Conjoined twins and double effect

In your Letters section of the January issue there is one concerning the surgery performed on the conjoined twins in England. To this case was applied the principle of double effect. In reply to your invitation for other views, I submit this letter.

The writer of the letter lays out the principle of double effect, giving as the first item, “the act itself must be morally indifferent or good.” She then applies it to the case at hand and considers it to be fulfilled.

I submit that whether the surgery is “morally indifferent or good” is precisely the point at issue! It cannot be both the question and also part of the answer. We are dealing with what moralists call an actus humanus and not with merely an actus hominis. The principle of double effect does not apply here. It is from another viewpoint that I consider the surgery immoral.

The conjoined twins were two individual human persons, therefore each possessing a spiritual soul created by God (if this were not so, there would be no controversy). They shared a few organs: the heart, lungs, perhaps others. I take the heart for my example.

For me, the crucial point is that each of the twins had an equal moral right to the heart. Jodie could not have said to Mary, nor Mary to Jodie, “This heart is mine, and I no longer allow you to make use of it.” No one may lawfully be deprived of one’s moral rights.

Take a hypothetical example. Suppose Mary and Jodie had been born as completely separate twins. Suppose further that Jodie was found to have a seriously defective heart, but in all other respects was quite healthy; whereas Mary was found to have several serious physical problems and yet did possess a strong and healthy heart. Suppose it was decided to kill Mary, harvest her heart, and transplant it to Jodie. Would anyone sanction this? Would it not be identified as murder? For, to repeat, each of the twins has a moral right to the possession of her heart: a moral right to her personal integrity. The fact that our present case involves one heart and my hypothetical case involves two hearts seems to me morally irrelevant. —Father David Wechter
Houston, Minnesota

Deliberate killing

I am a physician and write in reply to Suchitra Mytak’s letter in January. The operation to separate the conjoined twins was not an example of the “double effect” principle and therefore morally licit.

The first step in the operation was to cut off the circulation to the weaker twin. This meant direct killing. The parents understood this and refused to consent to the operation. The surgeons appealed to the High Court. The judges overruled the wishes of the parents and the surgery took place. Archbishop Murphy-O’Connor (since elevated to the College of Cardinals) wrote to the press stressing the fact that the operation entailed deliberate killing of the weaker twin and was therefore not morally permissible.

I interpret Germain Grisez’s moral acceptance of surgery for conjoined twins to mean that although surgery may be life-threatening, the aim is to save both babies. This is quite different from the sad “Jodie and Mary” story.

—Mary Knowles
Tadley, Hampshire, Great Britain

Double effect does apply

Suchitra Mytak, like Germain Grisez, is correct in saying that the principle of double effect allowed the separation of the British twins, even though one died. But this case is a little more complicated than the removal of a cancerous uterus from a pregnant woman. There, the fetus is removed intact and later dies. Here, there seems to be a question of taking an organ from one baby, killing her, and giving it to the other; and this makes it look like killing to save a life.

That is, in the case of separate babies, you can’t use the principle of double effect to remove, say, a heart from one and give it to the other, because that involves two acts: first the removal of an organ, which kills the baby, and later a second act which implants the organ, saving the other’s life. Obviously the first act itself does not have the good effect of saving a life, and so one cannot avoid choosing the death, even if the ultimate intention is to save a life. In this case, however, there is only one organ (or one set of organs), which belongs to both children. And the act which removes the organ from the first child is one and the same act as the one which removes the threat to the life of the second (because the organ cannot support both). Here, one may decide to separate the two solely to save the life of the second, recognizing (and deploring) the unfortunate side effect of the death of the first.

The way to decide whether this is “direct killing” of the first child is this: Is it the death that saves the life? No, because if the first child survived the operation (say, by having a donor organ implanted), the second child would still live. Therefore the death was not necessary for the second child’s life. Hence, even if it is inevitable in reality that the first child die, the separation does not involve choosing evil, always supposing that the death is not wanted for any reason.

One could even argue that there is an obligation to perform the act, given that the act of refusing to do so results in the death of both children, which is worse than performing the act which saves one of them.

—George A. Blair
Cincinnati, Ohio

“A dangerous precedent”

When I received the January issue my attention was very quickly drawn to the letter concerning the moral issues involved in the separation of the conjoined twins.

In giving the example of a pregnant woman with life-threatening uterine cancer as a case where the application of the principle of double effect is similar to that of the twins, that letter missed the fundamental point that a successful separation of the twins was only possible through the direct and intentional killing of a person (Mary), which is “gravely sinful” according to the Catechism (2268). The separation of the twins was not one in which a body organ was removed to save the person to which the diseased organ belongs and indirectly the fetus died, but was an operation whereby one person was directly killed to save another person. During the operation it was necessary to sever Mary’s aorta: an act which the surgeon was fully aware would directly kill Mary. Therefore, the first condition of the principle of double effect—that the action must be morally neutral or good—is not met in this case.

The Archbishop of Westminster, Cormac Murphy-O’Connor, who vigorously tried to persuade the authorities not to allow the operation, declared the High Court’s decision as setting a “dangerous precedent.” He reaffirmed Catholic teaching that it is an evil for one person to be killed to save another.

The similarity of this case with the recent decision in the Netherlands to legalize the practice of euthanasia—more appropriately called “mercy killing”—lies in the relentless striving of many for complete autonomy over life and death. This is particularly so in the “quality of life” judgments. The assumption is that as man is in possession of his life, he has the right to dispose of it as he sees fit, for the good of himself and for others. The Christian, however, has a different perspective on life and death. The precept “Thou shalt not kill” is not merely a negative command—as though God arbitrarily wills to restrict human activity. It protects the gift of life from those who seek to abuse that gift in the act of murder. As a gift from God, life is seen by the Christian as the manifestation of God’s love. Therefore it is not the sole private possession of man but a sharing—a partaking in the very image of God. Men are stewards, not lords, of that gift of life.

—Brian E. Pointer
Chichester, West Sussex, Great Britain

Some readers dislike speculation…

I was saddened and surprised to see a magazine such as Catholic World Report carrying a front cover and article (“Thinking about the Papal Succession,” January 2001) speculating about who might be the next Pope. It is, naturally, of great importance that at a conclave a wise, holy, and strong Pope be elected to guide the Church. And yet at the same time we have such a Pope. Could the current discussions about a future Pope not be compared to a family—in the hearing of their father—speculating as to who will be in charge and what changes might be enacted after the father’s death?

The Holy Father has led us so well and given us so much encouragement, and continues to do this in spite of ill health. Such speculations must cause a degree of instability in the Church and may even undermine the loyalty and obedience which some people feel toward the Vicar to whom Christ entrusts his Church here and now: Pope John Paul II.

When he visited our country as a new, young Pope the crowds chanted, “John Paul II, we love you!” for hours on end. Can it be right if that love diminishes with advancing years?

—Margaret Anne Armstrong
Ipswich, Suffolk, Great Britain

As he advances in years, a prudent man might actually encourage his children to think about how they will maintain the household after his death. But with or without the encouragement of John Paul II, the speculation about the papal succession is already well advanced; the article in Catholic World Report did not open the discussion, but commented on a discussion that has been in progress for some months. In fact, our analyst himself commented that some factions within the Church seem to be using the discussion to undermine the authority of the Holy Father—a development which he viewed as extremely unfortunate. Our love for the Pope is by no means diminished by his current frailty. And by the way, that same chant—”John Paul II, we love you!”—can still be heard whenever he addresses a large English-speaking audience. —The Editor

… Others welcome it

Your publication becomes better by the month! The excellent piece on papal succession is poignant.

I know that the “liberals” in the hierarchy are loud and defamatory. They are like the Judases of the past. Well, heresy and schism have plagued the Church for centuries, and things might become worse—and probably will. Nevertheless this is for testing us, to a point short of the limit. That is what we ask for in the Lord’s Prayer: not to be put to the test, that is to the breaking point.

Cardinal Martini of Milan would be one of the worst choices for the papacy. I trust that the Holy Spirit will rescue us with a man of John Paul’s character, mind, and virtue.

—John C. Morris
Orinda, California

St. Thomas More: not a politician

In your January issue (Letters), St. Thomas More is emphatically declared to have been a politician. Was he?

Thomas More himself would have shaken his head, wondering why on earth was he proclaimed the heavenly patron of “politicians,” whereas the “man of law” was the term with which he was regularly referred to in the minutes of the King’s Council. Shakespeare referred to Henry Bolingbroke as “this vile politician” in Henry IV.

—Paul Akio Sawada Tokyo, Japan

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