The DOI matches its Crossref record; 12 of the 13 references it cites were found in a registry or an index; none of the 11 sources its claims cite is checked for support yet.
Do we murder Mary to save Jodie? An ethical analysis of the separation of the Manchester conjoined twins
Open accessAbstract
“Everyone has the right to life so why should we kill one of our daughters to enable the other to survive?”* That question by the parents of conjoined twins, Mary and Jodie, who were so fused that any attempt to separate them would inevitably result in the death of Mary, stands as a challenge not only to their caregivers at St Mary's Hospital in Manchester, England, but to all who confronted the vexing issues raised by their plight. A 34 year old white woman with no other children became pregnant. At four months of gestation ultrasound revealed conjoined twins. The treating physician on the Maltese island of Gozo recommended transfer to St Mary's Hospital, Manchester where he had trained. Because of a long standing agreement between Malta and Great Britain the patient was transferred to the care of the British National Health Service. On transfer magnetic resonance imaging revealed significant problems with the pregnancy. The smaller of twins was not expected to survive. The parents, because of their religious belief that “everyone has a right to life”, declined the option to terminate the pregnancy. The pregnancy was allowed to continue for 42 weeks before delivery by caesarean section on 8 August 2000. The combined birth weight of the infants was 6000 g. Both infants were immediately intubated. They were ischiopagus tetrapus conjoined twins linked at the pelvis with fused spines and spinal cords, and with four legs.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
0 Valid · 2 Not valid · 12 Not checked · 5 Own results and interpretations
In the paper
“On 22 September 2000 the Court of Appeal issued its opinion authorising the surgery.11”
What the sources say
- Not matchedcites [11]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“The Catholic authorities in Philadelphia also approved the operation even though it could be foreseen that it would result in the death of one of the infants.They based their position on the doctrine of double eVect.”
What the sources say
- Not matchedcites Meehan FX
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plainstates a causeSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“The rabbinic scholars used two analogies to justify the separation.”
What the sources say
- Not matchedcites Meehan FX
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plainstates a causeSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“These single heart cases, as did the twins at St Mary's Hospital, required that one twin be sacrificed to save the other.”
What the sources say
- Not matchedcites Annas GJ
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“In 1996 a survival of nearly a year was reported in the case of one of the Lakeberg twins who had shared a single six chambered heart with its sibling.3”
What the sources say
- Not matchedcites Thomasma DC
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
- Probably not a substantial claim. 12
- It may state two separate claims as one. 6
- The quote only partly states this claim. 1
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
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
§ Discussion
“Annas in a 1987 essay described the prospects for this category of twins as nearly "hopeless". 2”
§ References
“2. Thomasma DC, Muraskas J, Marshall PA, et al. The ethics of caring for conjoined twins: the Lakeberg twins. Hastings Center Report 1976;26(4):4-12.”
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
§ Discussion
“In 1996 a survival of nearly a year was reported in the case of one of the Lakeberg twins who had shared a single six chambered heart with its sibling.3”
§ References
“3. Meehan FX. The siamese twin operation and contemporary catholic moral ethics. Linacre Quarterly 1978;45:157-64.”
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
§ Discussion
“In 1996 Thomasma began his commentary on the ethical concerns in the care of the conjoined Lakeberg twins”
§ References
“2. Thomasma DC, Muraskas J, Marshall PA, et al. The ethics of caring for conjoined twins: the Lakeberg twins. Hastings Center Report 1976;26(4):4-12.”
Citations
Cites
Just and Unjust Wars: A Moral Argument with Historical Illustrations, by Michael Walzer
O’Brien, W. V. (1979) · Political Science Quarterly · doi:10.2307/2150196 · Cited by 1,218
Just and Unjust Wars: A Moral Argument with Historical Illustrations
Paret, P., & Walzer, M. (1978) · The American Historical Review · doi:10.2307/1854700 · Cited by 868
Hastings Center (2018) · The Hastings Center Report · doi:10.1002/(issn)1552-146x · Cited by 865
Deciding to forego life-sustaining treatment.
Rm, L. (1986) · PubMed · Cited by 449
The Nature of the Judicial Process
Hand, L., & Cardozo, B. N. (1922) · Harvard Law Review · doi:10.2307/1328678 · Cited by 442
Wigodsky, H. S. (1984) · JAMA · doi:10.1001/jama.1984.03340380079034 · Cited by 202
The ethics of caring for conjoined twins: the Lakeberg twins.
Thomasma, D. C., Muraskas, J., Marshall, P. A., Myers, T., Tomich, P., & O'Neill, J. A. (1996) · The Hastings Center Report · doi:10.2307/3527600 · Cited by 43
Double effect reasoning from Jean Pierre Gury to Peter Knauer.
Kaczor, C. (1998) · Theological Studies · doi:10.1177/004056399805900206 · Cited by 39
The Nature of the Judicial ProcessPreprint
Kruger, S. (2009) · SSRN Electronic Journal · doi:10.2139/ssrn.1452116 · Cited by 23
(1980) · PubMed · Cited by 19
(1978) · PubMed · Cited by 5
Twins' lawyers may demand change of venue for operation
Dyer, C. (2000) · BMJ · doi:10.1136/bmj.321.7265.853 · Cited by 2
Research works printed but not linked: 3
- Annas, 1987, Siamese twins: killing one to save another.
- Thomasma, - 1976, The ethics of caring for conjoined twins: the Lakeberg twins., 10.2307/3527600 · DOI · Paper page
- 1980, Declaration on Euthanasia, the Sacred Congregation for the Doctrine of the Faith.
Cited by
Paris, J. J., Ahluwalia, J. S., Cummings, B., et al. (2017) · Journal of Perinatology · doi:10.1038/jp.2017.138 · Cited by 31
Self-citationCummings, B. M., & Paris, J. J. (2018) · Journal of Intensive Care Medicine · doi:10.1177/0885066618791953 · Cited by 12
“We also had the benefit of the thorough analysis provided in the similar British Manchester conjoined twins case.(6) In 1977, Dr C.”
BackgroundMethodSelf-citationConjoint twinning in the Maltese islands
Savona‐Ventura, C., Grima, S., & Buttigieg, G. G. (2009) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443610903082500 · Cited by 6
Cummings, B., Gee, M. S., Benavidez, O. J., Shank, E. S., Bojovic, B., Raskin, K. A., & Goldstein, A. M. (2017) · New England Journal of Medicine · doi:10.1056/nejmcpc1706105 · Cited by 5
Separation of Craniopagus Twins
Johnson, R., & Weir, P. (2016) · Cambridge Quarterly of Healthcare Ethics · doi:10.1017/s0963180115000274 · Cited by 4
Metadata
- Authors
- Paris, J. J., & Elias-Jones, A. C.
- Affiliations
- Tufts University (US)
- Leicester General Hospital (GB)
- Corresponding author
- Elias-Jones, A C
- Venue
- Postgraduate Medical Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2001-09-01
- Volume
- 77
- Issue
- 911
- Pages
- 593-598
- ISSN
- 0032-5473 (ISSN-L)
- 1469-0756
- PMC
- PMC1757916
- OpenAlex
- W2114427849
- Semantic Scholar
- f0536411c07c89ea7dca8710be37551ffc918cf5
- Cited by
- 17
- References
- 13
- Citations by year
- 2025: 2 · 2019: 3 · 2018: 2 · 2017: 3 · 2016: 5 · 2014: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Postgraduate Medical Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- 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
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Assisted Reproductive Technology and Twin Pregnancy
- Keywords
- conjoined twins, right to life, medical ethics, parental decision-making, fetal malformations
- MeSH terms
- Adult, Attitude to Health, Decision Making, England, Ethics, Medical, Euthanasia, Passive, Female, Humans, Infant, Newborn, Parents, Surgical Procedures, Operative, Twins, Conjoined
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
