Honors English 2

Paige Smith

Mrs. Cartier

March 4, 2012

Honors English 2

Part I

For my I-search paper, I have decided to research conjoined twins. For some reason two people being one person has always intrigued me. However I do understand the severity of the condition and realize the validity of wanting the twins to be separated if at all possible. Since this is such a rare condition, my knowledge is limited and has come from TV shows and Wikipedia, which we all know are just so accurate.

In Child Development I, which I took last semester, we studied conjoined twins a little and I can only assume some of my knowledge on conjoined twins is true. As far as I know there are different types of conjoined twins. The classifications are based upon where the twins are connected. I think being connected at the side and the heads are the most common.

The process of creating conjoined twins is similar to identical twins. There was one egg that was split, however it was either not split fully or it was split too late. Since it was one egg, the twins must be the same gender and identical. Since there are two bodies attached, it is fairly obvious to tell in an ultrasound that the mother is carrying conjoined twins. The body is not built for delivering two babies at once, which is why there must be a c-section to birth the twins.

I believe that is it up to the parents to chose whether they want the twins to be separated, however if the twins are thriving and healthy while conjoined I think the doctors are less likely to separate, unless they are sure the twins don’t share any vital organs.In some cases, conjoined twins cannot be separated without the potential for fatality, in at least one or both babies if they share a heart, brain matter, or some other organ you only have one of. Even if doctors can separate, health issues while in surgery and after are a major concern. First, there must be enough skin to close the body after separation. Many times, conjoined twins need prosthetics or they end up missing limbs since the twins are usually born with the right amount for one person, not two. Because they share many vital organs usually the mortality rate is probably high, since one heart, two lungs or one liver are not meant to support two lives. Fortunately, there aren’t too many cases, so not many people are the parents of or are conjoined twins.

Part II

Since this is such a broad topic, despite its obscurity, I must find a way to limit it down. I have decided to specifically focus more on the separation. Within this I am able to research the different types and which are able to be separated as well as the rate of survival on twins that have been separated versus conjoined twins that are not separated. I can also research the separation process of twins.

Questions to Drive My Research

What are the types of conjoined twins?
Generally which types are separated?
How many twins that are separated conjoined twins live?
How do they determine who can be separated?
Who decides if they should be separated? Parents? Doctors? The twins, if they old enough?
How long does a separation last?
How do doctors separate twins?
Can all conjoined twins be separated?
Will doctors separate all conjoined twins, if asked?
Would doctors rather keep them together or separate them?
Are there more complications before, during, or after separation surgery?
Can you perform surgery at all ages?
Can doctor separate the twins before they are born?
At what age is separation surgery generally preformed?
Is there a higher survival rate for twins that are conjoined or separated?

The research process seems lengthy and difficult; however my curiosity will not be put to rest until I have answered my questions to the best of my amateur sleuthing abilities.

Part III

Annotated Bibliography

Adams, Jacqueline. "Together Forever?."Science World63.12 (2007): 14.MasterFILE Premier. Web. 9 Mar. 2012.

This article focused on sets of conjoined twin. It was an online version of a magazine article and was written for younger or less knowledgeable audiences. It offered insight on the post-surgery needs. It was a valuable source since I was able to comprehend it and answered my questions on who decides to separate. However it offered a different number of conjoined twin births each year.

"Case Report Of Conjoined Twins After Transfer Of Day 3 Embryos."Fertility Weekly(2011): 10-11.Consumer Health Complete - EBSCOhost. Web. 9 Mar. 2012.

This article was very sophisticated with its content and its diction. It discussed the artificial insemination relating to multiple births. I found it difficult to read and it also had a conflicting number of the amount of conjoined twin births.

"Conjoined Twins."Columbia Electronic Encyclopedia, 6Th Edition(2011): 1.MasterFILE Premier.Web. 9 Mar. 2012.

This article provided technical information regarding conjoined twins. It gave me a lot of basic information including ability to separate the twins which is the emphasis of my paper. It was very helpful in mentioning the survival rates of the twins.

Polaneczky, Ronnie. "Closer Than Twins."Good Housekeeping237.2 (2003): 134.MasterFILE Premier. Web. 9 Mar. 2012.

This article told the stories of several conjoined twins that have been separated. All that are mentioned, both of the twins survived, but it does offer the truth following separation including the facts about one twin being physically slowing in growing and another being mentally slower. It mentioned facts about survival rates and another claim of the amount of conjoined twins born per year.

Rinaldo, Denise. "Twice As Nice."Scholastic Choices18.8 (2003): 14.MasterFILE Premier. Web. 9 Mar. 2012.

This article discussed twins, not conjoined mostly, and however at the end addressed them a little. I didn’t find it very helpful, but it offered yet another statistic about how many births of conjoined twins there are each year.

Schindehette, Susan and Macon Morehouse."Joined At The Heart."People66.14 (2006): 74.MasterFILE Premier. Web. 9 Mar. 2012.

This article recalled a story of a set of conjoined twins and at the end it gave statistics about conjoined twins. I only used the statistics and I found them very useful. They included how many there are and how many can be separated.

Spencer, Miranda. "Chang And Eng: The Original Siamese Twins."Biography2.7 (1998): 72.MasterFILE Premier. Web. 9 Mar. 2012

This article talked about one of the most historic sets of conjoined twins, Chang and Eng. It was a good article because I got an insight on the origins of conjoined twins and where the term Siamese came from. Great information was provided along with a different birth per year statistic.

Thomasma, David C.Muraskas, Jonathan. "The Ethics Of Caring For Conjoined Twins."Hastings Center Report26.4 (1996): 4.MasterFILE Premier. Web. 9 Mar. 2012.

This article although targeted at an audience with prior medical and ethical knowledge offered a point of view I had not yet thought of, the ethical side of when separation is acceptable. I realized that this could be a defining theme within my paper and this webpage will contribute much needed support. It also offered statistics and other rivaling births per year rate.

Wallis, Claudia and Jen M.R. Doman. "The Most Intimate Bond."Time International (South Pacific Edition)13 (1996): 66.MasterFILE Premier. Web. 9 Mar. 2012.

This article follows a few sets of conjoined twins. There is clearly more information on this site that I need to acquire since it had many person stories and quotes that could support an ethic claim of separation. One fact I have taken down so far is the birth rate of conjoined twins, yet another conflicting rate.

Part IV

The thought that two people can share parts of one body is baffling. Never in our wildest dreams could we imagine for the rest of our lives being attached to another person. However, this harsh and difficult reality, for only a handful of people, comes with more challenges than people not affected can comprehend.

Conjoined twins are a rare phenomenon in which a set of identical, either male or female, twins are born connected. They are defined as “congenitally united organisms that are complete or nearly complete individuals,” (“Conjoined Twins” Columbia Electronic Encyclopedia). The twins originate from one fertilized egg that hasn’t divided correctly, (“Conjoined Twins” Columbia Electronic Encyclopedia). If the egg splits after the thirteenth day, the egg will not completely split, (Spencer). The reason why the egg doesn’t fully separate is unknown, (Spencer). Without a known reason, prevention is impossible, or at least difficult without links to other diseases or genetic connections.

Fortunately conjoined twins are unusual. “Conjoined twins are exceedingly rare, occurring only about once every 250,000-500,000 births,” (Spencer). The most common place of connection is the chest, (Spencer). This type is called thoracopagus, (“Conjoined Twins” Women’s Health). There are eight other types of conjoined twins. They are organized based on where the two babies are connected, (“Conjoined Twins” Women’s Health). The second type is craniopagus; they are connected behind their heads, but their bodies are not connected, (“Conjoined Twins” Women’s Health). The third type is rachipagus; they are connected by the spine. This type is less common, (“Conjoined Twins” Women’s Health). Another type of conjoined twin is parapagus; they are connected at the abdomen and belly, (“Conjoined Twins” Women’s Health). Pyopagus is where the twins are attached at the butt. Again this is a very uncommon connection, (“Conjoined Twins” Women’s Health). When they are connected at the skull and thorax, the twins are called cepalopagus, (“Conjoined Twins” Women’s Health). The twins are called ischiopagus if they are joined at the anterior of the pelvis, (“Conjoined Twins” Women’s Health). A different kind is omphalopagus. In this case, the twins are joined at the midsection, (“Conjoined Twins” Women’s Health). The last kind is a parasitic twin. This happens when one twins dies in the womb and is consumed by the other twin. These twins have extra arms, legs, or heads, (“Conjoined Twins” Women’s Health).

In order to give the twins their own identity, doctors can sometimes separate the twins. “Since 1100A.D, when the first conjoined twins were recorded in England, there have been one hundred and ninety attempts to physically separate the various types,” (Thomasma and Muraskas). A third are eligible to be separated, (Schindehette and Morehouse). If they are connected with a band of musculofibrous tissue they can be separated, but if they share vital organs separation is unlikely, (“Conjoined Twins” Columbia Electronic Encyclopedia). In some cases doctors feel that the risks of staying conjoined are worse than that of surgery, (Adams). The price of surgery can be roughly $50,000 or more, (Thomasma and Muraskas). At that price, many people cannot afford this. If it is possible for the twins to be separated, rehabilitation and reconstructions would be necessary for the twins to recover, (Adams). They can require transplants and skin stretching in order to make up for the change from one being becoming two.

In order to separate the twins, all of the options must be considered and the consequences weighed carefully. The ethics are more complicated if one of the two has more to gain from the surgery than the other twin, (Moisse). Sometimes the parents and doctors must choose one twin to live over the other, unhealthy twin during a separation. Since they are essentially killing one child, it may be considered morally wrong and decide against a surgery. “What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that if is not even pro tonto morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose,” (Sinnott-Armstrong and Miller). In the cases where either both of the twins will die anyway or the less healthy one will, one child is sacrificed. Before an operation takes place, parents who are struggling with the facts and debating a separation, will consult with the doctors, and if the twins are healthy, the parents are allowed to decide whether to have the operation or not, (Adams). If the doctors are willing to risk a separation, it is either necessary for the survival of the twins or the two babies are able to survive on their own. However, if it is just the parents that think the risk is too high, they don’t always have the final decision. “In relation to health care, these agencies of society have a fairly consistent record of imposing treatment over the objection of parents only when (a) the lack of treatment would present a significant danger of death or disability, (b) the treatment is consistent with the professional standard of care, and (c) the treatment is proportionate (i.e. the benefits outweigh the burdens),” (Orr).

The idea that surgery is always the best course isn’t always true, (Moisse). Sometimes separation is what parents want for their children, but not what is really best. A mother in Chicago gave birth to conjoined twins. Despite doctors’ recommendation, she wanted to separate them. She was willing to sacrifice one baby for the potential benefit it gave to the other, (Thomasma and Muraskas). “When the parents still pressed forward with their request, the surgery, essentially an intentional sacrifice of Amy was planned for 20 August 1993,” (Thomasma and Muraskas). “The mother thought she could not live with herself if she did not at least try to save one life,” (Thomasma and Muraskas). One died in surgery, “Amy died in surgery as planned,” (Thomasma and Muraskas), and the other died before her first birthday, (Thomasma and Muraskas). Terrible as the thought of killing one child on purpose is, this mother had the intention of helping the other and felt it was her only option to keep one of the twins. As the children were not old enough to speak for themselves, the parents and doctors had to choose. An older set of conjoined twins were asked if they would want to be separated and they responded with, “They do not want to be separated from the only kind of bodies they have ever known,” (Spencer).

In another instance, there were two similar sets of conjoined twins that both had reversed arterial perfusions. One set was in the United Kingdom and the other located in Massachusetts, (Ratiu and Singer). “In both cases, both twins would ultimately have died had they not been separated. Finally, the expected outcome of both cases was comparable and is so far confirmed by the facts: one twin was sacrificed in the surgery, and the surviving twin will have a relatively normal development and lead a healthy life, “(Ratiu and Singer). As sad as it may be, if both twins are dying, a parent must choose to knowingly end a life sooner to save the other or watch them both die slowly and together.

Even getting to the point of a discussion about separation is difficult. One in two sets of twins is not born alive and a lot more die in less than a week, (“Conjoined Twins” Columbia Electronic Encyclopedia). Of the ones that are born alive, 35% don’t make it more than the first day, (Polaneczky). Living conjoined twins have high risk for mortality in long-term life, (Schindehette and Morehouse). The reason they are spectacles is because few are born and few survive. They are an anomaly that not only fascinates, but brings many health challenges and many dilemmas.

Works Cited

Adams, Jacqueline. "Together Forever?."Science World63.12 (2007): 14.MasterFILE Premier. Web. 9 Mar. 2012.

"Conjoined Twins."Columbia Electronic Encyclopedia, 6th Edition(2011): 1.MasterFILE Premier. Web. 9 Mar. 2012.

"Conjoined Twins." Women's Health. Totally Her Momtastic, 1 Jan. 2012. Web. 26
Mar. 2012. <

Moisse, Katie. "Conjoined Twins: Docs Debate Ethics of Separation Surgery."
ABC News. ABC News Network, 5 Oct. 2012. Web. 24 Mar. 2012.
<
conjoined-twins-ethical-implications-separation-surgery/story?id=14664819>.

Orr, MD, CM, Robert. "Ethical Opinions Differ on Separating Conjoined Twins."
Amednews.com. American Medical Ass, 5 Mar. 2001. Web. 24 Mar. 2012.
<

Polaneczky, Ronnie. "Closer Than Twins."Good Housekeeping237.2 (2003): 134.MasterFILE Premier. Web. 9 Mar. 2012.

Ratiu, Peter and Peter Singer. “The Ethics and Economics of Heroic Surgery.” Hastings Center Report 31.2 (2001):47. MasterFILE Premier. Web. 24 Mar. 2012.

Schindehette, Susan and Macon Morehouse. "Joined At The Heart."People66.14 (2006): 74.MasterFILE Premier. Web. 9 Mar. 2012.

Sinnott-Armstrong, Walter, and Franklin G Miller. "What Makes Killing Wrong?”.Journal of Medical Ethics. BMJ Publishing Group Ltd & Inst of Medical
Ethics, 19 Jan. 2012. Web. 24 Mar. 2012. <
early/2012/01/19/medethics-2011-100351.full>.