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The Bioethics of Separating Conjoined Twins in Plastic Surgery
Michelle Lee MD, Arun K. Gosain MD, Devra B. Becker MD
University Hospitals Case Medical Center
2010-03-24
Presenter: Michelle Lee MD
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Craniopagus twins AD and TD examines the bioethical issues faced by the Plastic Surgery team during the twins' planned separation.
Case report: AD and TD are craniopagus twins conjoined at the head. TD's head is conjoined to the back of AD's neck. Neurologically, AD has the dominant cerebral circulation. TD has two normal kidneys while AD has none. AD depends on TD's renal function. Upon separation, AD would require either a kidney transplant or life-long dialysis.
Discussion: This case report reviews three key bioethical issues: 1. Informed consent: The parents' ability to understand the risk of the separation as well as their motivation for consenting to the procedure are examined. The case also discusses the role of children in the informed consent process. 2. Double effect of separation: Each twin was treated as an inviolate individual. The ethical dilemma of potentially causing irreversible harm to one twin while improving the quality of life for another twin is reviewed. 3. Surgical risk for life enhancing procedure: Adult un-separated twins have been reported to lead normal and meaningful lives. Separating AD and TD will improve the twin's quality of life, however, it is not a life saving procedure. Is it ethical to perform a procedure with unknown surgical risk to improve quality of life? Parents routinely request life enhancing plastic surgery procedures in children with craniofacial deformities. Where is the boundary? Is it ethical for parents to request life enhancing aesthetic procedures for children? The case report discusses these boundaries.
