Health Effects of the Separation of Conjoined Twins:

1. Health Effects of the Separation of Conjoined Twins: An issue involving physical, ethical, and psychological dimensions

2. 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.

3. 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 don’t 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.

4. 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.

5. 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.

6. 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 it’s suspected to be caused by environmental factors.

7. 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.

8. 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.

9. 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 don’t work properly and can result in a single organism with two heads, two hearts, four legs and arms.

10. Risks involved in separating twins • It can be a life and death decision, because it can involve sacrificing one twin’s 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.

11. 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.

12. 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.

13. Parents Objection to Separation • Some parents don’t 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.

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

15. 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.

16. 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.

17. 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.

18. Types of Conjoined Twins • Pyopagus: joined at the posterior pelvis. • Separation possible. The survival rate is high.

19. 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.

20. Types of Conjoined Twins • Ischopagus: joined at the pelvis. • Separation is physically possible, however, excretion and sexual impairment might result.

21. 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.

22. 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?

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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 conjunction—in particular, the degree to which they share internal organs—can 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).

30. 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.

31. 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.

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

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

34. 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.

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

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