THE SIAMESE TWINS AND THE 'SANCTITY OF LIFE' DOGMA
AT 52 : October 15th 2000
Law Courts in the UK have been much exercised by the case of Siamese twin girls recently born to a Catholic couple. Medical opinion has been clear; one member of the twins is never going to be independently viable - without heart and without lungs and therefore being dependent upon the other for life-support. If separation is not achieved then both will, almost inevitably, die quite soon; if it is achieved then the viable member can be expected to survive.
Medical advice has been that surgical separation should be proceeded with. The parents had opposed this and the point of law at issue has therefore been as to the legality, or otherwise, of disregarding the parents' choice and proceeding with the operation. On 28 September 2000, the courts finally cleared the legal way to the separation being attempted and the parents have decided not to appeal the ruling.
The function of the courts in this case, and indeed in general, is not to make moral judgments, not to heed public opinion but solely to identify the current state of the law. It is only by our being properly informed, as to what the law actually is, that public and legislators are enabled to consider what changes in the law might be thought necessary - on any grounds such as moral concerns, practical enforceability and so on.
The purpose of this article is to consider what the due moral concerns and public acceptability might be in the twins' case. My conclusion is ...... for reasons that are not related to the familiar 'pro-life' arguments, and that are indeed not religion-based at all, but which are based upon secular realism .... that the surgical separation of the twins should not be attempted.
In order to consider the matter we must first ask whether morality is deontological (i.e. a matter of duty deduced from rules) or whether it is teleological (i.e considered in the light of the probable consequences of the action contemplated). Second, if we allow that consequences can be ethically relevant, then we have to decide upon an attitude to the 'acts and omissions' problem. Third, we have to consider what relevance, if any, the concept of 'miracle' has to all of this.
The two main ethical theories referred to above are both vulnerable to criticism.
The deontological ('rule book') source of ethical judgment can be questioned. Where do the rules come from, what authority do they have and, since intelligible rules are usually simpler than the real situations to which they purport to refer, how can the rules be interpreted with sufficient certainty and, in difficult cases, with sufficient avoidance of crazy counter-intuitive anomalies ?
The teleological ('consequences') source of ethical judgment is open to question. How can we be sure of the consequences of an action before they happen and what about unforeseen, perhaps unforeseeable, consequences of the action - 'side effects'?
I suggest that people, whatever they profess, rarely rely upon one only of these sources of ethical judgment; most of us (who are practically recognisable as good people) take both approaches at once. People generally adopt a both-guidelines-and-outcomes approach. Technically this approach to ethics is sometimes called 'rule utilitarianism'.
The 'acts and omissions' problem is this: can an act, and an omission to act, be deemed ethically equivalent if they have similar consequences? Let us assume that an act, and omission to act, having similar consequences, can be, but are not necessarily in all cases, ethically equivalent.
It might be argued that if we are going to let the joined twins die then we might as well simply kill them by lethal injection. This is hypothetical (nobody is actually suggesting lethal injection) but the outcome - death of both - is the same in these two scenarios so what is the difference, in this case, between kill and let die?
This is where a belief in miracles (as distinct from mere squeamish double-think) might come in.
A miracle is deemed by religious believers to be an event caused directly by God in one-off contravention of the natural course of things. Natural events, on this view, are events that would usually happen by the working of the generally applicable laws of nature (which believers hold to be God's Laws anyway).
Clearly a believer in miracles - and Catholics do so believe - might object to lethal injection in order to give God the chance to cause a miraculous survival of both twins. Of course a miracle-working god could make the intended lethal injection fail; so it would seem that a hoped for miracle is no answer to the 'kill or let die' dilemma as it relates to the fates of both twins.
In this particular case, the parental wish that the surgical separation be not undertaken cannot be justified on pro-life grounds unless the possibility of a miracle arises in their minds. 'No separation' naturally means two dead babies; separation means one dead baby and one baby capable of survival. Any thinking pro-life view must, in my opinion, favour attempted separation. To support the parental wishes is not pro-life; it is pro-choice. The babies are clearly incapable of choice; one of them is going to die soon anyway and the other, although possibly viable if her sister is cut away, is clearly not capable of choice in any real sense. Whatever choice may be identified as lawful ....... it is indubitably parental choice. It is strange to see pro-life propagandists - who are against surgical separation in this case - are in fact occupying a pro-choice position. (Would that they took such a position in connection with surgical abortion, the 'morning after' pill and euthanasia! But that is by the way).
The options - either surgical separation or let both die or kill both (by lethal injection?) are stark. The 'kill both' option is politically impossible; so either 'let both die' (by omission to cut the twins apart) or 'cut them apart' ...... are the only politically practical choices.
The option I prefer, on ethical grounds, is to 'let both die'. Except in so far as we have a duty to respect religious convictions, this is not a deontological matter; it does not relate to a perceived duty to be either pro-life or pro-choice or any other perceived absolute. It is a teleological matter; a matter of likely consequences.
Adherence to absolutes can lead to counter intuitive decisions. Unfettered parental choice might lead us to accept that religious convictions can warrant the killing of a sick child by omission to give a blood transfusion. Unfettered adherence to a pro-life position might have led the courts (in, for example, the Tony Bland case) to forbid the switching off of life support of the persistently vegetative patient.
My teleological reason for simply letting the twins die is that the one who stands to survive attempted surgical separation would, very possibly, be an emotionally abused child - a child with pious guilt loaded upon it. The perhaps unspoken thoughts to which that child would be subject would be "you live only because they killed your sister" and, particularly if the saved child is disabled in a big way, "your disability is a judgment upon us all for the killing of your sister".
That is not to say that these corroding thoughts would be voiced; it is to suggest that only such parents as are wholeheartedly in favour of surgical separation could be free from such thoughts - free from the risk of undermining the healthy self respect that each and every child and adult needs.
The mere fact that these particular parents have religious convictions with which atheists do not concur is no reason for shirking the atheistic argument against surgical separation of these tragic twins. Atheists are not logically bound, in principle, to oppose the wishes of religious people; their preferences and ours can coincide in particular cases and this, I suggest, is a case in point.
The doctrine of the sanctity of life is that human life is intrinsically valuable - so there is absolutely no such thing as a human life not worth living - and that consequently we have an absolute duty to preserve it.
The alternative view is that human life is valuable by reason of its quality, or prospective quality, and that therefore we are under no more than a prima facie duty to preserve it. So, on this view, there is such a thing as a life not worth living and consequently there can be instances in which the termination of human life can be ethically acceptable.
It seems that the sanctity of life doctrine leads to absurdity in the case of these twins. The alternative doctrine - although fraught with pitfalls - does not.
The next issue, Number 53, will appear on November 15th 2000.
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