Every few years, the attempt to surgically separate conjoined twins becomes a national, event international, media event. Conjoined twins occur once every 200,000 live births, according to the University of Maryland Medical Center. When separating these twins in surgery, it depends on where they are joined that determines the success of the surgery. There are four main common types of conjoined twins which includes, thoracopagus twins which are conjoined at the heart, liver, and intestine. Next, is omphalopagus which are connected at the liver, biliary tree, and intestines (refer to addendum 1). Another type is the pygopagus twins which are connected at the spine, rectum, genitourinary tract. Lastly, the ischiopagus twins that share a pelvis, liver, intestine, and genitourinary tract. The least common kind of conjoined twin is the craniopagus twins, which share a brain and meninges. With research and time, the surgery success rate is improving and saving many lives. Statistics show that the overall survival rate of conjoined twins is between five percent and twenty-five percent when first born. While the surgery can be successful, there are many risks involved. Though it is a risky and complex procedure, the separation of conjoined twins is an important surgery to consider for historical, ethical, and scientific reasons. The earliest reported case of conjoining individuals was in 1100 AD. This set of conjoined twin sisters were born in Kent, England. They were joined at the hip and lived to the age of 34. When the first sister died, the second refused separation and died within six hours. (Mainous, 6). Another known case was in 1680. Twin girls were joined at the spine to a peasant woman. These children were abducted at a young age and exhibited for money gain. At the time, conjoined twins were viewed as a medical marvel, and some people wished to exhibit the twins as such. There are reports of conjoined twins being used as props in the traveling circus. The first case of successfully separating conjoined twins was in 1987. Dr. Ben Carson gained worldwide recognition as one of the main surgeons in the 22-hour separation of siamese twins from Germany.This was the first time occipital craniopagus twins (joined at the top of the head) had been separated with both surviving. This surgery represents the first time craniopagus twins were separated and were neurologically normal. Dr. Carson received numerous honors and awards including more than 30 honorary doctorate degrees for this procedure and he was respected by many. (Gifted Hands: The Ben Carson Story, Thomas Carter) Dr. Ben Carson made a very big impact on separating conjoined twins and his success is a story told by many . Dr. Carson once said, “I’m a good neurosurgeon. That’s not a boast but a way of acknowledging the innate ability God has given to me. Beginning with determination and using my gifted hands, I went on for training and sharpening for my skills.” (Ben Carson) The second reason to consider the surgical separation of conjoined twins is ethical. First, parents have to consider is it morally correct to separate the twins even though one of the twins could die during this risk procedure? According to the article “Conjoined twins: whose best interest should prevail? An argue for separation”, the author Rosalie Mainous mentions that it’s better to save one life than to passively allow the death of one of the twins. She also mentions “The parents have made the decision to separate the twins based on the assumption that Twin B would have made that sacrifice on her own if she could do so.” If the twins get separated when they are first born they obviously can’t make the decisions for separation for themselves, so the parents make this decision based on both babies health. However, do parents have the right to refuse separation surgery? The ultimate decision to separate their infant twins is up to the parents. They are the ones that have to live with their child’s disability later in their life. An example of a story when the surgery of conjoined twins was unsuccessful,but necessary was when twin girls who were just 22 months old arrived at Mass General Hospital. These two infant sisters were fused at the pelvis and abdomen and shared only three legs. The twins also shared several vital organ systems. Although, each child had their own spinal cord, brain, and heart. “Twin B was larger, alert, vigorous, and interactive, whereas Twin A was less active and more difficult to engage,” the medical examiners wrote in the case study that they published in the New England Journal of Medicine. (Ferger, 2) Twin A was unfortunately diagnosed with a heart condition and was living off of Twin B’s blood supply through an artery that was connecting the two. At this point in time, Twin A was dying and if the medical team didn’t do anything quick both twins would die. Their last hope was to visit Mass General hospital for a very complex surgery for both twins to be separated. This separation was very high risk especially for the healthy child (see addendum 3 for cardiac anatomy of the twins). “We spent a lot of time talking about this, and would we be willing to do it and we went through all that emotional work,” Cummings said. “Some people think separating them when you know one will die is an act of killing, and other people think it’s the only humane thing.” The decision to separate these twins involved an ethical relocation whether the girls should be treated as one or two patients. “Twin A is considered to be a parasitic twin, since she was surviving off the life of her sister.” (Ferger, 4) This means that since one of the twins is undeveloped, the other twin is considered to just be apart of their body, just like an extra arm or leg. Dr. Cummings made it clear that since the twins have two different heads, therefore brains they should be identified or treated as two different individuals. In the end the final decision was up to the parents and they made the right decision to separate. Since the parents were not willing to be interviewed by the media, “they told the doctors the most difficult part of the process was the uncertainty of the surgical separation. And knowing with certainty what would happen regardless that Twin A would die.” (Ferger,4) After a 14 hour long surgery, Twin A died in the process. According to the parents Twin B is very healthy and is meeting all her milestones.The chances for independent living increase with the separation. Another ethical reason to consider separation of conjoined twins is the psychological benefits. Through separation, each twin is allowed to have a more defined, independent identity. Living life as a conjoined twin completely eliminates the possibility of privacy. Being physically attached to your sibling (chest, hip, or head) changes the type of bodily functions they share. Having your own identity is very important to your mental health when you are a conjoined twin. With conjoined twins, 98 percent of all sets each person has their own separate and different thoughts and feelings. (Olson,3) Craniopagus twins however, which are very rare share the same brain activity, since they are connected at the skull. An example of this would be the case of 8-year-old Tatiana and Krista Hogan. These twins were born conjoined at the tops of their heads and their mental processes affected each other by touch, thinking, and even eating! If one twin’s leg is touched, the other would feel it. When they write, their mind is prompted to anticipate the next word. When one twin eats something they dont like, they will definitely taste it. When Krista eats ketchup, Tatiana will scream.In most cases, each set of twins develop their own lifestyle and set of activities they complete. Just because twins are conjoined doesn’t mean that they can’t carry out daily activities as normal people can. Conjoined twins are seen swimming,running, and even bike riding. Of course when completing these tasks they have to work hard together as one. “I don’t think there’s anything that they won’t try or something that they couldn’t be able to do if they really wanted to,” said Paul Good (principal of conjoined twins at their school). Many people wonder and question the personal and private life of conjoined twins. This includes dating and sexual activities. Before separation occurs, parents may also consider the religious aspects on deciding whether to separate or not. The Protestant view on the separation is that it is “permissible to sacrifice one life for the good of a child that medically has a reasonable chance for survival.”(Mainous, 6) Catholicism has not forbid the separation of twins, but forbids the intentional killing of one twin. (Mainous, 6) It has been argued in the Catholic Church that the good of saving one life canceled out the sin of sacrificing the weaker twin.Scientists believe that conjoined twins develop from a single fertilized egg that fails to separate completely when it divides (refer to addendum 2). Conjoined twins are genetically identical, which means they are alway the same sex. These twins develop from the same fertilized egg and also share the same placenta and amniotic cavity. (University of Maryland Medical Center). When a woman is pregnant with conjoined twins, she only produces a single egg, which does not fully separate after fertilization. According to the University of Maryland, “the developing embryo starts to split into identical twins during the first few weeks after conception, but stops before the process is complete. The partially separated egg develops into a conjoined fetus.” (University of Maryland)This paragraph should be about the medical advances, including procedures, the education of surgeons and nurses, and technology. There are indeed risks to consider in the separation of conjoined twins. There are also the ethical or religious issues to consider. First, any surgery has risks of complications. The risks of the separation of conjoined twins can differ by the way they need to be separated. Some specific risks involved in the separation of conjoined twins include blood clots in new blood vessels, bleeding in the brain, heart complications, and even infections in the body. If the conjoined twins can be successfully separated, there are other great risks involved in this procedure which include complications undergoing anesthesia. Next, an example of a surgery that was unsuccessful was in Bahia, Brazil. Born in April 2009, Arthur and Heitor Rocha Brandao are joined at the liver,bladder,intestines, and genitals. The five year old twins undergo a 15 hour separation surgery. Unfortunately, due to heart complications Arthur died three days after the procedure of cardiac arrest. Another case that was unsuccessful in separation history was when twins Joshua and Jacob Spates were born on January 24, 2011, in Memphis, Tennessee. These twins were joined back to back at the pelvis and lower spine but each with separate hearts, heads and limbs. On August 29, 2011 they are successfully separated after a 13-hour surgery. A month later, Jacob Spates passes away and the cause of this death is unknown.Finally, this paragraph is your conclusion.