Re A (Children) (Conjoined Twins: Surgical Separation) [2001] 2 WLR 480, [2000] 4 All ER 961, [2001] Crim LR 400, [2001] Fam 147 was an English Court of Appeal decision on the separation of conjoined twins. The case raised several legal, ethical and religious dilemmas including whether it would be permissible to kill one of the children to save the other.[1] and whether it was permissible to act against the wishes of the twins' parents.[2] "Jodie" and "Mary", who were born on 8 August 2000,[3] were pseudonyms given to conjoined twins, Rose and Grace Attard, who were joined at the pelvis. The medical evidence indicated that Jodie was the stronger sibling who was sustaining the life of Mary. Mary had only survived birth due to a shared common artery that enabled her sister Jodie to oxygenate blood for both twins. If surgically separated Jodie could live but Mary would die. However, should they have not been separated and there would have been a chance that they could have died before they were one year old.
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At first instance, Mr Justice Johnson was left to decide the case without any direct precedents to guide him[4] but reasoned by analogy with Airedale NHS Trust v Bland where it was declared acceptable to remove life support. Johnson ruled that separation would not be murder but a case of "passive euthanasia" in which food and hydration would be withdrawn.[5]
The Court of Appeal rejected this analysis but the three judges who presided over the case gave very different legal reasoning. Lord Justice Alan Ward invoked the concept of self-defence suggesting that "If Jodie could speak she would surely protest, Stop it, Mary, you're killing me."[6] Lord Justice Brown relied upon R v Dudley and Stephens and invoked necessity as a defence. Lord Justice Robert Walker focused upon the intention of the surgeons in concluding that surgery could go ahead.
The operation to separate the twins took place on the 7th November 2000.[3] As expected Jodie survived the operation, but Mary died. Mary's remains were later buried on the Maltese island of Gozo.[4]