The intricacies, in this case, were so complex and complicated including the fact that should Jodie stay alive after the operation; then she would be left with substantial incapacities which would necessitate complex continuing therapeutic necessities for which treatment is unavailable in their home country. There was a possibility that her parents would have to leave her in a foster home or under the care of the state. The underlying question in this regard is, ‘if the Court orders intervention against the wishes of the parents and oblige them to take care of the surviving child for what may be many years with potentially significant emotional, financial, medical, practical and social effect on them, other family members and the child itself. Does the court or the state have any responsibility to provide ongoing care to the child?”  What if the parents disregard their responsibility of taking care of the child since their moral, religious, and parental views were not considered, will they be justified? It was a landmark twin separation case, and clearly, the Court of Appeal grappled with determining the contending opinions of the welfare of children, preservation of life and the need to find rational to authorize the killing of Mary to save Jodie.

Siamese Twins Facts:  The Bounds of Law at the Limit of Life

Until 2000, during the determination of the case of Mary and Jodie, Siamese twins had never been subjected to the legal battle.  This case illustrated the struggle of employing legal principles to the extraordinary life-and-death decision encompassing recommended medical intervention for twins whose parents and doctors differ on the best thing to be done.  If this case was presented in the United States, the parent’s judgment would be ultimate except if the state or physician proved to the judge that it was an act of child neglect.  The U.S still operates on the provisions used in the 1993 American case of the two Siamese girls who unfortunately did not survive the surgery.  In England, the applicable law is dissimilar since once the judge is presented with such a case, the judge needs to resolve in what is the best interest or welfare of the child by employing objective and independent judgment. The judge only considers the parent’s decision as one piece of evidence to be used in the determination of the case.  The legal reasoning of the different judges on the panel was conflicting which can be explained by the extraordinary characteristics of the case as well dependence on legal correlations that were impractical in this case.

Mary and Jodie conjoined twins

Lord Justice Ward began his breakdown by acknowledging the exceptionality of Mary and Jodie’s case. He broke down the details of the case by stating that it involved killing Mary, the fragile twin who would still have been feasible as a singleton and to offer Jodie a worthwhile life. After providing the medical intricacies of the case, Lord Justice Ward notes that while “every instinct of the medical team has been to save life where it can be saved,” it would also have been acceptable if the medical team respected the parents’ wish.  Ward evaluates the existing law and states that “it would be utterly fanciful to classify the operation as an omission treatment rather than as an active surgical intervention.” He concludes by declaring that the viable legal path in this case that is characterized by the conflict of interest between the conjoined twins, is to choose “the lesser of the two evils.”  

Ward further used the most dramatic terms to condemn the parents for refusing to pick life for Jodie by stating, “In my judgment, parents who are placed on the horns of such a terrible dilemma simply have to choose the lesser of their inevitable loss.” He said that any parents who loved their children equally and faced with the same situation would choose the stronger one’s life.  He further stated that no matter how hard the situation was, he still had to make a decision. Ward finally focuses his judgment on the principle of self-defense by condemning Mary of murdering Jodie in what is referred to as “quasi-self-defense”. He went on to state that in as much has Mary had the right to life, his chances of survival were minimal and she was just alive by depending on Jodie and if Jodie could speak, she could have protested. Ward concludes that the doctors have a legal responsibility to Jodie, which offers them a commitment to act, and that “doctors cannot be denied a right of choice if they are under an obligation to choose.” 

Lord Justice Robert Brooke’s Opinion

Lord Justice Brooke while in the open court observed at the pictures of Mary and Jodie and shocked the parents by asking, “What is this creature in the eyes of the law?”  He went on to provide a more reasoned analysis of the case and on some of the recommendations made by the advocate who opposed the detachment and submitted that the court had the power to create a new law that approved the procedure if it was necessary and proportionate and permitted earlier on by the court. Brooke suggests that in some circumstances the principle of necessity should be allowed even when the British law rejects it. He provides several examples to support his claims of applying the principle of necessity in this regard. He quotes many legal authorities but ultimately concluded by stating that in this case, the objection to the necessity paradigm offered in the Dudley case cannot apply since, “Mary is, sadly, self-designated for a very early death.”  He also thought that there was no harm in misusing the principle of defense by doctors in other case involving conjoined twins since “there will be in practically every case the opportunity for the doctors to place the relevant facts before the Court of Appeal or otherwise before the operation is attempted.

Lord Justice Robert Walker’s Opinion

Lord Justice Walker begins his opinion by terming the case tragic and ‘unprecedented anywhere in the world.”  According to Walker, Siamese twins may be distinctive but “there is no longer any place in the legal textbooks, any more than there is in the medical textbooks, for expressions (such as ‘monster’) which are redolent of superstitious horror. Such disparagingly emotive language should never be used to describe a human being, however, disabled or dysmorphic.”  Walker coincides with Brooke on the employment of intention and necessity to lawfully kill Mary. He goes on to use various analogies to support his claim but later closes by “there is no helpful analogy or parallel to this case.” Eventually, Walker defines that the doctor’s duty to the children is conflicting. Nevertheless, he believed the quandary does not encompass picking “the relative worth of two human beings” but rather “undertaking surgery without which neither life will have the bodily integrity (or wholeness) which is its due.”  To conclude, he states that physicians should separate the twins not intending to kill Mary, although with the intention of creation each twin complete and performing in the superlative welfares of both. He was further convinced by the testament of the doctors and stated, “Highly skilled and conscientious doctors believe that the best course, in the interests of both twins, is to undertake elective surgery to separate them and save Jodie.”