When Twins Are Separated: The Ethical Dilemma

Separating conjoined twins is a complex medical procedure that raises many ethical questions. These questions are often discussed in medical literature. A recent review looked at seven papers published between 2013 and 2023. These papers discussed the ethical challenges of separating conjoined twins. The review found that the four main principles of ethics were often used to analyze these challenges. These principles are beneficence (doing good), non-maleficence (avoiding harm), autonomy (respecting individual choices), and justice (fairness). However, applying these principles can be tricky. For example, beneficence and non-maleficence can conflict when considering the best interests of both twins. One major issue is autonomy. Since conjoined twins are often too young to make decisions, parents usually decide for them. In non-urgent cases, however, the twins should be involved in decision-making as much as possible. Another challenge is ensuring fairness. This is especially difficult when it comes to shared organs and survival chances. Doctors must balance the needs of both twins, which can be very tough. The review also mentioned other ethical principles, like the act-omission doctrine and the double effect doctrine. These principles add more layers to the ethical debate. The review had some limitations. It only looked at studies from certain regions and languages. It also didn't include unpublished studies. Despite these limitations, the review highlighted the complexity of the ethical issues involved in separating conjoined twins. There is no simple answer to whether separating conjoined twins is right or wrong. Each case is unique. The best approach is to consider the ethical principles and involve the family and ethical committees in the decision-making process.