Maltese twins,  known publicly as Mary and Jodie, were born joined at the abdomen and pelvis in August 2000. They were delivered by C section at at St. Mary’s Hospital, Manchester, to devout Catholic parents from Malta.

Early scans had revealed that the twins shared a spine and lower abdomen, although the full extent of the condition was not revealed until later.  While some parents opt to terminate conjoined pregnancies early on, Mary and Jody’s parents felt strongly that the babies had a right to life, regardless of the hardships they would no doubt face as a result of the condition. Maltese doctors referred the family to St Mary’s hospital in Manchester for specialist support.

Each set of conjoined twins is unique, and the severity of the condition varies. Without surgical separation, Mary and Jodie were given a less than 1% chance of living past their first birthday.

While Jodie had a healthy heart, brain, and lungs, her body was exhausted from keeping both of them alive. After just ten days she was in a critical condition, as her heart and lungs provided life support for her sister. Mary was much smaller than Jodie, and could not breathe without assistance from her. Doctors quickly established she was not capable of independent survival. Brain scans also revealed that although she might live for a short time if unseparated, she would have limited cognitive function, and likely die within just a few months.

Although conjoined-twins are exceptionally rare, surgeons have been performing successful separation surgery since 1689. In this case, doctors were confident that if they acted swiftly and with care, that Jodie could fully recover, and could go on to live a healthy and fulfilling life.

The parents faced three options

Permanent attachment

Both twins would die within 4 – 11 months of being born if no action was taken to separate them.

Elective separation

Surgeons would perform elective separation when the twins were between four and eleven months old, giving them time to prepare for the procedure.

Mary had a 0% chance of surviving the operation, but surgeons were confident it would allow Jodie to live a “good quality life”.  There was only around a 5 – 6% chance of both twins dying during the operation. Jodie would need multiple operations to repair organs she shared with her twin.

Emergency separation.

Mary was given a 0% chance of surviving an emergency separation, while Jodie had 40%.

The question of whether it was right to end one twin’s life in order to save the other was torturous for the Catholic parents. They believed that the fate of their daughters lay in God’s hands, and did not want medical intervention which would alter this. They argued that separating the twins violated the principle that human life is sacred. On the other hand, the doctors were resolute that if one of the twins could be saved, it was worth it.

Under normal circumstances, the parents’ decision would be final. However, in this case, the medical professionals involved called on the courts to intervene.

Unprecedented intervention

The case was heard at the high court, which ruled that the separation should go ahead. This decision was immediately appealed by the girls’ parents, who with the support of Catholic church, escalated the case to the Court of Appeal.

Judges described the decision as “agonising”, as they weighed up the moral arguments on both sides. Family lawyers, medical, and criminal lawyers were consulted, as well as doctors and faith leaders. Eventually, after extensive debate, they ruled that the separation must be performed.

In his leading speech, the senior judge, Lord Justice Ward, said that he was “left in no doubt” over the decision.

He said: “(Mary) is alive only because, to put it bluntly but nonetheless accurately, she sucks the lifeblood of Jodie, and her parasitic living will soon be the cause of Jodie ceasing to live. Jodie is entitled to protest that Mary is killing her. The best interests of the twins is to give the chance of life to the child whose actual bodily condition is capable of accepting the chance to her advantage even if that has to be at the cost of the sacrifice of a life. I am left in no doubt at all that the scales come down heavily in Jodie’s favour.”

Beyond the courtroom

The case triggered large scale protests in the Catholic community. They argued that the court had overstepped its role, and infringed on the parents’ right to decide the fate of their children. However, it was found that English law did support the ruling. The parental right to determine outcome must yield to the judge’s independent assessment on the welfare of each child. In this case, the doctors were the only people involved able to help Jodie, while Mary’s circumstances could not be changed.

Despite the protests, the parents decided not to take the case to the House of Lords.

It took surgeons 20 hours to separate the girls. Mary died in surgery, but Jodie pulled through. Fourteen years later, Lord Justice Ward addressed the trial, sharing the news that Jodie was healthy, bright, and “hoping to train as a doctor”.