1114 Evaluation of the Ethical Controversies in Separation Surgery of Conjoined Twins: A Critical Review of the Literature

Abstract

Abstract Aim To further examine the ethical concerns involved in separation surgery of conjoined twins, through analysing the relevant discussions in the published literature. Method A critical review on the ethical issues surrounding separation surgery of conjoined twins was conducted. A literature search on PubMed and Embase was carried out using three terms - ‘ethics’, ‘conjoined twins’ and ‘separation’. Relevant papers published in the past ten years (2013-2023) were included based on the PRISMA standard. Results Seven papers were included in this review. Most papers approached the ethical issues in separation surgery of conjoined twins from the four pillars of ethics. There are contradicting arguments with regards to beneficence and non-maleficence, depending on the perspective of the twins taken. All papers looked into autonomy and some into consent, specifically regarding decision-making. Most papers agree that the parents should be making the decision due to the patients lacking capacity. However, some argue that the patients should be making their own decisions where there is no urgency. Equality has been explored around the distribution of shared organs and survival opportunities. Other ethical principles, including the act-omission and double effect doctrines which support separation, have also been discussed. Conclusions There does not seem to be a definite answer to whether separation surgery is justified. Every case’s unique situation should be scrutinised differently, with guidance from the four pillars of ethics, and involvement of the families and ethical committees. Decisions should not be based on ethical considerations alone, but to take into account other factors.