Authored By: Solin Rasouli
The University Of Law
Abstract
A difficult moral and legal challenge was raised in Re A (Children) (Conjoined Twins: Surgical Separation): may doctors legally perform a surgery that will undoubtedly kill one conjoined child in order to save the other? The case and its ongoing relevance for medical law are concisely examined in this article. It reviews ethical questions concerning sanctity and quality of life, examines conflicts between the concepts of intention and necessity, and summarises the facts and judicial reasoning. The article contends that although Re A was a practical, narrowly defined judicial remedy, it revealed a void in legislative direction and left unsolved doctrinal ambiguities. Lastly, useful suggestions for improving clinical practice, judicial supervision, and statutory clarity in life or death medical choices are provided.
Introduction
It is unusual for the courts to be called to decide cases in which every legal solution would result in significant human loss. The Court of Appeal approved a separation procedure in Re A (Children) (Conjoined Twins: Surgical Separation), which would unavoidably result in the death of one twin (Mary) but probably save the other (Jodie). The judiciary was compelled to balance conflicting principles, including the sanctity of life, parental liberty, the obligations of physicians, and the limits of criminal responsibility, because of the parents’ religious objections and the medical certainty of Mary’s death. In order to shed light on the legal logic, analyse moral dilemmas, and suggest changes to lessen ambiguity in similar situations in the future, this piece reconsiders Re A.
Research Methodology
A doctrinal analytical approach is used in this investigation. It draws on statutory resources, secondary literature in medical law and ethics, and original sources (such as the Re A ruling and prominent criminal authority). The method seeks to evaluate doctrinal coherence and practical implications by synthesising case law and criticism.
Legal Framework
For major crimes like murder, English criminal law requires a definite mens rea and makes a distinction between acts and omissions. In criminal law, the idea of necessity has a limited role. According to R v Dudley and Stephens, need is often not a defence against murder. When intervening in a child’s care, medical law also applies a “best interests” norm, which is frequently expressed through the welfare concept utilised in child centred decision making. When doctors deal with therapies that will predictably shorten or end life, these threads come together.
Judicial Interpretation
Re A Concerned ischiopagus twins linked at the pelvis; Mary was unable to survive on her own, while Jodie had healthy cardiopulmonary organs. Both would perish in the absence of separation; in the event of separation, Mary would undoubtedly die, and Jodie was likely to live. In order to authorise the procedure, the hospital requested declaratory relief. Separation was approved by the Court of Appeal (Ward LJ, Brooke LJ, and Walker LJ), but each judge gave a different justification.
In order to prevent the worst consequence of two deaths, Ward LJ highlighted a necessity style decision of the “lesser of two evils,” allowing intervention. Jodie’s involuntary dependency effectively put her life at risk, and removal safeguarded Jodie’s right to life, according to Brooke LJ’s self defence analogy. Walker LJ used a restricted mens rea approach to reach his conclusion, acknowledging that the physicians’ goal was to preserve Jodie and that Mary’s death was an unavoidable but unforeseen result that could not be considered as murder
Despite the results being similar, there was disagreement about whether the permissive consequence was due to self defence, need, or a limited understanding of purpose (a kind of the “doctrine of double effect”).
Critical Analysis: Tensions and Ambiguities
There are two substantial doctrinal conflicts:
First, there is doctrinal tension in the way the courts handle intention. English law accepts a nearly inevitable outcome as intended for the purposes of murder culpability after Woollin. Mary’s demise was inevitable, not just predictable. Walker LJ’s reasoning seems to carve out an exemption to the Woollin test by interpreting the physicians’ goal narrowly as protecting Jodie. This might lead to inconsistent definitions of intention across circumstances.
Second, the seemingly categorical rule in Dudley and Stephens that necessity is not a defence to murder makes Re A unsettling. Although the Court of Appeal described Re A as extraordinary, it did not provide a precise, broadly applicable standard for determining whether “lesser evil” or necessity may support life ending medical procedures. Because of this, medical professionals are unsure about the legal limits of acceptable involvement.
The choice is made ethically by weighing distributive intuitions (saving one life instead of losing two) against the sanctity of life and quality of life. Defenders emphasise the compassion and functional need of the decision in an extraordinary factual matrix, while critics contend that judicial acceptance of such trade offs runs the risk of utilitarian calculations being applied without democratic legitimacy.
Recent Developments
Re A is still considered authoritative on its facts, but later case law has viewed it as extremely fact specific rather than a precedent for wide exemptions. In order to prevent ad hoc court remedies in similarly difficult clinical situations, academic opinion has frequently sought for legislative clarity. Although interdisciplinary decision making has grown because of advancements in newborn care and the institutional functions of ethics committees, there is still no regulatory advice on when deadly consequences may be permitted.
Suggestions
Three practicable changes are suggested in order to lessen uncertainty and safeguard vulnerable parties:
- Statutory Clarification: Parliament should pass specific legislation outlining restrictions, procedural protections, and the need for independent judicial review in cases where life saving treatment for one patient will undoubtedly result in the tragic passing of an additional dependent patient (such as conjoined twins).
- Obligatory Multidisciplinary Review: To guarantee fair, open thinking, an obligatory multidisciplinary review, involving impartial ethical advisers and child welfare advocates, should be mandated prior to any action with unavoidably fatal outcomes.
- Judicial direction and Training: To guarantee consistent, well reasoned decisions when courts must approve life ending measures, the top judiciary should provide direction and expert judges should undertake medical morality training.
By incorporating democratic legitimacy and clinical openness into choices that presently rely on ad hoc reasoning, these steps would maintain oversight by the judiciary.
Conclusion
The court’s narrowly tailored remedy in Re A (Children) spared one life while allowing the certain death of another, illustrating the law’s contact with severe moral issues. Although the outcome was practically justified, the theological foundation is still up for debate. Similar situations will continue to put a great deal of pressure on courts and physicians in the absence of legislative reform or unambiguous judicial guidance. In situations when morality and medicine meet, policy change and more explicit procedural protections would better balance legal certainty with ethical responsibility.
