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Opinion Column
For the week of October 4 through 10, 2000

What is the right decision and who should make it?

The doctors caring for the twins felt that, ethically, it was incumbent on them to save the life of Jodie and carry out the surgery. Last week, the London Court of Appeal agreed.

Commentary by ADAM TANOUS

Jodie and Mary, the cheery sounding and fictional names given to a pair of conjoined twins belie the horrible circumstance of their lives. Their dilemma is as real and grim as life gets.

Born in Manchester, England, on Aug. 8, the two girls entered the world joined at the lower abdomen.

Mary was born without a functioning heart and lungs and so depends entirely on Jodie. Mary has only what has been reported as a "primitive brain." Doctors have determined that if the two are not surgically separated within a few months both children will die. Jodie’s heart and lungs simply can’t carry the strain of supporting both bodies. And, of course, with the surgery, Mary loses her source of lifeblood and will certainly die.

The parents of the children, their names have not been released, are from the Mediterranean island of Malta. When they discovered the state of their twins in the womb, they went to England to get the best medical care possible. When they were apprised of the options, the couple, devout Roman Catholics, decided to forgo the surgery and "follow God’s will," even though it meant both children would die.

The doctors caring for the twins felt that, ethically, it was incumbent on them to save the life of Jodie and carry out the surgery. Last week, the London Court of Appeal agreed.

There really are two intertwined issues at hand here: what should be the right decision and who should make that decision. There are no good solutions to this one. I suppose if I had to choose, though, I would opt for the course that preserves life.

Opponents to the ruling argued that to preserve life one has to intentionally kill another. The court saw it differently, saying that the surgery amounted to "withdrawal of care," not intentional killing. In the same vein, I wouldn’t call unplugging a respirator from a brain-dead family member murder. Mary is not a viable person without the heart and lungs of Jodie. The cruel reality is that Mary’s effective respirator, Jodie, cannot continue on in this role. One could even go so far as say that Mary was killing Jodie, not intentionally, but in effect.

Unfortunately, we have to deal with relative moralities here; neither course absolves one of guilt and uncertainty. Given that Mary is doomed in both situations, allowing her to die seems less immoral than denying Jodie her very real chance at life.

More to the point is that inaction—when one has the capability and means to remedy a situation—should be considered, in effect, an action. It is the same difficulty I would have with a Christian Scientist family that refused medical care to a child dying an avoidable death. When it comes to withholding medical care, negligence is as morally questionable as other more assertive actions.

To say that something is "God’s will" when a situation is beyond all human remedy is understandable. Less defensible, I think, is to take that inactive position when something can be done, especially if it is the case of a parent deciding for a child. It seems that once these girls were born they were immediately thrust into a conflict: between a right to life and the rights of parents to live by the religion of their choosing.

Which gets us into very murky and inflammatory territory. At times, I wonder if morality is not more fundamental than religion, that morality needs to exist outside the prism of religion. Sometimes I find it hard to understand the practices of some religions: those that withhold medical care from their children, those that deny women basic human rights, those that mutilate female genitalia. There have to be some standards for what is right and wrong, and they must cut across all religions. These standards are basically reflected in our legal system, but sometimes they do not keep pace with technological and social changes.

This case brings to the forefront another question that continues to plague us—namely, where is the line between public and private interests? It is always easier to say from a distance that doctors should have the right to save one of the children, even if it is against the parents’ wishes. Notwithstanding, this kind of position does have precedence. The legal system not only condones but requires doctors to report parents of suspected child abuse victims to social service agencies. The state intervenes in the case of drug addicted mothers who put their fetuses or born children at risk.

We all have a natural aversion to any sort of outside body trying to tell us how to live. But while we need to protect the rights of individual families to choose their own paths, society also has an obligation to make sure every individual out there, child or not, has access to the basic protections and opportunities that a country offers.

All of these types of decisions take place on a slippery slope. The easy decisions—the ones that fit into a tidy little box—have already been made. What we face in the future are questions that are more complex and with further reaching implications.

To say, however, that a given decision puts us on a slippery slope and therefore shouldn’t be made is a non-argument. We are already there on the slope and there we’ll remain. Furthermore, each ethical dilemma is unique. We can not possibly extrapolate to other cases when it comes to questions of ethics.

While the case of Jodie and Mary is an awful one, it could be even worse. That Mary is certain to die in both scenarios, to an extent, makes the decision easier. Saving Jodie’s life is weighed against Mary’s certain death. What if without the surgery Mary’s death were not certain? What if there were a 10 percent chance she would survive? Or 20 percent? At what point does the possibility of her survival tip the balance the other way?

There are an infinite number of ways our ethical and moral natures can and will be challenged in the future. To see Mary and Jodie as freaks of nature and irrelevant to the average citizen’s moral universe is to underestimate the complexity of the world we are entering into.


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