Re A (conjoined twins: medical treatment) [2000] 4 All ER 961 (CA)

Conjoined twins – right to life – medical intervention – necessity – best interests

An operation to separate Siamese twins which would inevitably lead to the death of one of the twins was in the best interests of the other twin under the principles of family law, and was justified under the criminal law by the doctrine of necessity. The court said:

“Given the conflict of interests between [the twins], and the conflict inherent in the court’s duty to give paramount consideration to the welfare of each twin, it had to choose the lesser of the two evils and so find the least detrimental alternative. It was therefore necessary to carry out a balancing exercise, with the right of each of the twins to life going into the balance, alongside the worthwhileness of the treatment. When considering the latter, it was legitimate to have regard to the actual condition of each twin and hence the actual balance sheet of advantage and disadvantage which flowed from the performance or non-performance of the proposed treatment. At that point, it was legitimate to bear in mind the actual quality of life that each child enjoyed or might be able to enjoy”.

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