Medical Risks and Ethics
I was saddened, along with millions of others, to hear of the deaths of the conjoined Iranian twins during the surgery to separate them. Ladan and Laleh Bijani were intelligent, charming 29-year-old women who made an informed decision, fully aware of the risks. Unfortunately, the doctors who warned of the risks were also unable to overcome them.
What I don't understand is the plethora of stories (the one on NBC's Dateline just ended) addressing the "serious ethical issues" accompanying this situation. I don't see where there's any ethical question when a sound-minded, legally-aged, well-informed patient makes a free will decision to undergo a legal medical procedure that is clearly intended to improve the patient's quality of life...regardless of the inherent risk.
I think the bigger ethical issue arises when someone else tries to make that decision for them, and that includes removing their ability to make the decision for themselves.
Granted, in this case there is the question of whether the $200,000 surgery represented money well-spent... and if that money was taken away from other "needier" patients, then I might grant some legitimacy to the question. But I doubt that's the case here.
We can hope that Ladan's and Laleh's decision resulted in some incremental increase in medical knowledge and skill that will make the next such decision a little less risky.
I wouldn't be surprised to learn that most of the surgeons were donating their time and expertise, and I further suspect that private donations were more than ample to cover any remaining out-of-pocket costs.
Posted by: Eric at July 8, 2003 10:23 PMThe only thing that would give me ethical concerns would be if the doctors knew that there was no reasonable chance of success for either of them and went ahead anyway.
That is akin to going ahead with experimental brain replacement surgery and in my view is unethical.
Posted by: dan at July 10, 2003 09:12 PMOh, I absolutely agree with you about that. But in this case, my understanding is that the doctors tried to talk the women out of the surgery while admitting that there was yet a slight chance of success.
It does beg the question, however, of whether surgeons at that level of their profession ever view ANY surgery as completely unreasonable. Does the access to technology and, perhaps, the media attention ever allow their confidence to overwhelm their judgment?
Posted by: Eric at July 10, 2003 09:53 PMI definately agree. The doctors were simply carrying through with the requests of their patients. They were of sound mind and perfectly capable of making a decision based on the facts that they were receiving. The twins decided to take the risk in hope that they could be separated.
Unfortunatelty God had something else in mind. He beleived that he put them on earth that way and if they didn't want to stay that way he would have to remove them. But that was God and had nothing to do with the doctors. It was an ethical choice because it was the twins choice.
Posted by: Stef at August 25, 2003 11:02 PMAbout the publisher
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I agree. Before the operation commenced, I read an article quoting a doctor emphasising that there was reason to suggest that the failure to do the operation would threaten their lives at a later stage. He was quoted as saying "this is not simply a cosmetic exercise".
It made me mad. Two grown people joined at the head in such a way that they can't even see each other's faces want to take the risk to separate. I can't believe that there was any suggestion that it was a cosmetic operation. I can't see that there is anything less cosmetic than wanting to separate cojoined twins joined at the head.
As for the expense, I think that we should be circumspect. In any new and complicated surgery (I understand this had only been done once before and that was with infants), it costs money to develop the ability to perform the procedure.
Posted by: dan at July 8, 2003 10:09 PM