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Friday, 22 September, 2000, 16:20 GMT 17:20 UK
Siamese twins: The judgement
jodie and mary
Jodie and Mary are now six weeks old
The Court of Appeal has ruled that the conjoined twins Jodie and Mary must be separated, even though the operation will result in the death of the weaker twin, Mary.

The crucial issues considered by the three judges were;

  • Is it in Jodie's best interests that she be separated from Mary?
  • Is it in Mary's best interests that she be separated from Jodie?
  • If those interests are in conflict can the court balance the interests of one against the other and so allow one to prevail against the other?
  • If the prevailing interest favours the operation being performed, can it be lawfully performed?

From the conclusion of Lord Justice Ward:

"Each of us has truly agonised over this difficult case. The tragedy for this family has never been out of mind and I feel more sorrow for them today even than I did when first learning of their plight.

"The unique and the crucial feature of the case is that the twins share a common aorta. That enables Jodie's heart to pump the blood she oxygenates through Mary's body as Mary's heart and lungs have no capacity to sustain life.

The sad fact is that she lives on borrowed time, all of it borrowed from her sister

Lord Justice Ward

"She would have died probably in the womb but certainly at birth but for the life-sustaining support she received from her sister.

"The sad fact is that she lives on borrowed time, all of it borrowed from her sister. She is incapable of independent existence. She is designated for death.

"Doing the work for two imposes a terrible strain on Jodie's heart. It is common ground that her heart will fail and she will suffer a cardiac arrest. She is not expected to live more than 3-6 months, or perhaps a little longer. Mary's death will inevitably follow hers.

"It is not in dispute that the twins can be separated without significant risk to Jodie. That will leave Jodie living a more or less normal life.

"The separation will result in certain death for Mary within minutes of the common aorta being severed.

"Thus in deciding whether or not to consent to this operation the parents have had to confront the cruel reality that surgery will save Jodie but it will kill Mary.

"They could not bring themselves to give that consent because their girls are equal in their eyes and in their love.

"They sincerely believe that it was God's will that they be born with the afflictions they have and that they should be left to live their lives joined together as they are for so long as God in his mercy shall ordain it.

"The hospital, on the other hand, could not in conscience suffer a life to be lost and, although they were fully entitled to submit to the parents' wishes, they are every bit as entitled to come to court and invite the court to decide that critical question of life and death. That is what a court is for.

"The case has raised acute moral and ethical questions and those principles and the religious foundations for them have been well presented to us by the Archbishop of Westminster to whom we are indebted.

"They have rightly become the subject of huge public interest and public debate. It is, however, necessary to stress the obvious. This is not a court of morals but a court of law and our decision has to be taken from a solid base of legal principle.

'Welfare paramount'

"As to Jodie's best interests..the operation would be to her benefit. The experts from the Great Ormond Street Hospital for Children..confirm that Jodie should be able to live a fairly normal or at least a not intolerable life.

"Determining where Mary's welfare lies is more difficult. In my judgement it cannot be in Mary's best interests to undergo surgery which will terminate her life.

"That places the court on the painfully sharp horns of dilemma.

"The court's duty is to put the welfare of each child paramount. It is in the best interests of Jodie that separation takes place - it is in the best interests of Mary that it does not.

"There is an irreconcilable conflict and the court cannot fully honour its separate duty to each child to do what is best for that child. The court is placed in an impossible position.

In my judgement the only solution is to balance the welfare of each child against the other to find the least detrimental alternative

Lord Justice Ward

"How to resolve it has presented me with one of the real difficulties in the case because it is crucial to the eventual outcome.

"After anxious thought I conclude that the court cannot abdicate responsibility and simply say it is too difficult to decide.

"We are here to make tough decisions. In my judgement the only solution is to balance the welfare of each child against the other to find the least detrimental alternative.

"I am not entitled to value the quality of one human life as worth more than another's and I do not do so. But it is legitimate to look at the actual condition of the children as they are and assess their legitimate expectations when determining whether it is worth treating them.

"The worthwhileness of the proposed treatment is a legitimate factor to weigh. For the reasons given the treatment is not worthwhile for Mary for one cannot escape from the fact that Mary has always been fated for early death - her capacity to live has been fatally compromised.

"Though Mary has a right to life, she has little right to be alive. She is alive because, and only because, to put it bluntly but nonetheless accurately she sucks the lifeblood of Jodie and her parasitic living will soon be the cause of Jodie ceasing to live. Jodie is entitled to protest that Mary is killing her.

"I see no difference in essence between [a] resort to self-defence and the doctors coming to Jodie's defence and removing the threat of fatal harm to her presented by Mary's draining her life blood.

"I conclude, therefore, that the operation can be lawfully carried out."

Lord Justice Brooke

"I am in entire agreement with Ward LJ on all the issues of family law which arise in this case.

"As for the criminal law, four issues arise. Is Mary a human being in the eyes of the law? The answer is yes. Would the proposed operation amount to the positive act of killing Mary? The answer is yes.

"Would the doctors be held to have the intention of killing Mary, however little they desire that outcome? The answer is again yes.

"The doctrine of double effect, which permits a doctor, acting in good faith, to administer pain-killing drugs to her dying patient, has no relevance in this case. This leaves open the single question - Would the killing be unlawful?

"It has been said that there are three necessary requirements for the application of the doctrine of necessity.

"The act is needed to avoid inevitable and irreparable evil. No more should be done than is reasonably necessary for the purpose to be achieved. The evil inflicted must not be disproportionate to the evil avoided.

"Given that the principles of modern family law point irresistibly to the conclusion that the interests of Jodie must be preferred to the interests of Mary, I consider that all these requirements are satisfied in this case.

"Finally, the doctrine of the sanctity of life respects the integrity of the human body. The proposed operation would give these children's bodies the integrity which nature denied them.

"The proposed operation would therefore not be unlawful. I, too, would dismiss this appeal."

Lord Robert Walker

"In this case the doctors would perform a positive act of invasive surgery, but they would do so for the well-intentioned purposes which I have mentioned.

"The surgery would plainly be in Jodie's best interests, and in my judgement it would be in the best interests of Mary also, since for the twins to remain alive and conjoined in the way they are would be to deprive them of the bodily integrity and human dignity which is the right of each of them.

"Continued life, whether long or short, would hold nothing for Mary except possible pain and discomfort, if indeed she can feel anything at all.

"The proposed operation would therefore be in the best interests of each of the twins. The decision does not require the court to value one life above another.

"I would therefore dismiss this appeal."

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06 Sep 00 | Health
Experts back twins' separation
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