Death of the Bijani twins

[Donut]

I don't know how to feel about this. I do know that when I heard of the first death a part of me hoped the second twin would die.


Ananova:
Surgeons in tears as Iranian twins die

The 29-year-old Iranian twins joined at the head have both died hours after being separated by surgeons in Singapore.

A hospital spokesman said medical teams finished separating Laleh and Ladan Bijani, but the women were left in a critical condition by the dangerous procedure. A nurse said: "Everyone upstairs is crying."

First to die was Ladan. Hospital officials said she had lost a lot of blood as the latest stage of the surgery was coming to a close. Then, a few hours later, an official announced: "The second one has died. We treated them like family because they had been here for seven months."

Surgeons began the operation on Sunday afternoon - warning that the operation could kill one or both. It was the first time experts had attempted to separate adult craniopagus twins - siblings born joined at the head - since the operation was first performed on infants in 1952.

The operation had been expected to last at least another 24 hours as a team of plastic surgeons grafted tissue taken from the thighs of the women over their brains to protect them, Dr Prem Kumar said.

The team of doctors had to contend with unstable pressure levels inside the twins' brains just before uncoupling them and cutting through the last bit of skull joining them, Kumar said.

He said surgeons at the Raffles Hospital has separated the brains millimetre by millimetre. "They have to be teased apart very slowly," he said. "Cut. Teased apart. Cut. Teased apart. In the process, you encounter a lot of blood vessels and other tissues."

On Monday, five neurosurgeons completed one of the most dangerous steps in the surgery by re-routing a shared vein and successfully attaching a vein graft from Ladan's thigh. German doctors told the twins in 1996 that the surgery was too dangerous because of the shared vein.

The operation was complicated further when the team discovered that the pressure in the twins' brains and circulatory system was fluctuating. Ladan Bijani had said before the operation: "If God wants us to live the rest of our lives as two separate, independent individuals, we will."

An international team of 28 doctors and about 100 medical assistants were enlisted for the surgery. The Iranian government says it will pay the £180,000 cost of the operation. After surgery, the twins had hoped to move back to Iran and live together while Laleh pursued journalism and Ladan worked as a lawyer.

[ 07-08-2003, 07:05 AM: Message edited by: Donut ]

[Sir Taliesin]

I tend to wonder if this was really possible at this time. They also seemed awful old for this type surgery. Most brain surgerys tend to be more successful on children rather than adults. Something about the brain not being elastic enough in adults like it is in children. Still had I been in their shoes (the twins) I'd probably have opted for the surgery too.

Brave Women to undergo that. It is sad that technology couldn't save them.

[Melusine]

Oh no, that's so sad! Last time I heard the news the operation was going slower than expected because the skulls were thicker than the surgeons thought they would be. But at the time they said the twins were still doing well.
Sad news...

[Chewbacca]

How sad, I was rooting for them. Very courageous women.

[Bardan the Slayer]

Yeah, I heard about this earlier. It really is sad, but I take it as a testament to how skilful the surgeons were that the operation progressed as far as it did. I don't know whether to be happy that medical science has advanced to such heights that this can be attempted, or sad that the twins died. Maybe both.

[Aelia Jusa]

Yeah I heard this last night, so sad . Especially sad considering what their lives must have been like for the 29 years that they were together. They said they were prepared for this if it meant a chance at separation but it's still tragic

[Reeka]

I guess that it was for the best. Optimally, they would have lived as separate people. My father was a twin and died before his twin did. It was very difficult for his twin and they were not conjoined. Twins seem to have an unusually close relationship. I imagine with conjoined twins it is even closer. Also, perfaps if only one had lived she would have felt enormous survivor guilt. In any event, it is sad.

[Cloudbringer]

This is sad news, indeed. I saw a news item on the operation, where they spoke to both women who said they wanted this, even though they knew the risks were high.

[Timber Loftis]

Today's NY Times:
________________________________

OP-ED COLUMNIST
The Risk That Failed
By WILLIAM SAFIRE

We no longer call them "Siamese twins," after Chang and Eng, the congenitally united brothers exhibited by P. T. Barnum in the 19th century. The twins now called "conjoined" are treated not as circus freaks but as infants deserving an attempt at surgical separation or — far riskier — as adults with the right to risk their lives in a quest for physical individuality.

In the 19th century, Chang and Eng had no such choice, and lived out their lives as sideshow curiosities, often called monstrosities, though they managed to father 22 children. In our time, two famed Iranian sisters, Ladan and Laleh Bijani — 29-year-old law school graduates whose brains were linked in the womb — found a hospital in Singapore and a score of neurosurgeons willing to carry out the Bijanis' decision to risk their lives for physical independence.

The world held its breath as the unprecedented separation of adult brains began. The attempt failed; both sisters bled to death; people everywhere were saddened.

We now step into the world of neuroethics. This is the field of philosophy that discusses the rights and wrongs of the treatment of, or enhancement of, the human brain.

Were these patients capable of making an informed choice? Nobody disputes the sisters' mental competency to stake their lives on their hopes for individuality. Doctors, not to mention pre-operation media interviewers, made them aware of the 50-50 chance of death. Most of us would hesitate to challenge their right to take that risk.

Was the medical team acting ethically, putting the patients' interests first, or was it influenced by the humanitarian prospect of the advancement of specific knowledge about the brain — or by the attraction of the world fame and professional prestige that would follow a high achievement?

The available evidence is that the doctors thought there was a reasonable chance for success. When added to the sisters' strong desire to live free of a connection they found unbearable, that seems to tip the balance to a conclusion that the operation was right to do, even though it could and did end in tragedy.

Not just neurosurgeons but other brain scientists are thinking long and hard about the morality (right or wrong) and the ethics (fair or unfair) of what such breakthroughs as genomics, molecular imaging and pharmaceuticals will make it possible for them to do.

In the treatment or cure of brain disease or disability, the public tends to support neuroscience's needs for closely controlled and informed experimentation. But in the enhancement of the brain's ability to learn or remember, or to be cheerful at home or attentive in school, many of the scientists are not so quick to embrace mood-manipulating drugs or a mindless race to enhance the mind.

The brain's ethical sense may run deeper than we think. "The essence of ethical behavior," writes the neuroscientist Antonio Damasio in "Looking for Spinoza," his newest book, "does not begin with humans." Ravens and vampire bats "can detect cheaters among the food gatherers in their group and punish them accordingly." Though human altruism is much further evolved, in one experiment "monkeys abstained from pulling a chain that would deliver food to them if pulling the chain caused another monkey to receive an electric shock."

Damasio does not believe that there is a gene for ethical behavior or that we are likely to find a moral center in the brain. But we may one day understand the "natural and automatic devices of homeostasis" — the brain's system that balances appetites and controls emotions, much as a constitution and a system of laws regulates and governs a nation.

This week's sad loss of the conjoined twins in Singapore should remind us of more than the risks inherent in the most modern neurosurgery.

Something mysterious is going on in the minds of brain scientists as they debate going beyond the cure of disease to the possibilities of meddling with memory or implanting a happy demeanor. What drives them to grapple with the ethics of the manipulation or the equalization of the powers of the mind?

Maybe the human brain has a self-defense mechanism that causes brain scientists to pause before they improve on the healthy brain. Would we feel guilty about discovering the chemistry of conscience?