Twin Killing: The Culture of Death Advances In England

Wesley J Smith

Alas, poor Mary. She’s the conjoined twin in England, united at the chest with her stronger sister Jodie, and she’s been called a parasite, a tumor, a blood-sucker: someone whose “primitive” brain makes her life unworthy of protecting. And all that by two British courts, which wave wrenched away from her parents the right to decide whether or not to have her surgically separated from Jodie— though the operation will take Mary’s life.

The courts have done what the twin girls’ parents refused to do: make a real-life Sophie’s Choice. They have chosen to kill one daughter to save the other. The couple, from the small Mediterranean island of Gozo, view their daughters as equally precious and entitled to life. They rejected the dehumanization of Mary, asserting their right to refuse medical treatment and allow nature to take its course.

But last week, rebuffed by the court of appeals, they gave up the fight and announced that they would not take the case to the House of Lords.

Hard cases make bad law, or so the saying goes, and the facts of this tragic case are the worst possible. They are so unusual that most commentators have assured the public the ruling hasn’t set a precedent. But we have no assurance that this is true. Indeed, we have considerable evidence, in the history of euthanasia laws, that the opposite is true: Decisions reached in tragic cases quickly open the gates to a flood of new cases—each moving us one step further from a reverence for life. The decision to require the death of Mary has been imposed on a reluctant family, and that ought to frighten the average citizen of England— and of America, too, for that matter: An international precedent is now in place to deny parents the right to resist the “culture of death.”

That phrase describes a mindset that accepts intentional killing as an answer to difficulties stemming from illness, disability, age, and the social inequities caused by limited medical resources. It is a mindset that leads to what seems at first to be contradictory attitudes toward death and dying. Thus, some of the same commentators who now argue that the court was right to overrule the parents in order to save Jodie’s life also looked with approval on another recent court decision from England that expressly permitted doctors to refuse to save the life of a profoundly disabled child—even though his parents wanted him to continue receiving care.

This second case involved a 19-month-old boy born prematurely with an irreversible lung condition and brain abnormality. Even though he responds to his parents, smiles in recognition, and shows signs of acquiring a vocabulary, the court ruled that his doctor’s weak prognosis permits them to overrule his parents’ wishes and let the boy die the next time he has a medical emergency.

At first glance, these two British court decisions appear opposites: One imposes treatment, the other denies it. But looked at though the lens of the culture of death, they prove perfectly consistent. One imposes unwanted treatment on a family knowing that a helpless child will die. The other denies wanted treatment to a family knowing that a helpless child will die. In both cases, the child dies, and in both cases, the courts have held that the doctors’ values rule.

The same apparent paradox is seen in this country. On the one hand, supporters of assisted suicide argue that the terminally ill and severely disabled have a right to doctors’ help in committing suicide. On the other hand, supporters of “futile care theory,” now all the rage in bioethics, are ready to disregard the wishes of the ill or disabled if the patients seek expensive treatment their doctors deem unjustified by their quality of life. To apologists for futile care theory, autonomy has its limits. The real point of both policies, however, is the elimination of people judged to have a low quality of life. If “choice” gets the job done, fine. If not, death is imposed under another rationale (typically “distributive justice”: Timmy doesn’t have health insurance, so we can’t afford to give Granny Jones a respirator).

The case of Mary and Jodie presents a terrible dilemma. If the decision to separate the twins in order to save the stronger were being made against the backdrop of a culture still committed to the equal dignity of human beings, it would be far less worrisome. But we live in a time when the commitment to life is steadily losing ground to the culture of death. It is a time when a scholar like Peter Singer can assert that parents should have the right to kill their newborns to benefit the family—and be rewarded with a chair at Princeton University. It is a time when the Lancet can report (in 1996) that pediatric euthanasia based on quality-of-life judgments takes some 80 infant lives a year in the Netherlands—and not cause a ripple.

Those who say the conjoined-twins ruling will set no precedent simply do not understand how relentlessly the culture of death is advancing. With this decision we may have crossed a cultural Rubicon: It can reasonably be argued that the judges have ordered doctors to perform involuntary euthanasia. At the very least, the case of Mary and Jodie makes it easier to justify medical killing the next time some “worthy” case comes along.

[This article was originally published in The Weekly Standard (Oct. 9, 2000) and has been reprinted with the kind permission of the author, Wesley J. Smith, an attorney for the International Anti-Euthanasia Task Force and the author of Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder. His next book, Culture of Death: The Destruction of Medical Ethics in America, will be published this year by Encounter Books.]