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Ethical and Religious Considerations

Attention:

Please note that the matters expressed here are NOT endorsed by the Official Saudi Religious Scholars, but are merely presented as suggestions made by the medical teams.

  • Are conjoined twins considered to be one person or two people?
  • Is the request of their parents to separate them enough reason to proceed with surgery?
  • What is considered to be the highest acceptable medical risk when separating twins?
  • Should a weaker or life-threatened twin be sacrificed in order to save the life of the stronger twin?

Accepted Medical Policy:

In the case of two complete twins, each of which has the full complement of vital organs (brain, heart, lungs, etc.) the sacrifice of one twin is not medically permitted. When a parasitic twin is present which endangers the life of the complete twin, the parasitic twin can be removed to allow the complete twin to live.

Questions about Personhood:

  • Two complete conjoined twins: Each of these twins has all vital organs. They are considered to be two persons and would be good candidates for separation.
  • Semi-complete conjoined twins: These twins have separate heads and hearts and share other bodily organs such as a pair of legs, a kidney or the liver. They, too, are considered to be two persons and may be separated.
  • Incomplete conjoined twins: Dicephalic twins (where two heads grow from the shoulders of one body) are not considered to be safely separable, even though they are two people, so they must live life as a unity.
  • Parasitic twins: In some cases of conjoined twins, one baby is born completely developed and viable, and the other twin is incomplete to the degree that it will die when separated from its sibling. Often a parasitic twin has no brain or only a rudimentary nervous system, or it may appear - externally or internally - as additional limbs or organs and so may be removed.

Experimental Operations:

  • Thermal coagulation can be used to atrophy a parasitic twin in the womb.
  • In critical cases, separation of a parasitic twin from a healthy twin can be performed in the delivery room before the umbilical cord is cut.

Questions about Conjoined Twins and Abortion:

  • How soon can conjoined twins be diagnosed?
  • Is it possible to abort conjoined twins in the first trimester of pregnancy?
  • What steps are taken in the decision whether or not to abort conjoined twins?
  • What are the religious opinions of the parents about abortion?
  • Is abortion legally permitted in the parents' country?

Accepted Medical Policy:

If, by the tenth week of pregnancy, medical diagnosis confirms that conjoined twins have severe congenital defects which are incompatible with normal life and health, the most humane choice for the mother, other relatives and the twins themselves is considered to be early abortion.