Special verdict in inquest of conjoined twin

The conjoined twins were subject of a legal and ethical debate before being separated

MANCHESTER, England -- A coroner has recorded a special verdict in the death of a conjoined twin who died during an operation to separate her from her healthy sister.

The twins -- Mary and Jodie -- were born on August 8 in St Mary's Hospital, Manchester, after their strict Roman Catholic parents, Michaelangelo Attard, 44, and his wife Rina, 29, flew to Britain from their home island of Gozo, off Malta.

After a lengthy legal battle doctors won the right to carry out the operation to give Mary's stronger sister, Jodie, the chance of life.

Mary died -- as was inevitable -- shortly after the operation on November 6.

Coroner Leonard Gorodkin said at the inquest on the baby in Manchester, on Friday, that he was discarding all the usual verdicts listed in the coroners rules, adding that the case had been unique to him and to the Court of Appeal.

He said: "It is as unique for me as a coroner as it was for the judges.

"I don't believe any coroner has had to consider a death from surgery when it was known beforehand the patient was going to die.

"All surgery carries with it a mortality rate but in the case of Mary that was a 100 percent rate."

The UK Press Association said his verdict read: "Mary died following surgery separating her from her conjoined twin, which surgery was permitted by an order of the High Court, confirmed by the Court of Appeal."

Gorodkin said that he would not record any of the usual verdicts of accident, misadventure, unlawful or lawful killing or an open verdict.

He made his ruling after hearing evidence during the two-hour inquest that Mary had had no chance of survival following the operation.

He said a verdict of lawful killing was one which might have been considered.

However, he added: "The purpose and the reason for separation was not to kill Mary even though her death arose from it."

He said that clearly an unlawful killing verdict was not applicable "although some people emotionally believe that Mary was murdered, of course that isn't the case."

Gorodkin said that the Court of Appeal had ruled on two important questions -- whether Mary was a separate person, and whether surgical separation was lawful.

He said there was "complete unanimity" among the appeal judges on the first issue.

The judges had also ruled that it was in the best interests of both babies that the operation should go ahead, even though it would result in Mary's death.

Gorodkin said: "In view of their findings I don't have to consider the questions of lawfulness nor the question of moral, ethical and religious beliefs.

"I am sure there are many with such beliefs who objected to the separation of the twins. That debate on the decision will continue I am sure."

Consultant paediatrician Adrian Bianchi, one of the team of surgeons who carried out the 20-hour separation operation, said that the type of conjoining was well recognised but rare, occurring in about seven percent of conjoined twins.

What was unique was that one twin was totally dependent on the other for her survival.

As soon as Mary was divided from the placenta providing her with oxygen she would not have been in a position to survive.

"The only reason she was able to survive was because she was linked to her sister who acted as a life support machine," he said.

Doctors believed if the operation had not taken place, the babies would not have survived beyond three to six months, Bianchi said.

He said doctors faced a dilemma: "On the one hand, if we did nothing we were fairly sure both twins would die in a short time. As such, we felt ourselves negligent in not providing the good twin with a chance of survival.

"On the hand, providing that chance of survival was going to lead to the death of the other twin because her anatomical position was not such as to allow her to survive."

Jodie was now in an excellent condition, despite having needed an operation after contracting an infection 15 days after her birth, Bianchi said.

She was now a "bright, alert and interested child", who had been assessed as functioning at around four and a half to five months, in advance of her actual age, he added.

Her lower limbs were aligned normally, although there was a degree of deformity.

"We expect her to lead a relatively normal and hopefully good quality life with her family," he added.

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Bid to halt twins' separation fails
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September 7, 2000
Vatican 'haven' for Siamese twins
August 28, 2000

Social history of conjoined twins
St Mary's Hospital, Manchester
UK Courts
Inquest rules

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