The story of the Hilton sisters was very interesting to read because their experience paralleled and differed to other stories of conjoined twins. In my bioethics class last semester we read a very good book, “One of Us,” by Alice Dreger.
In the U.S. individualism often translates into independence and strength whereas interdependence suggests fragility and weakness (i.e. mother and baby relationship). So in a situation where two people—two conscious minds—are sharing one body, it’s often portrayed as a form of entrapment, forever dependent on one another. However, this is not the case in conjoined twins—they too feel as though they are independent individuals.
A very clear example of this is Abigail and Brittany Hensel who are dicephalic conjoined twins. The girls have never required extensive medical care and are highly encouraged to express their individuality in terms of tastes and hobbies. They’ve learned to swim and ride a bicycle. What these girls make clear is that conjoinment, which interrupts our concepts and structure of individuality, does not automatically result in attenuated individual development.
There have been many references to psychological literature in order to justify attempts at separation. The thought is that conjoinment intolerably limited one’s life. However, this is not the case with most conjoined twins who often reject the risky operation since it would result in the death of one or both twins and a drastic change in their identity which appears to be two-fold; they see themselves as individuals but also as part of a whole.
This contrasts the Hilton sisters where even in the newspapers their individuality was never questions, but celebrated, even before they could speak. Their anatomy was celebrated and exploited. Not once were they pressured to separate (at the time the surgery would have resulted in the death of both) nor was Mary Hilton blamed for not encouraging them to separate. The ethical implications of separation surgeries complicated and multifaceted.
“One of Us” also explores separation surgery where physicians sacrifice one twin in order to save the other. Whether it be to further ones career (i.e. the surgeon’s) or for good intentions, sacrifice surgeries are morally problematic because of the implications for other procedures such as assisted suicide and organ donations. One case mentioned is that of Rosie and Gracie Attard. In short, Gracie was keeping both alive because Rosie had a heart that was not able to sustain life. Gracie brain was also underdeveloped, which resulted in cognitive impairments. The surgery was proposed as an attempt to save Grace’s life and if not done, both would eventually die. The outcome of this case reveals medicine’s thoughts on who is allowed a right to life. While the reason for the separation was due to Rosie’s heart, it easy to speculate that Gracie was granted a greater degree of right to life due to other reasons, namely physical and cognitive abilities.
There are several key issues that these sacrifice surgeries bring up. One of them is that in the medical community, personhood appears to rely on being able bodied, cognitively competent, and being a singleton. Seen in this way it is easy to see why the physicians advocated so persistently for the surgery. The apparent success of separation surgeries, such as Rosie’s case, will influence decisions more strongly than the deaths of those being sacrificed.