The 29-year-old sisters Ladan and Laleh Bijani had made it clear
they were willing to risk death in high-risk surgery for a chance to
pursue separate dreams and live out their lives in different cities.
"They gambled and have lost," was the verdict of Singapore's
Straits Times newspaper, which nevertheless noted the unprecedented
procedure was "history in the making."
"It is not the done thing to talk about boosterism when patients
have died," it said in an editorial.
"But, wrung of its emotion in what was literally a clinical job,
Singapore will gain in international renown for its medical advances
when the verdicts of professional peers are in."
The man who brought up the sisters in Iran, however, could only
feel bitterness and anger at their deaths.
"We shared a house for 27 years and I feel a great emptiness,"
said Alireza Safaian, who adopted the twins as children.
"KILLED THEM"
A doctor himself, Safaian wept as he spoke to Reuters at his home
in southwestern Tehran of his distress at the decision of his
daughters and the Singapore doctors to go ahead with an operation
other surgeons had deemed simply too risky.
"When they took them to Singapore, I knew they would bring back
their bodies. They took them there and killed them," he said.
"Me and my brother, who is a doctor in Germany, we told everyone
that this separation surgery was impossible." Twins joined at the
head occur only once in every two million live births. A separation
operation had never been performed on adults.
A neurosurgeon in Germany who declined to separate the twins when
they were 14 said on Tuesday he was stunned the operation had even
been attempted.
Madjid Samii, president of the International Neuroscience
Institute in Hanover, said he had reluctantly turned down the
request of the twins.
He had decided after a month of examinations in 1988 that a
shared vein that drained blood from their brain to their hearts
meant the sisters' chances of survival were almost nil.
The Singapore doctors involved in the surgery admitted they, too,
stopped the operation at one point in the later stages of the
50-hour long procedure to discuss their options.
"The team wanted to know once again what the wishes of Ladan and
Laleh were, and were told that their wish was to be separated under
all circumstances," said Dr. Loo Choon Yong chairman of the Raffles
Medical Group, which runs the hospital where the operation was held.
IRANIAN PRAYERS
About 15 Iranians, mainly men, gathered at a private residence in
Singapore on Wednesday morning to hold prayers for the twins and a
formal service at a local mosque was due to be held later in the
day.
Iran cut into scheduled programming to announce the deaths to
viewers who had been glued to their TV sets as the media provided
continuous updates of the 52-hour operation by 28 specialists and
100 assistants.
"It is a sad day for Iran," Vice President Nohammad ali Abtahi
told Reuters.
Facing the world's media last month, Ladan had said she and her
sister had no fear: "We know that every surgery has a high risk."
Laleh, sharing a cream headscarf, added: "We would like to see the
face of each other without the mirror."
The pair were named after flowers in their native Farsi and
Iranian ambassador Shaban Shahidi Moadaab said: "Today these two
flowers do not exist any more."
Australian medical ethicist Nic Tonti-Filippini said consent of
the patients was not reason enough to proceed with the surgery.
"A lot of people say it's good enough if they consent. But it's
not good enough if they consent. The profession actually has to be
satisfied that it's a safe enough procedure," he told Reuters.
Dr. Richard Ashcroft, head of medical ethics at London's Imperial
College, called it "a genuine moral dilemma."
"And where you have a dilemma, people will make different
decisions because there is no obvious answer what the right thing to
do is."
