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One into two will not go: conceptualising conjoined twins
Open accessAbstract
This paper is written in response to controversial judicial decisions following separation surgery on conjoined twins "Jodie" and "Mary". The courts, it is argued, seem to have conceptualised the twins as "entangled singletons" requiring medical intervention to render them physically separate and thus "as they were meant to be", notwithstanding the death of the weaker twin, "Mary". In contrast, we argue that certain notions, philosophical and biological, of what human beings are intended to be, are problematic. We consider three compelling conceptualisations of conjoined twins and advocate a model that conceives them as two psychologically separate individuals who happen to share a body, the sharing of a body being integral to the individuality of each twin. While we reject an "essentialist" view of the conjoined state, a view which might render separation surgery unthinkable in all cases, we nevertheless argue against an "adversarial" interpretation of conjoined twins' respective best interests. We maintain that the physical entanglement should be regarded as a shared problem rather than one posed by one twin to the other. And if, after deliberation, separation surgery is deemed the "least detrimental alternative" or the "lesser of two evils", then there should be recognition of what conjoined twins will lose, as well as gain, through separation. The current drive to separate twins at all costs may evince a deeper unease with bodily configurations that appear to threaten the premium that the Western ethical and legal tradition places on personal sovereignty, and the physical circumscription that such sovereignty assumes.
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“While we reject an ''essentialist'' view of the conjoined state, a view which might render separation surgery unthinkable in all cases, we nevertheless argue against an ''adversarial'' interpretation of conjoined twins' respective best interests.”
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“We argue that this is difficult to maintain.”
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“Brooke LJ appears to have derived his notion of bodily integrity (and inviolability?) directly from the sanctity of life doctrine: ''the doctrine of the sanctity of life respects the integrity of the human body'' (Re A, 1 1051).”
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- Not matchedcites Re A
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“As a result, they were led quite easily into using language that suggested that Jodie and Mary (or at least one of them) were in wrongful and harmful contact with each other.”
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“In English law, the fetus only acquires full legal protection when it is born and has a separate existence from its mother.2 This is the so called ''liveborn'' principle.”
What the sources say
- Not matchedcites [2] Paton v Trustees of BPAS [1979] QB 276, [1978] 2 All ER 987 (QBD) .
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§ CONCLUSION
“The court's reasoning is a good illustration of Canguilhem's observation that ''the abnormal, while logically second, is existentially first''.21”
§ References
“20. Canguilhem G. The normal and the pathological [trans Fawcett C R]. New York: Zone Books, 1991:243.”
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§ **
“In a commentary on this argument Davis claims that what is important is not just an unbroken history of being joined, but the sharing of a body.20”
§ References
“19. Davis JK. Commentary on Thomson's violinist and conjoined twins. Camb Q Healthc Ethics 1999;8:435-9. 20. Canguilhem G. The normal and the pathological [trans Fawcett C R]. New York: Zone Books, 1991:243.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ THE WAY FORWARD
“Kenneth Himma explores this relationship in the case of hypothetical conjoined twins, known as Tom and Joe.19”
§ References
“18. Himma KE. Thomson's violinist and conjoined twins. Camb Q Healthc Ethics 1999;8:428-35. 19. Davis JK. Commentary on Thomson's violinist and conjoined twins. Camb Q Healthc Ethics 1999;8:435-9.”
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Cited by
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Vaginal Delivery of Dicephalic Parapagus Conjoined Twins: Case Report and Literature Review
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“Sacrifice of one individual to save another is supported by most religions and by courts, although some ethicists disagree with assumptions made in legal analyses (Atkinson 2004; Bratton and Chetwynd 2004 ).”
BackgroundInfluentialAnaesthesia for conjoined twins
Thomas, J. (2004) · Child s Nervous System · doi:10.1007/s00381-004-0980-9 · Cited by 27
Three-dimensional ultrasound for prenatal assessment of conjoined twins: additional advantages?
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BackgroundGêmeos unidos e autorização judicial para o aborto
Nomura, R. M. Y., Brizot, M. D. L., Liao, A. W., et al. (2011) · Revista da Associação Médica Brasileira · doi:10.1590/s0104-42302011000200020 · Cited by 11
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InfluentialPrenatal Management and Postnatal Separation of Omphalopagus and Craniopagus Conjoined Twins
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Moral Permissibility as a Guide for Decision Making About Conjoined Twins
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“May we separate Jodie and Mary if it will result in the death of Mary, and must we separate Jodie and Mary if it is the only way Jodie may survive? Conjoined twins are commonly conceptualized as Entangled Singletons, two individual people who are tragically ensnared (2,3).”
BackgroundClinicians’ criteria for fetal moral status: viability and relationality, not sentience
Campo‐Engelstein, L., & Andaya, E. (2022) · Journal of Medical Ethics · doi:10.1136/jme-2022-108392 · Cited by 8
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Conjoined twins and legal authorization for abortion
Nomura, R. M. Y., Brizot, M. D. L., Liao, A. W., et al. (2011) · Revista da Associação Médica Brasileira (English Edition) · doi:10.1016/s2255-4823(11)70045-5 · Cited by 5
Why Medicine Needs a Theology of Monstrosity
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Separation of Craniopagus Twins
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“…2001: 197) The legal language of individualism and competition was hardly appropriate to describe this least individualistic of all human states (Bratton and Chetwynd 2004: 279–85), but, from the judge’s perspective, the process of separating the twins in thought and word was necessary…”
BackgroundFreaks in late nineteenth-century British media and medicine
Pettit, F. (2012) · Open Research Exeter (University of Exeter) · Cited by 4
Conjoined twins and legal authorization for abortion
Nomura, R. M. Y., Brizot, M. D. L., Liao, A. W., et al. (2011) · Revista da Associação Médica Brasileira · doi:10.1016/s0104-4230(11)70045-8 · Cited by 3
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Anesthesia for Conjoined Twins
Thomas, J. M. (2011) · Elsevier eBooks · doi:10.1016/b978-0-323-06612-9.00029-8 · Cited by 1
Libertarianism for Conjoined Twins: A Reply to Wollen
Nowakowski, P., Slenzok, N., & Wójtowicz, S. (2024) · Philosophia · doi:10.1007/s11406-024-00803-8 · Cited by 1
“…in the disputes between conjoined twins, preferring instead a much more practically oriented debate on the ontological, ethical, and legal status of the twins in the contexts of their separation (see, e.g., Bratton & Chetwynd, 2004; Dreger, 1998; Munro, 2001; Overall, 2009; Wasserman, 2001).”
Hoeyer, K. (2012) · Springer eBooks · doi:10.1007/978-94-007-5264-1_3 · Cited by 1
Conjoined twins: bioethics, medicine and the law
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The ethics of separating conjoined twins
Winter, G. F. (2016) · Bulletin of The Royal College of Surgeons of England · doi:10.1308/rcsbull.2017.24
Anesthesia for Conjoined Twins
Thomas, J. M. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-34125-7.00036-x
Hearing Voices, Integrity, Theology, and Ethics
Robinson, S. (2024) · Springer eBooks · doi:10.1007/978-3-031-65687-3_9
Queered individuality: cultural responses to conjoined babies
Holloway, J. (2025) · Psychoanalysis Culture & Society · doi:10.1057/s41282-025-00602-4
“…and medical environments and—particularly for conjoined babies—motivate surgical interven - tions ‘even if such reconfigurations of the human body would result in catastrophic damage to the mobility, reproductive, and life functioning of the people concerned’ (Bratton & Chetwynd, 2004, p. 279).”
Influential
Metadata
- Authors
- Bratton, M. Q., & Chetwynd, S. B.
- Affiliations
- University of Warwick (GB)
- Corresponding author
- Bratton, M Q
- Venue
- Journal of Medical Ethics
- Publisher
- BMJ
- Published
- 2004-06
- Volume
- 30
- Issue
- 3
- Pages
- 279-285
- ISSN
- 0306-6800 (ISSN-L)
- 1473-4257
- PMC
- PMC1733862
- OpenAlex
- W2096742274
- Semantic Scholar
- 55215a25a3aaaefa092aa4aa01c17de28725bddb
- Cited by
- 27
- References
- 16
- Citations by year
- 2025: 1 · 2024: 2 · 2022: 2 · 2020: 1 · 2017: 3 · 2016: 2 · 2012: 3
- FWCI
- 1.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Medical Ethics (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- Goddard Space Flight Center
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Social Sciences › Law › Medical and Health Sciences Research
- Keywords
- conjoined twins, separation surgery, individuality, essentialism, best interests, individual sovereignty, bodily integrity, twin identity, legal personality
- MeSH terms
- Child, Child Advocacy, Child, Preschool, Ethics, Medical, Female, United Kingdom, Homicide, Humans, Legislation, Medical, Surgical Procedures, Operative, Twins, Conjoined, Bioethical Issues, Ethical Analysis, Personhood
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