Suppose that two babies are born conjoined, and sharing certain organs. Operating will certainly kill the weaker of them; but left without intervention they will very probably both die. Is it permissible to operate? Is it obligatory?

If you had two conjoined babies who shared certain organs, would it be alright to operate on them if this killed one of them, so that the other could live? This is the question that I am going to be answering in this essay.

This question is a real one because of the recent case of a pair of conjoined babies from a poor country, whose parents didn't want to separate them. In that case the court ruled that they must be separated. I agree with the decision of the court. Parents should not be able to say what happens to their baby's just because they are their parents. After all, what if the parents disagreed? Then what would you do? Another problem here is that once you let parents decide these kinds of things, then they might just decide in ways to suit themselves. What if the parents really didn't want to bother to look after a girl, and that was why they wanted both to die?

When we think about these issues we need to consider the doctrine of double effect. This seems to me to be a bad argument. A case that is sometimes talked about is the one in which there is a pregnant woman whose life is endangered by her foetus. It is said to be alright to operate on her to remove her womb (for instance, if it is cancerous) even though this will kill the foetus. But it is not alright to give her an abortion (for instance, if the growth of the foetus is killing her by pressing on her heart in some way). The difference is between what we are intending to do, and what we know will happen. This seems to me to be quite impractical. If you thought this, then you could always find an excuse that would do the job. For instance, the woman who wanted an abortion could say that what she wanted was to have an empty womb, she didn't actually want to kill the foetus. So this will not work. You can't say that you didn't want to kill the weaker baby, it's just that you foresaw it. Who would know whether you really meant it?

Another thing we need to think about is the distinction between killing and letting die. Suppose a run away trolley was going down a track towards five people. You could move the switch so that it went down a different track where there was only one person. Would you move the switch? This is the trolley problem. It seems to me that you would. The reason is that that way only one person would die, and not five. But that is killing the one person. So it is better to kill one person than to let five die. I think that it is the same in the case of the twins: it is better to kill one than to let two die.

One difference between the train case and the case of the babies is that in the babies case the parents didn't want to kill the one. But that is probably the same in the case of the train. If you did ask the parents of the one person, then they would probably say that they didn't want their child to die. So the cases are not really different.

Suppose though you had five people who all needed different organs to survive; one needs a heart, one needs a kidney, one needs a lung, one needs a liver, one needs a brain. Suppose a healthy man comes in to visit his friend, and the doctor's grabbed him and cut him up to divide his organs amongst the others. We wouldn't think that was right. So what is the difference here, because isn't his a case in which you kill one person so that you do not have to let five die? I think that the real problem is that you have no need to cut up the healthy person. After all it is nothing to do with him. What you could do is to take one of the five people who was sick any way, and cut him up. That way you'd have no need to cut up the healthy person. So this isn't like the baby case. There the babies are already in there together; it's not as though one is just visiting the other one.

So, in conclusion, I think that the baby case is like the trolley case. There isn't any difference between killing someone and letting them die. Only by operating can we save one of the babies. That is the way that we will maximize the happiness of the greatest number. The judges were right. We ought to operate.