Medical Ethicist Discusses Conjoined Twins And Other Challenging Treatment Decisions

Dr. Laurence McCullough is a medical ethicist that consults with pediatricians at Texas Children’s Hospital. He also teaches future doctors at Baylor College of Medicine.

Dr. Laurence McCullough


On Feb. 17, surgeons at Texas Children’s Hospital successfully separated conjoined twin girls in a 26-hour surgery. The complex procedure was a first for this particular type of thoraco-omphalo-ischiopagus twins: the ten-month-old girls were born face to face, joined along their front torsos from chest down to pelvis.

Doctors had to untangle and separate their lungs, the lining of their hearts, a shared liver, intestines and urinary and genital structures. They prepared the twins’ skin for surgery using tissue expanders, and used 3D computer models to strategize their approach; they also conducted a five-hour simulation and practice run.

Before all that, however, Dr. Laurence McCullough was quietly behind the scenes, consulting with the family and medical team on any ethical implications.

McCullough is a medical ethicist at Texas Children’s Hospital, and the Professor of Medicine and Medical Ethics at Baylor College of Medicine.  He is not a physician; his doctorate is in philosophy. But he has spent years training medical students and residents, and consulting on patient cases where treatment decisions are unclear or morally difficult.

In a conversation with News 88.7 Health and Science reporter Carrie Feibel, McCullough discussed health care costs, end-of-life legislation, and the ethics of operating on conjoined twins. In the case of risky surgery for conjoined twins, some cases are not clear-cut. McCullough suggested that one approach might call on the principle of “double effect.”

“The principle of the ‘double effect’ comes from Roman Catholic moral theology, it’s actually a very old idea,” McCullough said.

“It’s the idea that a single action has two separate outcomes or effects: one that’s acceptable ethically, and one that’s not acceptable ethically. As long as the unacceptable effect is not a means for achieving the acceptable effect: if separating the twins would actually kill the one twin, then that would not be permissible in that approach.”

But McCullough added that there are competing philosophical frameworks available for ethicists, families and doctors.

“Another (ethical) approach would simply say it’s better to have one survivor than none, placing a paramount value on human life and accepting horrible and tragic circumstances. And you would justify (a risky surgery) that way.”

“Both pathways are controversial,” he added.






Florian Martin

Florian Martin

Business Reporter

Florian Martin is currently the News 88.7 business reporter. Florian’s stories can frequently be heard on other public radio stations throughout Texas and on NPR nationwide. Some of them have earned him awards from Texas AP Broadcasters, the Houston Press Club, National Association of Real Estate Editors, and Public Radio...

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