Was surgery to separate the Iranian twins worth the risk?

by **Anil** » Wed Jul 09, 2003 7:16 am

It was indeed a very sad event especially after hearing them prior to their operation and how eager they were to start afresh. Even if they survived the surgery, the chances of they being absolutely normal were remote. They would have ended up with serious complications including paralysis.

by **Faheem** » Wed Jul 09, 2003 10:41 am

Totally agree with you Anil. It wasn\'t worth it! I wonder how the doctors and others involoved even thought it could work with the kind of complications they had. I can\'t imagine how they thought they could seperate the two systems that were so ONE.

by **Z C** » Wed Jul 09, 2003 5:17 pm

Easy to comment when it fails. Try holding your hands and living together, not leaving them even when you want to shit. Anyway, the twins have decided to go for the operation, so this topic is not worth discussing. Dear Faheem, let\'s consider that no doctor experiments coz you said, \"How did the doctors ever try to do it?\". Where will medicine be today? Pointing fingers at well-qualified doctors in this manner is not justified.

by **Z C** » Wed Jul 09, 2003 5:23 pm

BTW Anil, why are you talking now? Why didn\'t you start a board before the operation, something like, \"Should they take a risk?\"

by **Doc** » Wed Jul 09, 2003 6:54 pm

It was the decision of 2 grownups to get separated with the complete knowledge of the pretty low success. Doctors tried and lost the cause. You may have heard of other twins (boys and girl) of about 40 years in USA. Their fate is much more pitiable, being joined at back of their heads.

by **peeping tom** » Wed Jul 09, 2003 7:56 pm

I got a tremendous shock. And deep sadness. The chief surgeon who tried this surgery will be deeply depressed now. My consolation to the surgical team and MAINLY to the two atmas. I still can\'t forget the two smiling faces. Oh GOD.

by **Anil** » Thu Jul 10, 2003 5:07 am

Dear ZC, a clarification at the outset, if you haven\'t read the posting properly. I neither said a categorical yes or a firm no. But, it’s at times like this that man is pulled down to the ground and made to realise that there are still things which are beyond his control. OK, was all the hype before the operation necessary? This was one of the rare instances where it was all over the media prior to operation. Most of the times, we come to know of such operations only after they are performed. It involved two lives and wasn\'t meant to be a sordid exhibit of cocky individuals\' acquired talents and performing a fete for a world record! Whether the common man agrees or not, but in this case, most unfortunately, the surgeons were more keen to prove themselves. A very hypothetical question, what would the surgeons have done if the twins expressed their wish to be euthanized rather than going for the surgery? Isn\'t it puzzling that the Medical Community which is yet to come to terms with euthanasia willingly carries out a very critical operation citing the sole reason that the patient was fully aware and was willing to face the repercussions as severe as death???? There is absolutely nothing wrong with pointing fingers at \"well qualified\" doctors? The doctors we now have are neither Hippocrates nor Dhanvantris. It’s high time, we need to get out of this mind set that all doctors are infallible and are beyond criticism. And for your information I am a qualified surgeon so as per your criteria I guess I am \"eligible\" enough to \"point fingers\" at fellow qualified doctors. As to your question as why I didn\'t start the board before the operation - I am a die-hard optimist and thought the surgeons might pull out a miracle. At that stage, we (especially me) don\'t even want to entertain any negative opinions. Coming to some facts - Medical ethics actually don\'t condone even those cases where one of the twins must be ‘sacrificed’, because it is ethically wrong to take one life so another may live. In this case the risk was for both! It’s highly unethical to treat individuals with unusual anatomies according to a different set of ethical guidelines than others? (BTW, your comment \"don’t leaving them even when u want to shit\" was in very poor taste, especially in the light of the tragedy. I am very sure, that wasn\'t definitely the reason for the twins (May their souls RIP) to go for the major decision. I am also sure, living for 29 years, the twins have quite bravely come to terms with these normal physiological activities of everyday.) The common criteria for the surgeons to agree to the separation of VERY young twins is if the surgery is simple enough and that it doesn\'t result in the death or long-term disability of one of the twins. As per the renowned Alice D. Dreger, a Michigan State University medical historian \"separation surgeries in which one of the twins was sacrificed never are successful. At least nine have been attempted, and none has resulted in any long-term, healthy survivor. \"In all of the cases, the intentionally sacrificed twin died,\" she says. \"But, notably, in not a single case has the twin chosen to survive ever actually survived to go home or even live free of a ventilator.\" Lastly ZC, you are right this topic isn\'t worth discussing. We are much better discussing hackneyed juvenile themes involving matters related to basal senses (not that, there is anything wrong with that). My mistake, I expected some mature responses, for a change. Can\'t help being an eternal optimist

by **Arch** » Thu Jul 10, 2003 5:34 am

Two doctors, the same topic and such variation in expression of thoughts. just a passing thought (observation) of mine.Was not following the news item, so dunno what\'s what, yet.

by **Z C** » Thu Jul 10, 2003 9:25 am

You were hoping for a miracle and you point fingers when it didn\'t happen. You are a doc, I am a biomedical engineer. I have been in hospitals in and out on research projects, and I know a bit of ethics - though may not be as much as you know. I agree, everything is in God\'s hands, then why are you pointing fingers? Why do you want to question God\'s decision? Abt hype, you should ask the media abt it. Thanks for all the clarification, ciao.

by **NRI** » Thu Jul 10, 2003 9:27 am

You are talking as if you are the doctor involved in that operation! How can you say that the doctor tried to make a world-record? For your information, I\'m in Singapore, and here they showed the progress of the operation after every hour. And there was a situation when the doctors decided that it\'s in a critical condition and decided to stop the operation, but the twins persuaded the doctors to go forward, whatever the outcome may be. 
The doctors valued their lives, that\'s why they tried to stop the operation. Then how can you say that?

by **Z C** » Thu Jul 10, 2003 9:41 am

Anils lecture on ethics is here: http://www.conjoined-twins.i-p.com/ethics.html Quote the source buddy :-)

by **Kishore** » Thu Jul 10, 2003 12:03 pm

ZC, I checked up that URL. Anil just quoted something someone else said (clearly giving credit), in about a couple of sentences of his post which had a lot else, and you are making it look like plagiarism. Some 10-15% of his post quoted someone else, and you are making it look like he copy-pasted. Of course he read what Alice Dreger said someplace - she\'d hardly tell it to him personally! We all quote what others have said - do we keep giving the sources all the time? He didn\'t pass off what Alice Dreger said as something he himself said, did he? You should realize that things such as these amount to slandering, since almost nobody is going to actually click on that link, and will simply accept what you say - and it is so misleading. For all others, this is the text of that site - compare for yourself what Anil \"sourced\": When conjoined twins are born, it\'s automatically assumed that they should be separated. But, Alice D. Dreger, a Michigan State University medical historian disagrees with this. She says that, “When it comes to cases in which one of the twins must be ‘sacrificed’, it is ethically wrong to take one life so another may live.” She argues that it is unethical to kill one conscious head, given that we wouldn\'t do that in any other case.\" She also quotes, \"It is unethical to treat children with unusual anatomies according to a different set of ethical guidelines than other children.\"
 
Alice D. Dreger agrees to the separation of very young twins if the surgery is simple enough and that it doesn\'t result in the death or long-term disability of one of the twins. Dreger points out that separation surgeries in which one of the twins was sacrificed never are successful. At least nine have been attempted, and none has resulted in any long-term, healthy survivor. \"In all of the cases, the intentionally sacrificed twin died,\" she says. \"But, notably, in not a single case has the twin chosen to survive ever actually survived to go home or even live free of a ventilator.\"

by **Z C** » Thu Jul 10, 2003 4:03 pm

Yes, it does appear that I am blaming him for Plagiarism, sorry for that. i meant that people should read the complete article.

by **Z C** » Thu Jul 10, 2003 4:11 pm

And to the moderator: you have ordered the restructuring of many posts, including one by NRI in this board - if you didn\'t like what I said, why didn\'t you remove it? Especially coz only one person replied after my post!! I never understood your dotcom\'s rules on editing/deleting posts and now supporting some members :-)

by **The fullhyd.com moderator** » Thu Jul 10, 2003 9:25 pm

Dear Z C: We have only one rule really - to not interfere or judge others to the greatest extent possible. Most people here are far more evolved that we are, and we just modify some posts on rare occasions when we feel they are very likely to offend certain persons or communities. As for NRI\'s post, there was no change made to it (except perhaps some typos corrected). And the order of the posts is not determined by any individual, it\'s an algorithm. Cheers!

by **Faheem** » Thu Jul 10, 2003 10:52 pm

What????? Halfway down the surgery they were conscious to pursuade the doctors to go further???

by **Anil** » Fri Jul 11, 2003 4:16 am

Thanks a lot Kishore for saving me some time and words to clarify my stance. Unfortunately, I am yet to learn the \"art of plagiarism\". I would rather prefer NOT to post than indulge in plagiarism. Anyway, I took what was relevant to this post and I duly gave the credit to the original contributor and made it a point to put them in quotes! BTW, my source wasn\'t any website but a hand-out (“Conjoined or Siamese twins: To separate or not to separate?”) from one of Dr Dregger\'s lectures, which I was fortunate enough to attend. Dr. Dregger\'s work is focused mainly on scientific and medical treatment of sex and gender. Anyway, ZC thanks for giving us an additional source. And to all the contributors let\'s control the temptation to indulge in personal slander. And, why take anything personally? Let’s also remember that everyone is entitled to have an opinion, right or wrong. Let’s be suave in criticism and saving the poor moderator from repeatedly editing our messages. For instance, in this case, the question of how qualified we are to point fingers at others would have never arisen if only it wasn\'t started in the first place (Thanks to the moderator yet again - the original posting seems to be edited now). I remember a saying in English - \"Tell someone to ‘go to hell’ in such a way that he actually looks forward to it\". Hey ZC, please don’t say I am plagiarizing again! I really don\'t remember the source. But, I would welcome if you can do some research and enlighten us with the source for this quotation

Coming back to the topic, NRI, as far as I know, the operation was performed under general anaesthesia and there wasn\'t any discussion/persuasions nor any egging up to go further involved with the patient(s) in between the operation. Unfortunately, the Medical Science hasn\'t yet become so advanced (be it in Singapore or USA) to give us such luxuries and choices. As to expecting miracles, there isn’t anything wrong in that. Even if this surgery was a success, it would have gone in the annals of medical history as a medical miracle. And I believe in questioning the God\'s decisions too (if only, I could get a reply!) - no one should be immune to scrutiny!

by **Anil** » Fri Jul 11, 2003 4:52 am

More on the controversy: German doctors refused Ladan and Laleh\'s plea in 1996-1997 to operate, warning the operation would most likely kill one or both of them, or leave them in a vegetative state. Since similar operations began 50 years ago, four in five attempts (a very high failure rate of 80%) at separation have resulted in death or severe complications for one or both of the twins. Nine years earlier, in 1988, a German neurosurgeon of Iranian origin, Professor Madjid Samii, head of the International Neuroscience Institute (INI) in the western city of Hanover, had also rejected an operation to separate the twins. Dr Richard Nicholson, editor of the Bulletin Of Medical Ethics in Britain, says: \"These twins were not suffering from a life-threatening condition and although there were many things wrong with the quality of their lives, they had coped for 29 years. Doctors have a duty to act in the best interests of their patients and, in retrospect, one is bound to conclude that maybe this surgery was misguided.\" As per the lead surgeon Dr Keith Goh himself, \"The doctors were guided by the twins\' wishes!!! Laleh and Ladan wanted to be \'separated under all circumstances.\" Finally, regarding the questioning of the sagacity of the decision, our very own Dr Muralidhar Pai, a neurosurgeon at the Kasturba Medical College in Manipal (He operated on a pair of 18-month-old twins joined at the head last year but only one of the infants survived the operation), India, aptly says \"When all goes well, people will say very good. But if something happens, people will ask if there was a need for such surgery in the first place.\" That\'s human nature!

by **Anil** » Fri Jul 11, 2003 4:58 am

Ooops!! BTW, this is all over the news (and I can\'t quote all the sources; nevertheless please read carefully, I have given all the credit to the original contributors) so please spare me from the agony of living with an accusation of plagiarism inflicted ;-)

by **Z C** » Fri Jul 11, 2003 9:38 am

Anil, i already apologzed for making it look like plagiarism, again, regret it. what u are saying is like this \"i knew that the couple would not be compatible, i thought the marriage may have worked if they give it a try, but i regret/condemn that it didnt work, it shouldnt have taken place in the first instance\" i still dont understand y people talk of failures only after they occur and keep mum before the mission is started. many people here would again argue that India should go to war with Pakistan (or atleast keeping quite is like supporting it)and blame the PM or President if there is a nuclear attack !!! i dont understand and i dont think i will ever.......................

by **sunny** » Thu Jul 17, 2003 9:17 am

I don\'t know if I should intrude in here - you know, with you docs discussing serious stuff. But I couldn\'t cease from posting my opinion. I feel that the doctors have done their part in separating the twins. Looking at their counterparts one would notice that one person is shorter than the other which makes it literally demanding, unlike in the case of the Ladan twins who are of the same height. So after 29 years of survival, I don\'t think any separation was vital. Like Anil mentioned, there\'s no offense in pointing fingers at qualified doctors. But I\'m sure they did their level best to synchronize the separation.

by **NRI** » Thu Jul 17, 2003 2:11 pm

Sorry to ask , can u understand ENGLISH ... where did in my post did i say that it was half way through , and yes they were conscious when they asked docs to go forward ....

by **sunny** » Sat Jul 19, 2003 4:01 pm

hey Anil... u can\'t offend the doctors there man, they aren\'t Indian.
 so they probably did their part....

by **mrk** » Sat Jul 19, 2003 4:17 pm

we dont know our birth time or death time. It depends on god. According to my view for them the time has come. Thats why they left the world. But it is a sad thing about them that both of them lost their lifes.

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