Health Effects of the Separation of Conjoined Twins:

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Health Effects of the Separation of Conjoined
Twins

• An issue involving physical, ethical, and
  psychological dimensions

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Introduction

• Imagine having a sibling constantly at your side,
  waking up every morning to find your sibling
  lying right next to you.
• Imagine having to do everything together, even
  sitting on the same chair or riding the same
  bicycle.
• Then imagine that sibling being taken away from
  you.

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Introduction continues.

• About one to every 70,000 to 100,000 people go
  through this on a regular basis.
• . They are known to the world as conjoined twins
  
• Although many dont survive very long, about 40
  sets are born in the United States each year, and
  less then a dozen adult pairs are roaming the
  streets in the world today.

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History on Conjoined Twins

• Conjoined twins have interested people throughout
  history, and their images have been found in cave
  drawings and carvings many centuries back.
• In the earliest times they were known as gods, or
  feared as bad omens and exiled, abandoned or
  killed.

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Continues..

• In later days they were viewed as curiosities,
  and of the few sets whom survived into adulthood,
  became circus or sideshow attractions, or went on
  to the stage.
• Only in the last 30 years, has separation
  techniques become increasingly sophisticated and
  conjoined twins were no longer looked at as
  freaks but individuals.

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What are Conjoined Twins?

• Conjoined or Siamese twins are named for the
  first well-known pair from Siam (known as
  Thailand).
• They are formed when identical twinning goes
  awry.
• The cause of the syndrome is unknown, but its
  suspected to be caused by environmental factors.

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How Twins Become Conjoined

• It results when an embryo starts to divide but
  fails to complete the process, and the result is
  not quite two children.
• Wherever the embryo stopped dividing, the twins
  that would have been, become a single entity.
• It is believed that the first 13th and 15th days
  after fertilization the malformation occurs.

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Continued.

• The inner mass of the cell is split into equal
  halves, each capable of forming a normal
  individual.
• Complete separation of the inner cell mass within
  the chronic vesicle does not occur and
  non-separated parts of the otherwise normal twins
  remain fused throughout development.

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Continued..

• . In a normal embryo and fetus development every
  cell knows where it is in the body, because the
  neighbors produce chemical messages.
• If they are confused then conjoined twins dont
  work properly and can result in a single organism
  with two heads, two hearts, four legs and arms.

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Risks involved in separating twins

• It can be a life and death decision, because it
  can involve sacrificing one twins life in hope
  to save the other.
• Doctors have to convince themselves that the
  present quality of life is so worthless that the
  risky dangerous surgery is justified and should
  be performed.

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Continued.

• Survival depends on the type and extent of
  joining and on the presence or absence of
  associated anomalies
• There is only a fifty-fifty chance of survival,
  so parents risk death of their child or children
  to give them a chance to live separate lives
  because they believe it was the will of God.

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Greatest Risks

• The greatest risks to conjoined twins during and
  after separation are anesthesia and surgical
  complications.
• Complications can include formation of blood
  clots in the newly constructed blood vessels,
  intracranial bleeding, heart complications and
  infections.
• The critical period for conjoined twins is three
  to four days after surgery.

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Parents Objection to Separation

• Some parents dont want to risk losing their
  children so they think it is not such a terrible
  option to leave their twins joined because they
  believe their children are more able-bodied
  together than they would be apart.
• Objection to separating twins gives twins a
  chance of survival.

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Thesis

• The risks that follow separating or not
  separating conjoined twins in a physical,
  psychological, and ethical aspect.

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The Physical Aspect

• 60 of conjoined twins are either stillborn or
  die within their first few days of life.
  
• The opportunity for separation depends on the
  type of conjoined twins.

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Types of Conjoined Twins

• Thoracopagus Joined at the chest.
• The most common type of conjoined twins,
  representing 35 of all conjoined twins.
• The heart is shared, and separation is rarely
  attempted for this reason.

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Types of Conjoined Twins

• Omphalopagus Joined at the chest or abdomen.
• Similar to thoracopagus twins, but in this case
  the twins do not share a heart.
• The second most common type of conjoined twins,
  representing 30 of the total.
• Highest rate of separation survival. Usually,
  only the liver is involved. Because the liver can
  regenerate itself, this scenario is preferred.

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Types of Conjoined Twins

• Pyopagus joined at the posterior pelvis.
• Separation possible. The survival rate is high.

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Types of Conjoined Twins

• Parapagus joined from the thoracic cavity down.
• Separation possible, depending on the number and
  sharing of internal organs
• Life with artificial limbs is the result.

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Types of Conjoined Twins

• Ischopagus joined at the pelvis.
• Separation is physically possible, however,
  excretion and sexual impairment might result.

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Types of Conjoined Twins

• Craniopagus joined at the cranium.
• Separation is possible, depending on how much of
  the brain is shared.
• High risk of brain damage.

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The Ethical Aspect

• Even if there is a chance for physical
  separation, the family must make an ethical
  decision. Should a separation be attempted if one
  or both twins might not survive?

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Factors Complicating the Ethical Dilemma

• The survival rate Often, one twin will die at
  the expense of the other. Should it be attempted
  if one twin has a better chance of surviving than
  the other?
• The number and presence of organs if organs must
  be divided, the doctors and family must decide
  how.

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Factors Complicating the Ethical Dilemma

• Legal issues In a number of cases, courts have
  ruled that there is a moral obligation to save
  one twin over another. Following this logic, is
  it acceptable to kill one human being in light of
  possibly saving another? Many legal questions
  ensue.
• As such, in many cases, politics is involved.

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The Psychological Aspect

• Many of the ethical debates are fueled by the
  basic assumption that the twins want to be
  separated.
• Some of the most famous sets of conjoined twins,
  such as Chang and Eng Bunker, refused to be
  separated when procedures became available.

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The Psychological Aspect

• Twins go through the crucial development of the
  first few years of life with the presence of
  their condition. As such, they develop a paradigm
  about the world that involves being conjoined.
  Separation causes psychological turmoil by
  upsetting their way of looking at the world.

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The Psychological Aspect

• Guilt Complex If only one twin survives, that
  twin is at risk for developing a guilt complex
  about being the one who lived.
• Family Mental Health This ordeal is also
  psychologically taxing on those making the
  decisions. The family is very vulnerable for
  guilt complexes and depression.

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Summary

• In the end, a family must make a decision based
  on all three of these factors the physical,
  ethical, and psychological aspects.
• The health effects are far reaching, going beyond
  the physical aspect and affecting the mental
  aspect of both the twin and the family.

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Possible Solutions Should conjoined twins be
surgically separated, causing the immediate death
of one but enabling the other to survive, when
inaction would lead to the death of both, but
when such separation was contrary to the strong
religious beliefs of the parents?

• Separating conjoined twins is not only
  technically challenging it can involves life and
  death decisions about whether one twin should be
  sacrificed in the hope of saving the other.
• Some pairs, depending on the degree of
  conjunctionin particular, the degree to which
  they share internal organscan be separated by
  surgery.
• One ethical issue with separation is when the
  operation will result in the death of one twin
  (for example, in the case where they are sharing
  a heart.)
• The good effect must not be produced by means of
  the evil effect. I submit that the evil effect
  (the possible death of the one twin without
  essential organs) is not directly intended, at
  least as a means of producing the good effect
  (life for the other twin).

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Conclusion

• The decision of separation when dealing with
  Conjoined twins is an extremely complicated one.
• It is a decision that we feel should be made
  solely by the parents.

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Conclusion

• This decision should not be made, however,
  without researching all the facts related to
  Conjoined Twin separation.
• There is at best a Fifty-Fifty shot of survival
  when it comes to separation.

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Conclusion

• Separation in most cases is based mainly on the
  fusion of the heart.

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Conclusion

• After researching this topic surgery, if
  possible, is the best solution.
• Separation depends mainly on the number of shared
  vital organs.

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Conclusion

• The most difficult thing when it comes to
  separation of conjoined twins is the fact that
  there is a good chance one or both of the
  children will die.

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Summary

• Separation is extremely risky
• If at all possible surgery seems like the best
  option for Conjoined Twins

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Summary

• Parents should make the final and informed
  decision on separation.
• Only after examining the physical, ethical, and
  psychological aspects of a possible separation.