Re A (Children) (Conjoined Twins: Surgical Separation)

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Re A (Children) (Conjoined Twins: Surgical Separation)
Royal Coat of Arms of the United Kingdom.svg
Court Court of Appeal of England and Wales
Full case name A (Children)
Decided 22 September 2000
Citation(s) [2001] 2 WLR 480, [2000] 3 FCR 577, [2000] HRLR 721, [2001] Fam Law 18, [2000] Lloyd's Rep Med 425, [2001] Fam 147, [2000] EWCA Civ 254, 9 BHRC 261, (2001) 57 BMLR 1, [2000] 4 All ER 961, [2000] Lloyds Rep Med 425, [2001] 1 FLR 1, [2001] UKHRR 1
Court membership
Judge(s) sitting Lord Justice Ward, Lord Justice Brooke, Lord Justice Robert Walker
Necessity, Medical law

Re A (Children) (Conjoined Twins: Surgical Separation) [2001] 2 WLR 480 [1] is a Court of Appeal decision on the separation of conjoined twins. The case raised several legal, ethical and religious dilemmas including whether it would be permissible to kill one of the children to save the other,[2] and whether it was permissible to act against the wishes of the twins' parents.[3]

Both Jodie and Mary, who were born on 8 August 2000,[4] were pseudonyms given to conjoined twins, Rose and Grace Attard,[5] who were joined at the pelvis. The medical evidence indicated that Jodie was the stronger sibling who was sustaining the life of Mary. Mary had only survived birth due to a shared common artery that enabled her sister Jodie to oxygenate blood for both twins. If surgically separated Jodie had a 94% survival rate but Mary was guaranteed to die. However if they were left conjoined then Jodie's health, which was already rapidly deteriorating, was predicted to fail before they were six months old. Jodie's death would inevitably result in Mary's.


At first instance, Mr Justice Johnson was left to decide the case without any direct precedents to guide him[6] but reasoned by analogy with Airedale NHS Trust v Bland where it was declared acceptable to remove life support. Johnson ruled that separation would not be murder but a case of "passive euthanasia" in which food and hydration would be withdrawn.[7]

The Court of Appeal rejected this analysis but the three judges who presided over the case gave very different legal reasoning. Lord Justice Alan Ward invoked the concept of self-defence suggesting that "If Jodie could speak she would surely protest, Stop it, Mary, you're killing me."[8] Lord Justice Brooke relied upon R v Dudley and Stephens and invoked necessity as a defence. Lord Justice Robert Walker focused upon the intention of the surgeons in concluding that surgery could go ahead.[citation needed]


The operation to separate the twins took place on the 7th November 2000.[4] As expected Jodie survived the operation, but Mary died. Mary's remains were later buried on the Maltese island of Gozo.[6]

See also[edit]


  1. ^ "Re A (Children) (Conjoined Twins: Surgical Separation) [2001] 2 WLR 480 (22 Sept 2000)". Retrieved 2013-01-30. 
  2. ^ Mcallister, J.F.O. (2000-09-18). "Kill Mary to Save Jodie?". TIME magazine. Retrieved 2010-09-18. 
  3. ^ Allen Jr., John L. (February 2001). "Sophie's Choice". Retrieved 2010-05-14. 
  4. ^ a b "Jodie and Mary: The medical facts". BBC News. 2000-12-07. Retrieved 2010-06-09. 
  5. ^ Harris, Paul. "Amazing Grace: three years on". London: Daily Mail. Retrieved 16 Feb 2013. 
  6. ^ a b "Siamese Twins Case Presents Serious Legal Doubts". Retrieved 2010-05-14. 
  7. ^ Annas, George, Conjoined Twins - The Limits of Law at the limits of Life, Volume 344:1104-1108 April 5, 2001 Number 14
  8. ^ "NEJM - Conjoined Twins - The Limits of Law at the Limits of Life". doi:10.1056/NEJM200104053441419. Retrieved 2010-05-14. [dead link]

External links[edit]