From at least the time they were teenagers, Iranian twins Laleh and Ladan Bijani dreamed of living separate lives. In the 1980s and ’90s, German doctors told the sisters, who were joined at the head, that any operation to separate them would be fatal. But medical advances–and the omnipresent urge to push the boundaries of medical science–apparently convinced a team of prominent doctors assembled in Singapore to attempt the risky marathon surgery, which began last Saturday.
In the end, the sisters were separated, but they died Tuesday within 90 minutes of each other, after doctors were unable to control the bleeding. Even though the 29-year-old twins entered the surgery saying they were well aware of the risks, part of the postmortem likely will include an ethical debate about whether the doctors were right to attempt such an extremely risky surgery.
Of course, doctors attempt risky surgeries every day. But they also weigh the risks against the benefits. In this case, the twins likely were not in any imminent peril. Presumably, they could have lived many years in their condition.
But the doctors acceded to the sisters’ oft-stated desire to live separately, after what the women described as a lifetime of compromises on everything from when to wake up each morning to what career to pursue. Ladan told reporters she wanted to continue as a lawyer, while Laleh wanted to become a journalist.
In order to explore the frontiers of medical knowledge, it is often necessary to attempt what seems impossible. In this case, doctors had the full consent of the twins. But what are the limits of such informed consent? As one medical ethicist noted, doctors are bound not only to do what’s best for the patient, but also to refuse a patient’s request, even with consent, when doctors deem the chances of success too slim.
The doctors who undertook this surgery obviously realized the risks were great, but they were hopeful of a reasonable chance for success. It was said to be the first time surgeons had ever tried to separate adult twins joined at the head. Similar operations have been performed since the 1950s, but only on infants, whose brain and bones are far more resilient and malleable.
Now questions rightly will be asked about whether the doctors miscalculated the risks and whether the sisters really understood how great a risk they were taking.
In a world where medical miracles have been performed time and again, it was easy to be optimistic that the skill and determination of the team of 28 doctors–and the engaging ebullience of the twins–would somehow defy the odds. Even after more than 50 hours of surgery, that was not to be.
But the sisters’ deaths should not shroud the fact that what the surgeons learned undoubtedly will add to medical knowledge and perhaps guide future surgeons to help others.
That may be cold comfort to the millions who followed this saga, in Iran and around the world, rooting for a happy ending. But they should also note that the sisters died in pursuit of their goal: to be able to live separate lives.
