Conjoined twins' operation dilemma

LONDON, England -- A British couple face a legal and moral maze if they opt to have their conjoined twins separated, a medical expert has said.

Tina May, who is six months pregnant, and her fiance Dennis Smith are expecting to have to decide which of the twins lives and which dies.

The babies both share a heart and liver, and one will die if they are separated. An operation is scheduled for a month after they have been delivered by Caesarean section at the end of April.

Kypros Nicolaides, a professor of foetal medicine at King's College Hospital, London, said permission to separate the twins could involve the High Court because it is not clear if the babies, already named Natasha and Courtney, would both die if an operation does not go-ahead.

The High Court stepped into a conjoined twins case last year when they ruled a separation should go ahead after experts said both babies would die if the operation had not gone ahead.

That operation on Gracie and Rosie Attard -- who were given the names Jodie and Mary by the court -- went against the Maltese parents wishes, and the weaker baby did die following the operation. Her sister survived.

Nicolaides said the court could block the latest operation because it is the parents' choice on which of the two babies should die.

May, 23, and Smith, 33, from Hertfordshire in southern England, plan to go ahead with the operation at the famous children's Great Ormond Street Hospital in central London.

May told the British tabloid Sun newspaper: "This is the most horrific choice for any parent."

Nicolaides said: "The real problem here is the medical-legal nightmare arising from the involvement of the High Court in the case of the previous twins from Malta, the Attard twins, because in that case it was very clear that if the operation had not been carried out, both babies would have died."

He told BBC Breakfast News: "The baby that was sacrificed in that case essentially was half dead in as much as there was no heart and there was no brain development.

"In this case, both babies would be alive and, based on my understanding of the degree of sharing, the parents may be faced with the dreadful dilemma, one month after the birth of the babies, of truly sacrificing one.

"Both babies would be alive, the parents would bond with both.

"It may well be that the previous involvement of the High Court will produce the opposite effect because in this case it may well be that the High Court may apply the opposite logic that it may be illegal to separate them."

Doctors have told the couple, who also have a nine-month-old son, Damien, that the dominant twin Natasha has most of the heart and stands the best chance of survival.

The twins also share a liver which will have to be divided in the operation.

Conjoined twins occur in about one-in-100,000 pregnancies.