Two Tales of Conjoined Twin Separation

In one story, two once-conjoined toddler girls are heading back to the Dominican Republic, having been successfully separated by a day-long surgery that divided their liver, pancreas and other shared organ systems and reconstructed their abdominal walls. Virginia Commonwealth University had a farewell party for them. In the other story, one of two girls separated at Santiago, Chile's Calvo Mackenna Hospital has died, and her sister is said to be in stable but critical condition. The two, who had had a shared intestine and liver, had been struggling since their 18-hour separation surgery in early November.

The decision to attempt to separate conjoined twins is an ethically challenging one. First, there are the medical risks. Sometimes separation is simply out of the question; sometimes it is medically required if one or both of the twins are to survive infancy. Often, though, separation is surgically possible, but risky. The question then arises, "What risks should parents submit their children to for the sake of bodily normalcy?" An additional problem arises if the medical risks of separation are not be shared equally between the twins: May one twin be put at risk, or even sacrificed, for the sake of the other's attaining a more "normal" life?

There are also some very complicated questions about the motivations of the parties seeking separation. After all, many twins have lived happy lives without separation, and a certain amount of desire for separation may be driven by social pressure for bodily normalcy and biases against disability. (Parents and medical personnel can, of course, share those social attitudes.) More troubling is the possibility that the separation surgery is being pressed by physicians or hospitals for the sake of publicity or reputation-enhancement.

To be clear: I cannot tell from the media coverage which of the above questions or ethical problems were in play in either of the two stories I cited above. It's just that the simultaneous stories, with their very different outcomes, put me in mind of this set of issues.