Friday, January 12, 2007

Conjoined Twins: A Response and a Question [Serge]

Daniel states in the comments:

While it's true my biological formulations may be undersophisticated, I nevertheless feel like you have failed to address my primary question, so let me see if I can 'tweak' the conjoined twins scenario to better bring out my question.
I believe I did, but I'm happy to clarify.

As you probably know, fetal development can really go wrong. While some conjoined twins are conjoined at the hips, or the liver, or whatever, others are almost entirely fused (e.g. up to their upper-torso). I'll have this be case A.
Agreed. There are sometimes two human organisms that have their bodies fused together.

You probably also know that in some cases, one of the twins can be underdevelopped--to the point of lacking a heart, a brain, or simply being underweight. In some cases, a baby can be born with odd extra limbs (e.g. a leg sticking out of the side, or teeth in the back of the neck), even though the second 'twin' has been subsumed back into the first (or never really developed in the first place). Let's have this be case B.
OK. You are speaking of the (horribly titled) parasitic twin or rare inclusion twin. I need some more information to address this, but you state that the dependent twin "never really developed in the first place". Let's go on.

Since you seem to be more up-to-date on your biology than me, make whatever modifications to the two above scenarios for them to be medically plausible.
So far, so good.

In case A, I affirm that it is morally wrong to cut off the second twin's head. This is murder.
Agreed. It is wrong to cut off the head in case A because that action would result in the death of a human organism. The same would apply if you poisoned the twin. Performing an action that results in the death of a human being without justification would be morally wrong.

In case B, I affirm that it is morally acceptable to cut off the second twin's limbs (the leg sticking out of the first twin's torso).
Generally you are correct if the second "twin" is not a human organism. If the "twin" is unable to guide its own development and to integrate its bodily functions as a biological organism, then there is no moral qualms about its removal even though it is made up of human cells. Human organisms and teratomas begin as a single totipotent cell. However, there are distinct differences which maked the former a human organism and the latter not. Robert George mentions one:

If the embryo were not a complete organism, then what could it be? Unlike the spermatozoa and the oocytes, it is not a part of the mother or of the father. Nor is it a disordered growth such as a hydatidiform mole or teratoma. (Such entities lack the internal resources to actively develop themselves to the next more mature stage of the life of a human being.)

The former develops and integrates its own bodily systems, the latter does not. It is immoral to kill the former and not immoral to remove (and kill the individual cells of) the latter. This is true whether they are fused together or not.

Now, what accounts for this difference in ethical decision making? Both case A and case B are fused human organisms (two or one depending on how you look at it).
I think I covered this, but you are wrong here. Case A involves two human organisms fused together. Case B involves one human organism. Just like a human being with a teratoma that is removed, the fact that the extra part was once a totipotent cell makes no moral difference. If there was another human organism fused in case B, it would be immoral to kill it.

If killing a human organism is always wrong (which is what I understand you and Scott to be saying), then chopping off limbs in case B is murder.
Nope. Chopping off limbs in case B would be immoral if and only if it resulted in the death of a human organism. It does not. My logic is consistent.

To me, this is counterintuitive. Which is why I'll stick with my view: destroying a functional brain is murder, because the brain is the seat of the soul (they go hand in hand).
I hope I answered your questions, for I have one of my own. My example is a realistic one that could happen. Lets say there are two xiphopagus conjoined twins that are born. This means they are joined by the xiphoid cartilage in the ribcage and thus can be easily and safely separated surgically. However, as the twins are being delivered, one of them suffers head trauma and is born comatose. We have no way to determine when , if ever, the one twin will come out the coma, and what lasting effect the coma will have on his future development.

Question: should we perform a separation procedure on the twins or simply kill the one in the coma?

Using my analysis, it would be wrong to kill the comatose twin because he is a living human organism, albeit one who has suffered an injury. However, under your view, I don't see why it would be wrong to kill the other twin off. It has never experienced consciousness, and does have a "functional brain" (using your terminology). It seems to lack the working neural structures that would otherwise enable it to have moral value in your view.

What do you think? Thanks again for the interaction.


  1. Serge, glad to hear from you! Thanks for taking the time to elaborate on this issue for me.
    You do a good job of showing how your view that moral value should be attached to individuated human organisms is internally consistent.

    From a gut perspective however, let me share with you that using 'human organism' as a moral category seems more arbitrary to me than using that of consciousness-capable human. Phenomenologically speaking, conscious beings are Others. If a child sees me picking a lock or listening at a door, I have a pang of guilt (I realize instinctively that I am in the presence of another). Such self-transcendance doesn't occur in the presence of, say, a rock (the rock is not an Other).
    So that's where I'm coming from, from a phenomenological, common-sense perspective.

    Of course, if this were this only ingredient to my moral theory, it would be severely malnourished. I also think communitarian considerations have considerable moral import. I think it is morally best, as a human community, to foster and respect life, especially (though not exclusively) human life. Cavalier disregard for disabled humans can lead to cavalier disregard for humans, which leads to violence, death and war (viz. the objectification of Others).
    In the scenario you propose then, I would say that if it is neurologically possible that the child would at some given point regain consciousness, and if there is no other reason not to, he/she should be allowed to live. Head trauma always makes for difficult diagnosing (contrary to, for example, oxygen deprivation), and so I think it's better to err on the safe side. This is, however, different from euthanizing someone in anoxic PVS (e.g. Nancy Cruzan, Terri Schiavo)--since there is in the latter case no possibility for the recovery of consciousness.

    I'll close off with some general comments: as a Christian, I have severe moral qualms with abortion for no reason other than convenience. This fosters the worst attitudes towards human life as can be imagined. On this point I imagine we are totally agreed.
    I do think however, that it is conceivable for situations to arise in which abortion would be morally permissible (even for a Christian couple). These are, in my estimation, few and far between (e.g. a child with a Tay Sachs disease diagnosis, or an anencephalic baby). On this point, I think, we disagree.

    I think that's all I've got for the time being. Thanks for the chat!

    I wish you all the best,

  2. I will leave the medical stuff to Serge, as he is a physician and more qualified to discuss that aspect than I am. My comment on this is spurred by the repeated mentioning of Terri Schiavo as a case where it is morally acceptable to kill someone based on his or her mental limitations. I believe that Daniel would take issue with my referring to her as a “someone” because the irretrievable loss of her higher brain function (gross simplification of terms I know) means that she is no longer a person. I am not sure what else she can be, but I will leave that to those who wish to redefine her. My question on this issue is this. Why did we want to kill Terri Schiavo? There is so much of the opposition’s point on this case that was incredibly inconsistent.

    1 – Terri never wanted to live like this.
    This argument assumes a continuity of being from the fully functioning Terri and the severely brain damaged Terri. Terri now exists in a state or condition that she previously voiced that she wished to avoid. The problem is you are now arguing that this is Terri, an innocent human being suffering from brain damage. Whatever her wishes, we can not be compelled to take lethal action against her because killing innocent human beings is wrong.

    2 – Terri died when her higher brain functions ceased.
    It assumes that the defining characteristic of humanity is higher brain function, but we will not dwell on that as we have argued against that idea extensively elsewhere. The inconsistency lies in two other areas of this argument. If Terri is not suffering because Terri is not there, why do we want to kill this new life? If Terri is not here, then why do her wishes apply to this new being that now exists?

    3 – Ending her life is the right thing to do.
    If this is true, why did they starve her? Why not give her a lethal injection? Why the fa├žade of natural processes? If you have the strength of your moral conviction then it seems more “humane” to end her life as quickly as possible. Doctors did not withhold treatment, they withheld nourishment to purposefully starve her to death. If you are right, then kill her quickly and “humanely.”

    Terri was not a burden on her family, as they fought for the right to care for her. Why did we want her to die and why was killing her the moral thing to do? Why, if she was not a person any longer, did they release statements saying she was “resting” and at “peace” while she was dying of starvation? If they honestly believed that Terri was no longer technically living and that her family was taking care of a physical being with no quality of life worth preserving, why did they care if the family did so? What does it matter to them if Terri’s family wants to care for their vegetative daughter? If Terri is no longer Terri, then her previous objections are irrelevant to the new life. If she still is Terri, then it is humane to provide care her for and love her though she offers nothing in return. My question is this, what did Terri become that starving her to death was the moral thing to do?

  3. Hi SK, Serge, and Bob, Sorry, these questions are off the topic. Is partial birth abortion legal in all the states? Roughly how many partial birth abortions are there each year? At what point in the pregnancy are most of the partial birth abortions done? A lot of the people I have talked to are not even familiar with it. It is more accurately described as infanticide. BTW, great talk on the conjoined twins.

  4. Jay--thanks for your thoughts. You clearly have thought alot about the Schiavo case. Let me go on record as saying that the legal process associated with the case is different from the moral questions it raised. The moral questions it raised are pretty much the ones you bring up (all of which have good replies, in my opinion). However, the legal Schiavo case was primarily about who, between her ex-husband and her parents, had legal custody of and decision-making power for Terri.
    As for your questions, I would argue that between the legal and moral questions, there were three concepts referred to by the name 'Terri': 1. the legal person, 2. the biological person, 3. the moral person (though I realize most here would equate 2 and 3, and perhaps 1, 2 and 3). The 'stickiness' of your questions, in my opinion, is significantly lessened once one clarifies in what way the word 'Terri' is being used.
    But this is not the question at hand. If you would like to discuss this further, please post a comment on my blog or send me an email.
    I wish you all the very best.

  5. Well said Jay. I have only one comment about Terri and the cruelty shown to her and her family by her "loving" husband and I address her husband with my comment: Don't you think Terri would have been devestated by the hurt and aguish you put her family through by "carrying out her wishes". Don't you think that she would have rather had her family at peace caring for her (at no expense to you) instead of hurt and devestated that her "loving" husband was trying to kill their only daughter? I wouldn't want to be there on your judgement day when you face God and he asks you this question. What will your answer be Michael?


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