Sunday, April 19, 2009

Separation of conjoint twins - where are our medical ethicists when you need them?

Minister of Health Khaw Boon Wan has taken an important public position (today's ST) on the past attempts and present intent to separate conjoint twins.

"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 operations 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.

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

The previous surgical attempts have left many doctors and ethicists dumfounded. To many, they were mainly attempts to do heroic operations for no other reason than self glorification. The only people who would truly benefit from the operations were the surgical teams and the institutions involved.

So Mininister Khaw should be congratulated for speaking out against it.

But where were our local medical ethicists when you needed them? And where was the Singapore Medical Council? Why didn't they have an opinion about the surgery?

What worries me also is the fact that the past surgery had been vetted and approved by the hospital ethics committee. One could question how objective and independent they were in coming to their decision. Or were they functioning more as advocates for the surgical team?

The workings of institutional ethics committees need to be seriously audited so that the public can be confident that they will independently act in the public's interest and not just pay lip service to ethical standards, while glancing at the hospital's bottom line. These processes will have to come under greater scrutiny if we are to go down the organ trading road. So much will hinge upon our ability to do things ethically.


auntielucia said...

I don't know who makes up a medical ethics committe but if members are mainly from the medical profession or in related professions such as pharmacists or scientists, then obviously there's little breadth.

As for operating on conjoined twins, I thought we celebrated the Nepalese separation, as tho it was a modern day miracle.

I think one way to stop such experimental ops is to stop funding them, whether by charities or soft hearted pple. Unless pple like Keith Goh and others who want to do the ops can undertake to give their patients lifelong post op support, thru thick and thin.

gigamole said...

I will try and post a bit later about the medical ethics environment in Singapore. I see the NMEC came up with some wise words today, but I haven't really had time to read yet. Pretty busy today trying to meet several deadlines.

nofearSingapore said...

Hi giga,
There are many things about Khaw Boon Wan that I like and here is exatly one of the reasons why.
As a doctor, there are many things I want to say but I can't.
I am glad KBW is not a doctor and hence is not similarly restrained.

gigamole said...

Yep....I must confess to being very disappointed in our medical council and the shadowy NMEC for not taking a stand on this sort of self aggrandizing behaviour.