Siamese Twins

A case of Siamese twins has hit the media and I wondered what the Jewish position would be.

The twin girls are joined at the lower abdomen. One has no heart or lungs and is being kept alive by her sister. The medical opinion is that the one with the heart and lungs has a good chance of survival if separated from her sister. If not, they have only a few months to live.

The girls parents are devout Roman Catholics and believe that the girls' fates should be decided by "God's will." They are appealing against a recent High Court decision to allow the surgery. Meanwhile, time appears to be ticking away for the twin girls.

What is your opinion?

The Aish Rabbi Replies:

Such complexities are not new to Jewish law.

A case of Siamese twins is mentioned in the Talmud (Menachot 37a), and in recent times, the illustrious Rabbi Moshe Feinstein used Talmudic sources to present a clear and unambiguous ruling in such a case when new-born Siamese twins were brought to Children's Hospital in Philadelphia. (Dr. C. Everett Koop, who subsequently became Surgeon General of the United States, was then the hospital's Chief of Surgery.)

Doctors had determined that if the twins – who were sharing critical internal organs – would remain joined together, both would die. The only option was to perform an operation which would kill one and save the other. But, argued the moralists, isn't this murder?

When the team of two dozen medical professionals were awaiting a decision, and indeed, were expressing impatience, Dr. Koop quieted the group with the following statement:

"The ethics and morals involved in this decision are too complex for me. I believe they are too complex for you as well. Therefore I referred it to an old rabbi on the Lower East Side of New York. He is a great scholar, a saintly individual. He knows how to answer such questions. When he tells me, I too will know."

Here’s how Rabbi Feinstein arrived at his decision. He asked the doctors: "How do you intend to perform the surgery?"

They told him: "We will save Baby-A, and kill Baby-B."

Rabbi Feinstein then asked, "Could you reverse the procedure and achieve the same results? Meaning, could you use all the available organs to save Baby-B and instead kill Baby-A?"

The doctors answered: "No. Baby-A is the only one we can save."

At which point, Rabbi Feinstein told them to go ahead and perform the surgery. His decision was based on the Jewish law which states that if one person is directly threatening to kill another, then it is morally correct to stop the pursuer, even if it means killing him. The law of the pursuer applies even in the case where the threat to life is unintentional, for example where a fetus is unwittingly threatening the life of its mother. (see Maimonides – Foundations of Torah 5:5)

Applied to the Siamese twins case, Rabbi Feinstein ruled that since Baby-B had no independent ability to survive, the very existence of Baby-B was threatening the life of Baby-A. This gave Baby-B the status of a killer (albeit unintentional), and Baby-A could, so to speak, stop his killer.

In a recent case brought before the British High Court, they used a much different line of reasoning. Judge Robert Johnson said that for Mary – without heart and lungs – her harsh life would only worsen as low levels of oxygen in her blood further destroyed her brain. So killing Mary – by stopping delivery of Jodie's blood – would be an act of euthanasia, like withdrawing food and water from a terminally ill patient. If they stayed together, the few months of Mary's life would be hurtful and mean nothing to her, he said.

The contrast is quite ironic. The ruling of the Talmud is predicated on the preservation of life. Whereas the British court ruling is based on a decision to end a life, that of the non-viable sister. Without that factor, they'd be prepared to let Jodie, the viable sister, die.

These cases always involve numerous medical and legal factors, and we cannot derive any practical decision based on this discussion. But this does illustrate how in a world full of ethical issues, the truth of Torah is precious today more than ever. Society is increasingly searching for direction, giving new meaning to the Jewish role as a "Light Unto the Nations" (Isaiah 42:6).

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