For many parents, seeing their newborn child for the first time is nothing short of a miracle. As seen in countless movies and television shows, these newborns are usually healthy living beings, from their pink, wrinkled faces all the way down to their ten fingers and toes. However, this scenario is not always a reality for parents; between three and five percent of all babies born in the United States suffer from some kind of birth defect or deformity. One of the most unusual problems is the birth of conjoined twins. This rarity leads to the controversial issue of whether or not separation surgery should be carried out in order to allow both children to lead separate lives.

Conjoined twin births are extremely rare among populations. When they do occur, most parents begin to consider the option of separation surgery for their children. In some cases, separation surgery is the only option that will ensure both children will continue to live. However, in may cases, conjoined twins are able to live together for many years without severe complications. In these instances, parents or twins themselves may choose to have separation surgery in order to live a more normal life.

The process of separating conjoined twins is a daunting task. Preparation for such a specialized surgery can last between several months to years. Typically, this procedure may involve numerous specialists, surgeons, and nurses from around the world. Due to the extreme risks involved in this procedure, all professionals need to be given ample time to plan their tasks and prepare for any possible obstacles that may arise in the operating room. The chance of a successful surgery will vary depending on the age of the twins, where they are conjoined, and how deeply they are connected. [1].

Earlier this year, the separation of twenty-nine-year-old Iranian sisters Laleh and Ladan Bijani in Singapore made international headlines. Their surgery was considered to be particularly risky because it was the first attempt at separating adult twins conjoined at the skull. The principle medical team was comprised of nearly thirty international specialists. After extensive planning followed by many hours in the operating room, the surgery ended unsuccessfully. Afterwards, many questions were raised about whether the surgery was worth the risks taken. Some critics felt that the surgery should never have been attempted to begin with. Others believed that doctors may have been overly optimistic when predicting the women would have a fifty percent chance of survival. In fact, a German doctor who labeled the surgery to "have no chance of success" had turned the girls away years earlier [1]. However, many ethicists maintain that the physicians acted in complete ethical fashion. Not only did they create a very skilled team, but they also took reasonable chances and made certain the twins fully understood the risks before the surgery. Furthermore, the sisters made it clear before the procedure that they preferred to risk dying rather than to continue living life as conjoined twins[1].

Although the Bijani twin surgery was unsuccessful, there have been many successful separation cases. Many of these successful surgeries occured in younger twins, due to the fact that children's bodies tend to adapt more easily and recover better than mature adults. For example, recently Ahmed and Mohamed Ibrahim, two-year-old Egyptian twin boys conjoined at the head, made it through the surgery without any major complications. Doctors still remain cautious because they cannot yet predict whether or not the boys will suffer side effects such as brain damage [2].

Conjoined twin separations are often viewed as not only innovative and experimental treatments, but highly controversial ones as well. For risky and complicated experimental procedures such as these, it is imperative that doctors clearly explain the risks and uncertain nature of the surgery to the patients. It then becomes the patient's responsibility to make a choice regarding their available options. Should they decide to have the surgery, they not only need to understand the possible fatal outcomes of the procedure but also must be willing to accept the results. If the twins involved are not emotionally and mentally stable enough to make a good choice, the decision is ultimately left to guardians or family members [1].

However, for twins who are extremely young, the decision-making process can be become more complicated. Some experts feel that the twins themselves should make the decision when they are of suitable age. Others believe that the parents ultimately have the right to decide whether separation is right for their children. If parents wait to let the children make the decision themselves, their chances of survival may decrease owing to the finding that younger children will generally have higher recovery rates. Thus, many factors must be taken into consideration when deciding if separation surgery is the best option available. Simply being able to separate conjoined twins with some success is an amazing medical accomplishment. At the same time, it presents one of the greatest risks taken in medicine, and its outcomes often raise many ethical questions and dilemmas. Despite improved, more accurate medical technology, there will always be many uncertainties when performing an operation of this scale. However, each procedure performed, whether successful or not, will undoubtedly provide both experience and valuable knowledge for the next attempt that will take place.