End-of-Life Decision Making in Orthodox Judaism: The Case of the 1977 Conjoined Twins

Abstract

In 1977, conjoined twins were born to an Orthodox Jewish family in Lakewood, New Jersey; they were treated at Children’s Hospital in Philadelphia. Following legal deliberations in the American court system, as well as religious deliberations within the Orthodox Jewish, Protestant, and Catholic communities, the twins were separated by surgeon C. Everett Koop, who later became Surgeon General of the United States. Evaluation of the medical decision making process in the 1977 case illustrates the distinctly legal nature of Orthodox Jewish discourse—a feature that sets it apart from Protestant, Catholic, and secular ethics. This legal character of Orthodoxy had been highlighted a decade earlier, in a report issued by a panel that had been convened to study the different approaches to conjoined twins among Jewish, Protestant, and Catholic authorities. Close examination of that report, and of the circumstances of the 1977 case itself, bring to the fore the legal nature of the Orthodox Jewish procedures determining the medical outcomes of the conjoined twins. The distinctive nature of the Jewish approach is thrown into relief even further by comparison with the differing approaches among Catholic, Protestant, and secular authorities and medical caregivers. Following an elaboration and explication of the report and the 1977 case in which I examine the important contrasts between the adherents to different traditions and legal systems, I explore their broader implications for understanding the cultures of Jewish medicine in an increasingly complex scientific and technological landscape.