Operation: "Separating Conjoined Twins" | Neurosurgeon Keith Goh disagrees with the Health Minister Mr. Khaw Boon Wan

So who shall have the final say?

Published on 19/04:

Three of the four twins joined at the head who were separated in operations here are dead, and the fourth is not in good shape.

Given this track record and the similarly dismal results overseas, Health Minister Khaw Boon Wan on Sunday suggested that doctors reconsider plans to separate yet another pair of such conjoined twins.

Indian twins Vani and Veena, five, will go under the knife at East Shore Hospital in August, if the medical team involved decides to proceed with the operation.

Neurosurgeon Keith Goh, who was involved in the marathon surgeries here to separate the two earlier sets of twins joined at the head, has been asked by the state government of Andhra Pradesh in India to carry out the surgery.

Speaking to reporters on Sunday at a grassroots event, Mr Khaw said that doctors would likely end up harming the patients, and should not attempt such operations.

'Surgeons, in some instances, have to pick one twin to die to save the other. Even those who survived would often be left with brain damage. So, to what extent is this quality of life?'

International studies have shown the chances of surviving surgery for 40 pairs of twins joined at the head was rated 50:50 - one twin would not survive the operation.

And the Health Minister said the outcome of the two operations here 'reaffirmed these awful statistics'.

In 2001, a team from the Singapore General Hospital separated 11-month-old Nepali conjoined twins Ganga and Jamuna.

Ganga, the weaker twin, died at age eight from a severe chest infection while Jamuna, the surviving twin, had numerous complications, including a potentially-fatal problem with her spinal cord.

From Straits Times, "Reconsider plans: Khaw".

And on 21/04:

A prominent Singapore doctor said Monday it was "premature" to rule out an operation to separate Indian twin sisters joined at the head despite a warning from his own country's health minister.

Neurosurgeon Keith Goh, who had been asked by the state government of Andhra Pradesh in India to separate five-year-old twins Vani and Veena, said he was still in discussions with doctors and officials in Hyderabad on the case.

Goh said he would not be able to confirm any surgery until more thorough investigations had been carried out.

But he disagreed with published remarks by Singapore's Health Minister Khaw Boon Wan cautioning that an operation is more likely to harm the patients than improve their situation.

"I think that Mr Khaw is entitled to his opinion... but that it is a little too premature to close our minds to the possibility of doing such an operation, especially when the full evaluation and all the investigations have not been done," Goh told AFP.

He also disagreed that separating conjoined twins amounted to changing the course of nature.

"Nature never intended for any of us, humans or animals, to be conjoined to another individual," Goh said.

The Indian twins "represent a most extreme form of congenital malformation and deformity, and should be considered an aberration of what nature intended", he said.

"If such patients ask for help to correct their abnormalities, I feel that we, as doctors, owe it to them to see what we can do."

Health Minister Khaw said in remarks carried by the Straits Times on Monday that in certain situations, it may be better not to operate on conjoined twins.

He also said that in some cases, surgeons have to pick one twin to die in order to save the other, and the survivor is often left with brain damage.

In 2001, Goh was involved in a 97-hour operation that separated 11-month-old Nepalese twins Ganga and Jamuna Shrestha, who were born with fused skulls.

The surgery left Ganga with brain damage and Jamuna unable to walk. It also left a hole in Jamuna's skull covered only by a layer of skin.

Ganga survived for seven years before dying last year from respiratory problems at a hospital in Kathmandu.

Goh was also involved in the tragic operation of 29-year-old Iranian twins - Ladan and Laleh Bijani - in July 2003. Both women, joined at the head, died from severe blood loss following a 52-hour operation.

"Let me point out that Ganga and Jamuna both survived the separation surgery, and that Ganga's survival after the surgery was seven years, dying only because of a chest infection," Goh said.

"Jamuna is still surviving and is a happy, intelligent and delightful child, although she has some limb weakness."

Goh said his preliminary assessment of Vani and Veena showed their clinical condition is very similar to that of the Nepalese twins.

He believes a "better outcome" can be achieved with the Indian pair because "the collective experiences and knowledge of all the centres worldwide which have done such conjoined twins surgeries is much more than in 2001".

From Asiaone, "I disagree with the Health Minister: Neurosurgeon Keith Goh".

Or perhaps, like what the Associate Professor Roy Joseph--the chairman of the National Medical Ethics Committee (NMEC)--stated: "No single party has the right to make a unilateral decision when faced with a risky medical procedure."

No single party has the right to make a unilateral decision when faced with a risky medical procedure - such as the separation of twins joined at their heads - said Singapore's top ethicist.

Associate Professor Roy Joseph, who chairs the National Medical Ethics Committee (NMEC), said doctors and hospitals have a 'large responsibility' when evaluating such treatment.

But it should be a team decision - involving also patients, their family and other relevant team members - which should consider all relevant medical and non-medical considerations.

From Straits Times, "Doctors to decide on treatment".