A reader writes:
You may have heard of the recent surgery to remove a second head from a ten month old girl.
I found this very troubling for a couple of reasons.
1. The kept on refering to the "second head". Looking at the photograph and the fact that "it" could smile and blink, I would be inclined to refer to "it" as a conjoined twin.
2. By refering to the conjoined twin as a second head, it seemed as if they were trying to remove or ignore the personhood of the conjoined twin.
With all of that in mind, was it morally licit for them to have the twins seperated knowing that the not fully formed twin would surely die.
If the unintended consequence of the seperation is the guaranteed death of one of the children is it still permissable to have the seperation surgery.
First, I agree that the situation here is not merely a case of a "second head" but of a conjoined twin who happens to (a) be joined at the top of the head and (b) lacks a body below the neck.
VIEW THE CHILDREN (PRE-OPERATION) HERE.
(I won’t reproduce the photo here since it’s a little disturbing.)
The fact that the body-less child is able to blink and smile makes her personhood easier to demonstrate, but the fact that she is a head with a brain shows it as well. A head is not just an extra organ. If a child were born with an extra leg, you could remove the extra leg without it leading to the death of a person, but removing a head with a brain and not sustaining its life somehow results in the death of that person.
Consequently, it could be done only under those conditions in which it would be morally licit to disconnect on person from another knowing that this would lead to the death of the disconnected person.
Are there such conditions?
The closest well-thought-through situation is that of a mother with a tubal pregnancy. In such cases the child will definitely die when it grows too large for the fallopian tube to contain it and it will cause a hemmorage that threatens the mother’s life as well.
Catholic moralists have been debating about whether the law of double-effect may apply to the case of removing an ectopic child in the case of a tubal pregnancy. For a survey of the debate SEE HERE (scroll down). A consensus seems to have emerged that at least one type of surgical procedure (known as a salpingectomy) might be morally licit to deal with the situation.
One group of conservative moral theologians, including William May and William Smith, hold that the thing that makes a salpingectomy possible is that it is a procedure done on the mother rather than on the child. Specifically, the segment of the mother’s fallopian tube is cut out that happens to contain the child. The child will die as a result of this procedure (until such time as we can transplant the child to the womb or to an artificial womb), but the procedure does not directly kill the child (in contrast to other procedures, such as injecting methotrexate to stop the child’s placenta from developing and functioning. Since a salpingecotomy does not directly kill the child, it is argued to be potentially justifiable under the law of double effect (i.e., for a porportionate reason an action can be taken that is licit in itself though it will have a foreseen but unintended evil side effect).
If it were the case that the bodiless-twin was certain to die or posed a grave threat to the life of the bodied-twin (which would also result in the death of the bodiless-twin) then it might be possible to perform a procedure on the bodied-twin that would disconnect it from the bodiless-twin in such a way that the death of the bodiless-twin is an unintended but foreseen side effect, analogous to the case of a salpingectomy.
Unfortunately, the story give me no reason to think that the bodiless-twin poses any threat to the life of the bodied-twin. As far as I know, they could live a normal life while remaining conjoined. The bodied-twin’s heart might have to develop a little more to cover the extra blood pumping to the bodiless-twin, but no evidence is presented that this would be problematic.
Consequently, I have no reason to regard the severing of the bodiless-twin as anything other than murder.
READ THE (DISGUSTING) STORY. [WARNING: Also has picture.]
As I have briefly noted elsewhere (warning: the link DOES include a pre-separation picture), the fact that the second child did not have a body below the neck is critical to me. A “person” is not merely a head, but is also heart, lungs, etc. Therefore, in my personal view, I side with those who performed the separation.
So . . . if someone detached your head from your body and hooked it up to a life support machine, I could then come along and kill your head over its objections without killing a person. Right?
Ontario, come outside your “personal view” and tell us what you think the objective view is?
I was just thinking about this story and wondering what a Catholic should think. Your blog is so helpful and awesome!
How do we know that the existence of an extra head means the presence of another soul and that the existence of an extra leg does not?
I’m just asking because surely we know that a child born without a brain still has a soul (right?). So why do we conclude that extra brain —> second soul, while extra leg —> no second soul (i.e. chop away)?
I thought (perhaps mistakenly) that the brain was just a conduit through which our intellects and wills (part of our spirits/souls) managed to interact with the physical world (i.e. control our bodies, perceive the physical world and get feedback information from it). So a brain damaged person doesn’t sustain damage to the intellect and will which is part of the spirit/soul. He only sustains damage to the mechanism by which that intellect and will can perceive and communicate to the physical world. A brain lacking person would still have a soul then, just one that is incapable of doing anything other than give life to a mass of flesh (i.e. mitosis, burning of glucose in the mitochondria). Am I completely mistaken here?
So how do we know that the extra leg isn’t being given its life by a separate extra soul, and that removing that leg isn’t murder?
And as far as the above situation is concerned, why is the act of separation considered an evil in itself? Isn’t separation a good thing with the unpleasant and unwanted effect of causing the second child’s death? Why doesn’t this fall under the principle of double effect? I’m assuming it’s because the reasons aren’t proportionate (i.e. the first child having a “normal” life without having to carry around a second head is not proportionate to the life of the second child).
Sorry for all the babbling questions, I’m just thinking out loud. Maybe someone can point out where I’m mistaken.
the original news story reminds me of a rather nasty Tales from the Crypt/Weird Science story about a brilliant chessplayer with a very tall top hat…and a tragic history dating back to when he was a baby and the doctor decided to amputate the child’s conjoined twin…or most of him. Ew.
The Ontario/Jimmy exchange reminds me of “That Hideous Strength.” Double Ew.
And of course, if Robocop had been an accurate prediction of the course of cybernetics-we wouldn’t be having this debate-just transfer the second head very carefully to her own robotic body. I hate it when scientists can’t outpace scifi 😉
Is it official Church teaching that a second head is in this sort of case a separate physically handicapped person? Theoretically, it seems to me that you could argue that God could give a single soul to a two-headed/two-brained person. I’m not saying Jimmy’s wrong, I’m just curious about what foundation he’s operating from here.
Uh, Billy does a beter job of summarizing my concerns. Sorry for the simul-post :/
Theoretically, it seems to me that you could argue that God could give a single soul to a two-headed/two-brained person.
Have there been any cases of conjoined twins of this type living to an age capable of reason or even communication? Whether there have or there haven’t, I’m certain if there were to be such a case both twins would have distinct though similar personalities and would have their own memories (though their experiences would be mostly identical, one could read a book without the other doing so). Two brains, two personalities, two memories, two souls. That there would only be one soul between them makes no sense to me.
I’m just asking because surely we know that a child born without a brain still has a soul (right?).
It’s my understanding that anencephaly does not mean that there isn’t brain matter. Here’s a quote from the NINDS Anencephaly Information Page.
“Anencephaly is a defect in the closure of the neural tube during fetal development. The neural tube is a narrow channel that folds and closes between the 3rd and 4th weeks of pregnancy to form the brain and spinal cord of the embryo. Anencephaly occurs when the “cephalic” or head end of the neural tube fails to close, resulting in the absence of a major portion of the brain, skull, and scalp. Infants with this disorder are born without a forebrain (the front part of the brain) and a cerebrum (the thinking and coordinating part of the brain). The remaining brain tissue is often exposed–not covered by bone or skin.”
Understood. I simply included the presence of a brain to make the case clear. Was not saying that a full brain or even any brain was required. It’s a sufficient condition but may not be a necessary condition.
Jimmy,
Didn’t a similar case come up in the UK a couple of years ago? In this case, I think there was a second, weaker twin whose death was forseen as a result of the separation, because its organs wouldn’t have been sufficient enough to support it on its own. I know at that point some moralists were arguing that double effect couldn’t be applied in that situation, even if the death of both twins were forseen, because a separation procedure to separate the twins would have been equivalent to an attack on the weaker, because the surgical procedure to detach them would have necessarily involved direct operation on the weaker twin’s body. This compromise of the weaker person’s bodily integrity doesn’t take place in the same way in a salpingectomy, e.g., because the mother’s tube is removed without direct violation or action on the body of the baby. Any thoughts on such a distinction? Is there actually a moral difference there?
It seems to me that at least part of a brain is needed – for much the same reasons as brain death is the death of the human being. To be “informed” by a human (rational) soul, you need to have the basic capacity to participate in rational life – i.e., a brain (or the potential to develop one – as in an early embryo). Thus, I think, if there’s a head (with at least some brain structure), there’s a human being (as in this conjoined twins case) – but I don’t think that’d be true in the case of nothing but, say, an extra leg.
Adam: The UK case you refer to is the sad case of “Jody and Mary” where the English Court of Appeal ordered a separation operation against the wishes of the children’s Catholic parents. The law report can be found at Re A(A Child) [2000] EWCA Civ 254. A brief explanaiton of why the operation should not have been ordered is contained in Cardinal Cormac Murphy O’Connor’s submissions to the court.
This little girl
can thank God that surgeons in our day can fix things like this. But the bizarre variety inherent in our physical frailty is emotionally exhausting to behold. And what a cute kid at that. Update: A “reader” (apparently named ‘Racheal’)…
This little girl
can thank God that surgeons in our day can fix things like this. But the bizarre variety inherent in our physical frailty is emotionally exhausting to behold. And what a cute kid at that. Update: A “reader” (apparently named ‘Racheal’)…
“As far as I know, they could live a normal life while remaining conjoined.”
Ha!
Bwahahahahaha!
Ha!
Kevin, why is a brain necessary to a rational soul? A brain is a material thing; a soul is spiritual. God himself (Father, Holy Spirit) is pure spirit and therefore does not have a brain (although the Son, as a human being, does). Angels are also pure spirit. It does not seem that a rational soul is dependent upon having a brain.
I think it would be better to say that a single human being with an extra leg can be presumed to be a single human being who developed abnormally (for example, extra fingers and toes in not all that unusual and we don’t presume that there was a twin), while a fully-developed head is evidence of a separate human being.
Eric, is the wild laughter necessary? I don’t think the point was that the twins would live like other people; only that the disability and deformity were apparently not life-threatening.
Mia: Sure, angels are intellects without bodies – and, for that matter, the human soul can be itself without the body – as between death and resurrection. But my point is that the human soul can’t inform a body to begin with unless that body can somehow participate in the soul’s (rational) life – i.e., unless it has a brain, or something like it. That’s pretty much straight Thomas Aquinas.
Okay, Kevin. Thanks for the clarification. 🙂
But my point is that the human soul can’t inform a body to begin with unless that body can somehow participate in the soul’s (rational) life – i.e., unless it has a brain, or something like it. That’s pretty much straight Thomas Aquinas.
Kevin, at conception, the single cell embryo does not have a brain. Would you support a theory of ensoulment then, or would ‘something like that’ include the push towards the development of a brain as the embryo’s end?
I’m still confused about why the extra head can not be removed according to the law of double effect. even though the healthy twin was not endangered by the extra head, it did inhibit her normal development. Isn’t everyone naturally entitled to a life without the burden of an extra head to drag around?
Actually, the idea that “brain death is the death of the person” is not the open and shut case that Kevin says that it is. The National Catholic Bioethics Center Quarterly has published some interesting work challenging this by Fr. Nicanor Austriaco, OP (a brilliant biologist AND moral theologian) and there is a lot of work showing that brain death may not in fact be “death of the person” by Dr. Alan Shewmon, a Catholic neurologist at UCLA. Lest someone say that these are isolated wahoos going against medical and Catholic norms, the Holy Father has taken enough of their concerns into account to ask the ITC to try to find a more useful definition of what the signs of death are, since so many questions have been raised.
*nods* Allan Shewmon is most certainly not an isolated wahoo. He’s a leader in his field, and his case against brain death has gone unchallenged. Well, no one has disputed his actual conclusions. They’ve not reacted the way we would either, though, as the case of Ronald Cranford, who praises Shewmon’s progress on the one hand and tries to get Terri Schiavo killed on the other, shows.
It is a pity that more of Shewmon’s work isn’t available easily on the web, since I think it’s very important reading for pro-lifers. I spent a few days ensconced in our university library reading papers on PVS when working on a pro-life newsletter some months back, and hence discovered the breakthroughs Shewmon is making. My post here: http://booksgalore.blogspot.com/2005/02/terri-schiavo.html references one of his most interesting papers in light of the Schiavo case.
For reference to the Brain Death debate, Shewmon’s groundbreaking paper was ” The “Critical Organ” for the Organism as a Whole: Lessons from the Lowly Spinal Cord” which can be found in Brain Death and Disorders of Consciousness, Ed. Machado, Shewmon, 2004. Fascinating reading.
One Shewmon paper that is on the web is his Consciousness in Congenitally Decorticate Children:
“Developmental Vegetative State” as Self-Fulfilling Prophecy” http://hydranencephaly.com/drshewmonsarticle.htm which I found both heartwarming to read – some heroic parents featured within – and also quite sad in parts. The bit where he speaks about the normal fate of these children, the self-fulfilling prophecy, is sombering.
Isn’t everyone naturally entitled to a life without the burden of an extra head to drag around?
Yes. But it is not proportional to the injury inflicted on the other head, namely certain death.
Note that Jimmy discussed the case of ectopic pregnancy, where the mother will die, but specificially pointed out that there is no reason to believe that the intact twin’s life is threatened.
Eileen:
1. Regarding the early embryo – I said in a comment above – “To be ‘informed’ by a human (rational) soul, you need to have the basic capacity to participate in rational life – i.e., a brain (or the potential to develop one – as in an early embryo).”
But an “extra leg” has no such potential.
2. Regarding brain death: Shewmon is mistaken, as various scholars have shown (and, I’m afraid, is confusing Thomas’s view of the soul-body relationship with Descartes’s – indeed, the problem is that while Shewmon may get the medicine right, he gets the philosophy very wrong). John Paul II has taught (subsequent to a number of Shewmon’s papers on the subject, like his Linacre Quarterly one detailing his change of mind at great length) that there is moral certainty that brain death is death (and people like Bishop Sgreccia have confirmed on his behalf that this is the teaching of the Church – I have in my desk a copy of a letter Sgreccia sent to a Harvard transplant doctor). The pope has also recently said that there needs to be more study of the clinical signs of death – i.e. – of how we know someone is actually brain dead. I think he’s right on both counts. At any rate, the second point does not negate the first one.
(Shewmon is good on topics like PVS – but that’s distinct from brain death.)
More on the burden of carrying around someone else’s head: If the operation _risked_ the twin’s life — or both twins — one might argue that refusing an operation to separate them was extraordinary care. Certainly
conjoined twins have long shown that when adults, they are willing to take considerable risks to separate.
But not doing something that WILL kill you is different from not doing something that might risk your life and might bring you great benefits.
I hate that picture, seen it way too many times.
As the brains were conjoined, the case could be made that the second head was merely a parasitic appendage of Manar. Furthermore, I see no reason to even suggest that this second head was ensouled (all of its “life” came from Manar). It is necessary for there to be a soul for it to be murder.
Paul:
When “it” blinked and smiled, in what sense did this “‘life’ come from Manar”?
Yes – “it” was heavily dependent on Manar for blood, etc. But I’m not sure why we can’t say “it” has “its” own soul. In fact, the latter strikes me as more likely.
Just because it blinked and smiled did not mean it was an independent life. With the lack of development and total dependency on Manar for every aspect of life, I would consider it to be simply a “rump brain” belonging to Manar, capable only of extremely minor functions and those functions applicable only to the parasitic head.
Well, clearly, it’s not biologically “independent.” I’m not sure why that’s decisive, though. And I don’t think a brain’s functions are “minor,” vis-a-vis the life of a human being.
Just to emphasize: the reason the principle of double effect doesn’t justify removing the twin who’s missing a body is that one of the conditions of the PDE is that the evil effect must be proportional to the good effect. What’s at stake for the twin without the body is her life itself; what’s at stake for the other twin is a lesser good.
However: I wonder if a case could be made that what keeps the twin without the body alive is extraordinary means. But even if it such a case could be made, it would have to be established that the twin without the body was just being disconnected, and not directly killed. That seems unlikely to me.
I hope they baptized her before they killed her.
I think it speaks a lot that those who argue in favor of keeping the two joined are so freakishly horrified by his/their appearance that they dare not directly show a picture of the joined twins.
I personally do not think that the one with a full body is obligated to carry an extra head because medical science is not advanced enough to transplant it on to its own cyborg/cloned body or other means of keeping him alive. I believe it is one of those cases of a true ethical dilemma in which the only answer is the one which the sophists decide is the best answer… for today.
I think we can all agree that this is a terrible tragedy.
But that somewhat begs the question – is this just “an extra head,” or is this another human person?
Kevin, such miniscule motor functions as smiling and winking cannot be considered evidence of being anything more than a malformation of the true brain. There is nothing to suggest that the second head is another life.
Well, they’re certainly motor functions. There’s something of a functioning brain there. And that means there’s the basic potency for bodily participation in rational life. And that suggests a rational soul.
There might be motor functions, but that isn’t evidence of a seperate person. Furthermore, a functioning brain does not a person make.
Paul: I would say that where there is, at least potentially, a center of rational life, there is – by definition – a human soul, and, therefore, a person.
But the soul is what gives us rational life, not our brains.
A horrifying conundrum. But there is the old prohibition against a hunter firing into a thicket at what is “probably” an animal, but what he cannot be certain might be another human being.
What if the twins were yours? What would you do?
I’d cut off the second head.
Paul: Yes, the soul gives us rational life.
My point is that if we’re a living being with the potentiality for participation in rational life – that’s an indication that we are made a living being by, precisely, a rational (i.e. human) soul.
At the very least, I think that has to be the presumption.
It’s what follows from the (Aristotelian-Thomistic) understanding – adopted officially by the Church – that the soul is the form of the body, not a Cartesian “ghost in a machine.”
Except that there was no potential for rational life in the second head.
Could you give us a link to how you know that the second head had no potential for rational life?
Paul:
We’re going around in circles.
If there is something of a brain (or even the potential to form one – as in the early embryo), then there is, metaphysically, by definition, the potential to participate in rational life. Which means that the living body in question is informed by a rational (human) soul. Which means “it” is a human person. Etc. Whether the body in question is complete, or, instead, dependent on another body even for all other functions (as in this case), is not relevant.
RULE 2 is hereby invoked.
wht do you not answer the question??????????????????
should the defence of necessity be made available to the medical profession in cases that require them to make ‘value of life’ judgments by choosing the lesser of two evils, even where such decisions result in the death of the person considered to be less worthy?
hey .. i saw this case on discovery health, and they said that the extra head could blink and smile only when the baby did ..
I watched with horror on Discovery as they prepared for the surgical separation of the twins. Why horror? Because I saw them put a mask of anesthesia over the healthy twin’s mouth before beginning the cutting apart of the heads — but they did not put a mask over the mouth of the “head.” I am hoping this “head” was not able to feel pain. I remember when my grandmother had a stroke but then recovered. She said she could only blink but could not respond, but that she could hear and understand everyone around her. So, so sad for all.
The information regarding this case is crucial to the decision about removing the “parasitic” twin. The healthy twin was providing extra circulation and blood supply to the parasitic twin. As they got older, this was causing life-threatening complications to the healthy twin. Her heart would not have been able to sustain this burden and eventually(maybe a year)would have perished herself. I don’t believe it was murder to perform this operation. It would have been murder to allow them to both die without any intervention….but, you can also argue that, if left alone, mother nature would have taken her course and both would have died anyway. I believe that regardless of opinions, there was a mother in a desperate situation that none of us can understand, and she did what she could with the information given to her. To my knowledge, the surviving twin is disabled and also has some brain damage. Should they have been left to die? Should they have done nothing? I don’t believe that God made that choice for them…God created them, and also created the doctors with the skills to intervene. Its a debate that is endless. What matters, is there is a soul still alive, albeit, damaged physically and mentally, and loved and cherished by her family.
If conjoined twins remain conjoined as one body, and one person goes to heaven and the other to hell, can the body be both in heaven and hell?
At the end of the world Lana
(I’ll answer because you seem to have calmed down, and I apolagize if I seemed harsh)
At the end of the world, we will resurect to either our “perfect”selves without defects, or to the ugliest convicts of Hell.
Got it?
we will resurect to either our “perfect”selves without defects, or to the ugliest convicts of Hell.
The “we” in this situation is two persons sharing one physical body. One person goes to hell and the other person goes to heaven. Where does the one shared physical body go?
But there are parts that are evidently his.
Anyhow, put it this way, every soul will have its own body.
As I said no defects unless that soul is condemned or will be condemned.
But there are parts that are evidently his.
The only part that is uniquely their own are their heads. The rest of the body is shared.
Well then that anwsers your question.
The head would indicates another human combined with the fact that they have separate intellect.
2 perfect bodies (assuming they are saved)
Anything else?
Well, no. As I said, THE body is shared. That’s one body, not two. A head is not a body. Nobody is just a head. It’s one body with two heads. It’s not two bodies.
Don’t be square.
Let me just say something silly.
God will take the little head (now dispered through the Earth as dust) reassemble it, make it pretty and make the head grow out a pretty body.
Does that help?
Now you’re just messing with me? 😉
Well, no. As I said, THE body is shared. That’s one body, not two. A head is not a body. Nobody is just a head. It’s one body with two heads. It’s not two bodies.
Yes — only one physical body but there are, in fact, TWO consciousness though — TWO souls.
Yes — only one physical body but there are, in fact, TWO consciousness though — TWO souls.
So we have two souls sharing one body. And with resurrection, how many souls will share that body?
That depends, Lana, on how many angels can dance on the head of a pin.
Don’t you think that sometimes we just have to be content not to know EVERYTHING?
So we have two souls sharing one body. And with resurrection, how many souls will share that body?
Lana:
It’s not like such an event operates on the Pauli Exclusion Principle wherein no two electrons can occupy the same quantum state.
Besides, if God can make something out of nothing, I’m pretty certain God can make two bodies for the two souls that had occupied the one body.
Don’t you think that sometimes we just have to be content not to know EVERYTHING?
How about being content with just a question? Are you there yet?
I’m pretty certain God can make two bodies for the two souls that had occupied the one body.
What for? What’s wrong with two souls in one body? After all, how many are in the Body of Christ?
Let us say Lana that at the very instant of conception nuke blows on the very point where that embyro is. It was a twin. We won’t know till the end of the world, but God knows and created two souls.
Opps neither have bodies.
So what are they going to share embryos at the end of the world. NO!
Every one will rise to their own glorious and perfect body (assuming they are saved)and as it is licit to believe, to the age of 33, the perfect age as Our Lord was and is when He died.
ARRRRRRRRRRRRRRRRRRRRRRRRRH!
Again, Lana, as I’ve stated, it’s not like such an event operates on the Pauli Exclusion Principle wherein no two electrons can occupy the same quantum state.
Besides, if God can make something out of nothing, I’m pretty certain God can make two bodies for the two souls that had occupied the one body.
One soul, one person two wills and a lot of love.
Now if you refer to the Church, the mystical body of Christ, well the keyword is in the adjective.
THIS THREAD IS OVER TWO YEARS OLD!!!!!!!!!
And one day before the Feast of the Chair of St.Peter, also the date of approval of the Heralds of the Gospel, a Pontifical association.
That this thread has lasted two years, I think shows the complexity.
One of the things that has not been mentioned is the presence of more than one unique DNA. Wouldn’t that be somewhat important? After all this is part of the basis for making a distinction between mother and child in womb as opposed to the fallacious “its my body” argument in support of abortion.
Nor does the post seem to fully consider how much the presence of a second face seems to impact of Mr. Akin initial argument. E.g., a second brain, but no face, and no unique DNA: second person or single person with a bigger head than than one normally sees?