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Monday, 4 February, 2002, 12:55 GMT
Dreadful dilemma facing twins' parents
Kypros Nicolaides
Prof Nicolaides is a miracle worker to his patients
A Hertfordshire couple who are expecting Siamese twins could face the stark choice between which of their daughters can be allowed to live, a medical expert says.

Kypros Nicolaides, professor of foetal medicine at Kings College Hospital, London, says that compared with a similar dilemma faced by a Maltese couple in 2000, Tina May and Dennis Smith may have an "even worse" decision to make.

The case of Rina and Michaelangelo Attard, from the tiny island of Gozo, made legal history when the High Court ruled an operation to separate them should go ahead - despite the opposition of the parents.

Professor Nicolaides says that whereas in that case, there was an obviously weaker twin that was not likely to survive, the British couple may have to choose between two babies who could potentially live.

He said that any challenge to the operation could present "a medical legal nightmare", in the wake of the previous high profile case.

Parents' battle

The Attards' determination to leave the lives of their conjoined twins in the hands of God ended up in a High Court battle in the UK in September 2000.


The parents will be faced with a dreadful dilemma one month after the birth of the babies of truly sacrificing one

Kypros Nicolaides

The couple travelled to Britain for treatment at the St Mary's Hospital in Manchester, where Rosie and Gracie were born.

Gracie was the stronger twin and doctors were confident she could survive if she was separated from her sister.

Rosie was less developed and could not survive without using Gracie's heart - which placed the organ under far greater strain.

The Attards were against the operation but the High Court ruled the twins should be separated and Rosie died during the operation.

Sacrifice

Professor Nicolaides says the Siamese twins due to be born in April - who share one heart - could present their parents and medical staff with an even more complicated dilemma.

"In the Attards' case, it was very clear that had the operation not been carried out both babies would have died and the baby that was sacrificed was essentially half dead in as much as there was no heart and no brain development," he told BBC's Breakfast News.

"In this case both babies would be alive."

Prof Nicolaides, who has a reputation among his patients of being a miracle worker, said there will be no obviously weaker child.

Rina Attard
Rina Attard at the funeral of the twin who did not survive

"Both babies will be alive and the parents will bond with both.

"Based on my understanding of the degree of sharing, the parents would be faced with a dreadful dilemma one month after the birth of the babies of truly sacrificing one."

The professor, who was the subject of the BBC series Life Before Birth and is an expert on surgery in the womb, said the case might end in a "medical legal nightmare".

He said that in the Attards' case the High Court ruled the twins should be separated because to not do so would be to condemn a healthy baby.

In this case, to separate the girls will also mean one baby will have its chance of life taken away.

"The High Court may apply the opposite logic that it may be illegal to separate them," he said.

Legal dilemma

If the court does not intervene, pro-life groups may consider legal action, but face a difficult hurdle.

The only people who could launch an action on behalf of the children are the Official Solicitor or others related to the children known as people "of standing", according to the Society for the Protection of the Unborn Child (SPUC).

The organisation's general secretary Paul Tully said: "This case raises serious concerns that go further than those of the Maltese conjoined twins.

"It seems as though it is the medical authorities and their legal advisers who have made the decision here and the parents have agreed with them.

"We are concerned what would have happened if the parents had disagreed and we rather suspect this case would have gone to court.

"I think a legal challenge is very unlikely.

"The difficulty of bringing a legal challenge is very great.

"In the previous case with the conjoined twins, the doctors who had an interest in the case, were in a position to take it to court and we feel that was inappropriate action.

"In this case who is in a position to challenge this decision?

Jack Scarisbrick, the national chairman of the pro-life charity Life, said his organisation refused to rule out legal action if it was at all possible.

He said: "If there was a clear indication in English law that it was murder or it was morally obvious it was a deliberate action to kill one twin in order that another can survive, in these cases we may consider something."

See also:

24 Dec 01 | England
Siamese twins home for Christmas
12 Dec 01 | Health
Pioneering Siamese twin op
17 Jun 01 | Health
Siamese twin returns home
25 Aug 00 | Q-S
Siamese twins
06 Apr 01 | Asia-Pacific
Surgery to separate Siamese twins
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