerous times) two developed twins, but the doctors come to find out that, by the nature of their linkage, only one possesses the capacity for independent life. Would the luckier of the two then have the right to ask to be separated from the burden of his brother, that he might get on with a normal life? I think not. A person who would inevitably die due to disease or untreatable defect can be allowed to do so, but cannot be sped on his way by an act of either commission or omission that intends his death. That is murder. So it seems to me we are thrown back on the previous question about the undeveloped twin's personhood, and that right now we don't have enough facts to make that judgement. Unless someone can make the case that the absence of heart, lungs, and all other vital organs essential for survival renders one a non-person. One can be missing many parts and still be considered human... but all these things? Sometimes I hate nature for the puzzles it presents.
Posted by William Luse email at February 22, 2005 01:48 AM


seein' as how i'm pregnant with twins...i ain't touchin' this one with the neighbor's ten foot pole.
Posted by smockmomma email at February 22, 2005 01:40 PM


This story creeps me out. My first thought as I read of the disconnection of the two heads was to wonder if the other head was alive and sentient since it (she) appeared real, alive, and alert.
Yet, I think if I were a doctor, I would advise the surgery even if it meant the death of the other person in this case.
Still, for a Catholic, this is one of those situations which one wonders if you can make any moral sense if there's a question of two lives.
What a horrible situation. How it tests the game of theology and intellectual arguments. There is nothing in the Gospel that prepares us for these kinds of choices.
I mean that. There is nothing were we find Jesus confronting anything like this. It's not enough to try and extrapolate from some other saying or action. Nothing fits this case. God have mercy on us, and those involved.
Posted by mark butterworth email at February 23, 2005 01:20 AM


It certainly seems a tough one, Mark, but I don't think I could consent to the surgery if there were any chance that the undeveloped twin might be a person rather than a vestigial appendage. That Jesus never faced this situation is, I hope, irrelevant. Most of the ethical dilemmas (particularly the bioethical ones) confronting us today were not around in His time. But by His grace, and with the guidance of the moral tradition of His infallible Church, we ought to be able to come to a conclusion. There is nothing in the Gospel that prepares us for these kinds of choices. How about: Thou shalt love thy neighbor as thyself?
Posted by William Luse email at February 23, 2005 04:20 AM


I'm still too battered and bruised by my last bout in the bioethics arena to comment much on this, but I lean towards Jimmy Akin's perspective.We didn't confront some of these cases 2000 or even 200 years ago because a pregnancy with some of these deformities would have led to death of both mother and child in the process of attempting to deliver. Or maybe the mom might surive with some horrific damage. I am willing to wager that this baby was born via cesarean - I can see no easy way for the baby to come out otherwise.Some conjoined twins could be born normally (ie Chang and Eng, the original "Siamese Twins", but most would present too large a diameter to fit through even the most generous of pelves.Progress leads to new dilemmas.
Posted by alicia email at February 23, 2005 03:26 PM


Bill,
You would think you could apply some aspect of the Gospel, but not being a doctor, I have no idea how I would handle the situation if two lives are involved in this conjoined situation. My speculation is imaginary and thus worthless as far as that goes.
These cases are simply tragic.
Posted by mark butterworth email at February 23, 2005 07:47 PM


But to allow this as the reason for separation is the same thinking that allows abortion in the cases of rape, incest and fetal deformity. In short, the hard case exceptions. I think by 'normal' Akin meant that she could make a go of it, however difficult.
Bill,
I'll admit I overreacted a little bit to Akin's statement. And I agree that if the other head is truly a person, it would be wrong to kill her. In regards it abortion, even after becoming pro-life, I struggled with the rape and incest exceptions for some time. I knew it was inconsistent, but I was afraid that being consistent in this would show a lack of compassion for rape and incest victims. I finally came to the conclusion that since the baby was a life, killing it would be wrong no matter how it was conceived. I also realized that compassion for the unborn child and compassion for a rape or incest victim were not mutually exclusive.
Posted by susan b. email at February 23, 2005 11:01 PM


At least you came to the right conclusions.
Posted by William Luse email at February 24, 2005 03:46 AM


I’m curious why this is even a debate. Wow are you people extreme!! You would say that it is perfectly alright to let another child spend their life being the life support for a child with only a head. While it is painful to think about the child with only one head there is only one choice in this matter – to remove it from the other child. If the child with only a head can sustain itself on it’s own or with medical life support so be it but to tell another child that it is their responsibility to carry this burden for life is absolutely nuts. I am against abortion but you people who are against this are the extremist that gives religion a bad name. I say walk in that girls shoes & lets see what you would think then after living a life like that. It so easy to say that it’s wrong to remove the head when you will never be forced to live that type of life.
Posted by Jeanne email at May 19, 2005 03:49 PM


Actually, I took no hard and fast position on whether or not the separation was right or wrong. It would have to be medically established that the "parasitic" head was in fact a separate individual for us to conclude that it was indeed the wrong thing to do. If that fact were established, and you still consented to the separation, then you would not be as you claim "against abortion." Or you would be only in those cases you find convenient.
Posted by William Luse email at May 19, 2005 04:13 PM

I should add that I no longer subscribe to this: "Could the separation fall under the principle of double effect, in which (as in the case of ectopic pregnancy) the surgery might be deemed necessary to save the life of the developed twin, with the death of the other an unintended side-effect?" I retract it completely. Double-effect applies only when the evil effect is unintended. It cannot be called upon in those cases where one's intention is to kill the innocent as a means to an end. [Updated August, 2009]





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