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Back to Question of the Week Q: There is a pair of Siamese twins. They must be separated or else they will both die. But when separating them one will die while the other will survive. Halachically, can the operation be done? --Eric |
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A: Dear Eric: Presumably, you're referring to the case now in the news, in which a pair of Siamese twins, joined at the abdomen, may end up being separated, killing one over the parents' objections. As I understand it, the English court considering this case has ruled that the weaker twin, who would die anyway, may be removed surgically from the stronger one, who then has a chance at life. The court's reasoning was that the weaker twin lives only by virtue of its dependence on the stronger twin, and even "sucks the life" out of the stronger twin, endangering it. Thus, according to the English court, the weaker twin has no independent life, thus making a "right to life" rather irrelevant. That's the viewpoint, in a nutshell, of the British legal system, at least in this very unusual case. Although I must stress that I am not an expert in Jewish biomedical ethics, it appears to me that Jewish law might reach substantially the same conclusion as the English court. The relevant concept here would be the rodef, or pursuer, who may be killed in self-defense without legal penalty. This is based on Exodus 22:2-3: If a thief is caught breaking in and is struck so that he dies, the defender is not guilty of bloodshed; but if it happens after sunrise, he is guilty of bloodshed. As understood by the rabbis of the Talmud, the basic idea is that someone breaking into your house is presumed to be "armed and dangerous," because he knows in advance that the householder might physically defend his property. From this, the rabbis derive a general principle that one may kill in self-defense. (Cf. the tractate Sanhedrin, pages 72a-75a.) Another principle that may be applicable to our case is "third-party" defense- i.e., where one person kills a pursuer so that the pursued person is saved from harm. The ancient rabbis learn this from a verse in Leviticus: Do not stand by the blood of your neighbor. (Leviticus 19:16) It is quite possible that these general principles would lead experts in Jewish biomedical ethics to reach the conclusion that the weaker of the two Siamese twins fell into the category of rodef, i.e., one who actively mortally endangers another. If they did reach such a conclusion, it would not be considered murder to save the stronger twin by surgically removing the weaker one. On the other hand, there is a dissenting voice in the Talmud which might disagree. In the middle of a long discussion of the laws defining the rodef, one rabbi, Rav Huna, says that even a minor may be killed to save the victim. The immediate context of this statement is the requirement that the rodef be warned of the consequences of his actions before he can be killed. (By saying a minor can be killed in self-defense, you undercut the requirement to warn, because presumably a minor wouldn't fully comprehend the legal consequences of his actions.) Rav Hisda challenges Rav Huna: We have learned: Once his head has come out, he may not be harmed, because one life may not be taken to save another. (Sanhedrin 72b) Rav Hisda is discussing a fetus that endangers the life of the mother; he is basing himself on the idea that the fetus is not a living being, and thus may be killed to save the mother, until the point where its head exits the birth canal, at which time it assumes the status of a living being, and thus its life is equal to the life of the mother. The Talmud then questions Rav Hisda's objection: Why is this [a valid objection]? Is he [the baby] not a pursuer? You can see the Talmud's objection to Rav Hisda: if the baby is threatening the life of the mother, perhaps it should, in fact, be killed, in order to save the "victim." The text then answers its own question: There it is different, for she is pursued by heaven. In other words, the baby is not a conscious rodef, certainly not maliciously or intentionally endangering anybody, so perhaps it is also merely the victim of circumstances, and as deserving of life as the mother. Thus the later, anonymous voice of the Talmud ends up agreeing with Rav Hisda's objection to Rav Huna's permissive stance on taking the life of minors. Perhaps, then, Rav Hisda and his supporters in the Talmud would agree with the parents of the twins in England; they apparently did not want the twins separated surgically, but were willing to let them both die if that was the "will of God." Personally, I don't think the weight of precedent and principle would support letting both twins die; I am only pointing out that there may be texts within our tradition that would support such a position. This discussion is meant only to illustrate some of the issues involved. Truth be told, if ever faced with such an awful dilemma, I would quickly seek the counsel of those far more learned and experienced, and pray earnestly that God would illuminate for them the correct path among the painful choices. NJL |
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