蘇菲的抉擇？——分割連體嬰的倫理難題

Sophie's Choice? The Moral Dilemma Concerning Conjoined Twins

Abstract

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

本文以西元兩千年八月誕生在英國曼徹斯特的連體嬰姊妹喬蒂與瑪麗的案例為基礎，來探討連體嬰的倫理問題。這個個案由於它的獨特性與爭議性，受到西方各國媒體高度的注意。文分四部分，首先鋪陳個案的來龍去脈，使讀者對於相關的事實與發展有一個大概的理解。其次，本案倫理爭議的焦點在於是否可以給這對連體嬰施行分割手術，各方對此有許多不同的立場。因此有必要將最主要的觀點與正反意見加以介紹。接下來則根據倫理學的思考方式，對各種不同立場，進行批判性的反省。反省的重點不在於肯定成否定某種結論，而在於檢視各個立場背後的理據或論證。最從一部分是綜合反省。透過對於各種不同立場的批判，筆者將提出自己的看法並說明主要理由。

This article deals with the moral dilemma of a sensational case of conjoined (often called Siamese) twins who were born in Manchester, England, on Aug. 8, 2000. The most controversial issue in this case is whether it is morally permissible to separate them surgically foreseeing that one of the twins will die in order to save the other. I argue that the separation surgery is morally justified.

My argument consists of four steps. First of all, I outline the most significant facts without going into irrelevant details; In this case, the medical indication leaves no doubt that both twins will die within months if not separated; but if separated, one will die immediately while the other could live a long life. Doctors in the hospital insist then on the moral and legal permissibility of the surgery, but the parents have a different opinion and cannot agree to it. So the case came before the courts where the decision whether or not to permit or to refuse the medical treatment would be made. The Supreme Court at last decided for the separation on the 22nd of September, 2000, and the surgery took place in November of the same year. As predicted, one died and one survived.

Secondly, different positions - the pros and cons - on the issue are presented: (1) the parents of the conjoined twins and the Catholic Church .in England oppose the separation. The parents cannot imagine that one of their children should die to enable the other to survive. Supporting this idea, Archbishop of Westminster Cormac Murphy-O'Connor holds that there is a fundamental moral principle at stake. No one may commit a wrong action that good may come of it. Applied to this case, one is not allowed to kill in order to save. (2) Most physicians are for the surgery, and the legal system has also decided in their favor. Appeal is made to the principle of proportionate reason and the doctrine of necessity among other considerations. The issue of intentional killing is also carefully analyzed by the judges.

Thirdly, I will examine various arguments underlying different positions. The point of the examination is not so much an affirmation or denial of certain positions as a critical analysis of their soundness and consistency. Based upon this analysis, I present, lastly, my own arguments, which justify the separation surgery in this unique case.

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