Twins’ dilemma a terrible challenge to parents, court

WASHINGTON — I’ve been trying to think of an appropriate analogy: Two children drowning and the parent able to save only one? Shooting a monster that has grabbed one of your children and is menacing the other, even though the shot will mean the death of the first child as well?

The reason nothing useful comes to mind is that the facts are as awful and as stark as anything I could imagine.

The British Court of Appeal ruled Friday that conjoined twins will have to be separated, even though the operation will almost certainly mean the death of one of them. The desperate parents fought unsuccessfully against the surgery.

They had come to Manchester from the Mediterranean island of Gozo when the mother was six months pregnant because they had learned that the babies were joined at the lower abdomen. They came in hope of finding a way "to give our babies the very best chance for life in the very best place."

What they found was a dilemma too cruel to contemplate. Their daughters "Jodie" and "Mary" were not merely joined but "Mary" had only a "primitive brain" and relied on her sister for heart and lung function. Separating them would kill "Mary" but give her "bright and alert" sister a real chance at survival. Leaving them conjoined would most likely mean the death of both.

But when the physicians announced plans to proceed with the separation, the Roman Catholic parents balked. They wouldn’t kill one child to save the other.

They were firmly backed by Archbishop of Westminster Cormac Murphy-O’Connor, head of the Catholic church at Manchester. "There is a fundamental moral principle at stake," he said. "No one may commit a wrong action that good may come of it. The parents in this case have made clear that they love both their children equally and cannot consent to one of them being killed to help the other. I believe this moral instinct is right."

Separation, the prelate insisted, would be "morally impermissible."

The distinguished Catholic ethicist J. Bryan Hehir of Harvard Divinity School finds Murphy-O’Connor’s reasoning unassailable. "Traditional Catholic thought holds that ‘directly intended killing of the innocent’ is always wrong," he said. The other moral calculus, which Hehir describes as "consequentialist" or "utilitarian" — and which he personally rejects — holds that the right thing to do is to "maximize good consequences."

That seems to be the court’s rationale. A High Court judge ruled a month ago that the surgery should proceed, and the parents appealed to the Court of Appeal.

Almost as though to make the "lifeboat" dilemma more difficult, the judges were told two weeks ago that Jodie appeared not to be growing, while her sister — the one given no hope of survival — was "growing normally."

Lawyers appointed for each of the twins laid our their arguments. "Without Jodie, Mary will die," said Jodie’s lawyer. "With Mary, Jodie will die."

Mary’s lawyer countered that his client had an interest in continuing her life. "Although this is a life of short duration very severely handicapped, there is insufficient evidence that it is so intolerable as to render it in the child’s best interest that it should end."

The first of the obvious questions is the ethics class question: What would you do? Would your answer be different if you were committed to the right-to-life view and found the deliberate taking of innocent life unacceptable?

But if your answer leads you to spare Mary’s life, doesn’t that decision make you guilty of taking Jodie’s equally innocent life and Mary’s as well?

The other obvious question, in some ways more difficult, is: What should the government do? And in particular what should it do when medical science and the religion-based wishes of the parents are counterposed?

It’s one thing to believe, as I do, that the decision the Appeal Court reached is the morally correct decision — quite another to concede to the three judges the right to make it.