Conjoined Twins, Embodied Personhood, and Surgical Separation

Abstract

The medical treatment of conjoined twins presents a compelling example of the need for non-idealizing approaches to ethical decision-making. Since surgical separation often results in the death of one or both twins, the question whether separation is justified is controversial. I argue that the debate remains unsettled because of insufficient attention to the actual metaphysical status of conjoined twins.

Until the twentieth century, conjoined twins were usually seen not as two entities but one, and treated as freaks and objects of exhibition. Since then, although they are more readily recognized as two persons, conjoined twins continue to be regarded as inherently impaired—as if they were essentially singleton individuals who happen to be contingently joined—and therefore in need of repair via surgical separation. The error arises from the idealization of singletons’ embodied personhood, and the failure to notice that embodied personhood is crucially different for conjoined twins—different with respect to physical independence and the relationship to the corporeal, bodily ownership and authority, and self-awareness and privacy. The implication is not that surgical separation is never justified, but rather that surgical separation must be decided within the context of a non-idealized, non-ableist understanding of conjoined twins’ actual embodied personhood.