(30/Nov/2001 生命倫理学読書会発表用)
受精卵が一卵性双生児になるときに分離しそこねたときに生じる。 10万の出産に1の割合で起きる。生存率は5%から25%。 4割から6割が死産、3割方が出産した日に死ぬ。 (BBC NEWS `Siamese twins' 25/Aug/2000)
参考サイト:
ジョディとメアリという名前は仮名。 (後に本名が発表される)
双子を分離するとメアリは死ぬがジョディは95%生きる (普通の知性、歩行可能、出産可能、平均余命)。 手術をしなければジョディの心臓に過度の負担がかかるために (ジョディの心臓、肺、大動脈が二人のあいだで共有されている)、 8-9割方3ヶ月から6ヶ月のあいだに二人とも死ぬ。 生後3ヶ月ぐらいに手術をするのが最適。
`The twins were joined at the abdomen and had a fused spine as well as sharing bladder. Jodie has a normal brain, heart, lungs and liver. She has normal legs but her hips were dislocated, causing the legs to lie at right angles to her body. She will have had surgery on her bowel and bladder and orthopaedic surgery to relocate her hips. One of the trickiest parts of the operation will have been the separation of the spines where a false move could leave Jodie paralysed.' (07/Nov/2000 Independent)
`[Mary's] face is deformed and she has no effective heart or lung function and she probably has braid damage. Her sister is effectively her life support machine.' (Guardian 26/Aug/2000)
二人が結合している様子については、 BBC NEWS (Jodie and Mary: The Medical Facts)を参照。
アタードAttard夫妻(Michaelangelo and Rina): マルタ共和国ゴゾ島(98%ローマカトリック)で妊娠。 妊娠初期にシャム双生児をみごもっていることがわかり、 出産のために5月に英国に来る。
はじめはプライバシー保護のため、 "remote" countryから来たとだけ報道されていた。 (cf. Deborah Orr 23/Sep/2000 Independent)
We cannot begin to accept or contemplate that one of our children should die to enable the other one to survive. That is not God's will.
Everyone has the right to life, so why should we kill one of our daughters to enable the other one to survive?
We have very strong feelings that neither of our children should receive any medical treatment.
Guardian 26/Aug/2000
http://news6.thdo.bbc.co.uk/hi/english/health/newsid%5F895000/895822.stm
手術の許可を得られるように、Central Manchester healthcare NHS trust (保健当局)が訴訟を起こす。
Mr Justice Johnson:
I conclude that the few months of Mary's life, if not separated from her twin, would not simply be worth nothing to her, they would be hurtful. To prolong Mary's life ... would ... be very seriously to her disadvantage. (Guardian 26/Aug/2000)
両親はこの判決に納得せず控訴院へ。
判決に先立ち、 カソリックとプロライフアライアンスが参考意見を述べることが許される。
Cormac Murphy-O'Connor, the Archbishop of Westminster: to save the life of Jodie at the expense of the weaker Mary "should be regarded as morally impermissible."
Though the duty to preserve life is a serious duty, no such duty exists when the only available means of preserving life involves grave injustice. (15/Sep/2000 Independent)
A precedent might be set in English law that could allow an innocent person to be killed, or lethally assaulted to prolong the life of another. (23/Sep/2000 Independent)
`This tragic case is justifiably causing great distress to disability groups in this country and worldwide.' (07/Nov/2000 Independent)"The eugenic reasoning adopted by the judges is a severe blow to the rights of the weak and disabled, and enshrines in English law a terrifying precedent which leaves the most vulnerable members of society in grave danger." (The Guardian Weekly 28-9-2000, page 1)
「手術をしなければ二人とも二年程度生きるかもしれない」という セカンドオピニオン (15/Sep/2000 Independent)
"The question is simple - do you kill one to save the other, or do you let two die?" (BBC NEWS `Judge: An excruciating decision', 22/Sep/2000)
問われるべき問いは:
裁判長(Lord Justice Ward)の見解:
"[Mary] sucks the lifeblood of Jodie and her parasitic living will soon be the cause of Jodie ceasing to live.... She is designated for death." (23/Sep/2000 Independent)
"In my judgement the only solution is to balance the welfare of each child against the other to find the least detrimental alternative." (BBC NEWS `Siamese twins: judgement', 22/Sep/2000)
家族法的には上の議論のとおり。 刑法的には以下の問いが問われるべき。
Three conditions for the doctrine of necessity.
手術はジョディとメアリの双方にとって最善の利益。 今のままでは身体的全一性と人間の尊厳が損なわれている。 したがって二つの生命を比較する必要なし。
`The worst tradition of English utilitarianism' (Independent Opinion 23/Sep/2000)
"I express dismay at the judgement that has been reached as it amounts to the direct killing of an innocent person, whose basic right to life will be denied." (The Roman Catholic Archbishop of Birmingham Vincent Nichols, BBC NEWS `Siamese twins: The reaction' 22/Sep/2000)
"Ultimately, it is better to preserve one life rather than lose two." (Rabbi Dr Jonathan Romain, a spokesman for the Reform Syngogues of Great Britain, BBC NEWS `Siamese twins: The reaction' 22/Sep/2000)
"Contrary to what is claimed by critics of this decision, this decision was pro-life and we must be wary of people declaring that they know God's will when it conflicts against the interests of others." (Lib Dem MP Dr Evan Harris, who sits on the BMA's ethics committee, Great Britain, BBC NEWS `Siamese twins: The reaction' 22/Sep/2000)
`It is difficult to see how Mary's right to life could encompass a right to the organs and life of her sister as well. [...] Unless Mary had a moral entitlement to the use of Jodie's vital organs as the sole source of her inevitably doomed existence, it would have been unfair not to attempt to free Jodie from the mortal sacrifice being exacted from her by that role.' (Alex John London, Hastings Center Report, Jan-Feb 2001, 49)
両親、貴族院あるいは欧州人権裁判所への上訴を断念。
03/Nov/2000、プロライフアライアンスが貴族院に上訴するために オフィシャルソリシター(Lawrence Oates)の代わりにメアリの 法的保護者となろうとするが認められず。 (07/Nov/2000 Independent)
聖マリア病院のAlan DicksonとAdrian Bianchiが執刀医。 予期された通り、メアリは手術中に死亡。 ジョディについては手術は成功し、 今後ほとんど障害を持つことなしに生活することが可能。
両親がテレビのドキュメンタリー番組に出るかわりに推定15万ポンド(約2700万円)受けとることに承諾。
`Hopefully, one day we will all go back together, taking Jodie back with us, and Mary because she is part of our family and will be close to us all the same. We still love them the same, they are both our daughters.' (Guardian 07/Dec/2000)
"We were upset that we lost the cases because we always thought we should have the right to say what was best for our children and that the taking of life was wrong.
"The decision was taken out of our hands in the end but we are happy that the decision to separate was taken by the judges."
(http://news6.thdo.bbc.co.uk/hi/english/health/newsid%5F1392000/1392811.stm)
(Jodie=Gracie, Mary=Rosie http://news6.thdo.bbc.co.uk/hi/english/health/newsid%5F1392000/1392811.stm)
The fact that Mary is going to die anyway cannot possibly give anyone else the right to decide that her few months of life are not worth living, or that she would choose, were she capable of so doing, to sacrifice her life to save her sister's. (23/Sep/2000 Independent opinion)
高等法院と控訴院ではこの点に関して意見の相違。 そもそも「これが正解」という答が出せるのかという問題がある。 ただし、意見を表明できない患者について「死ぬのが最善の利益」という 推測をすることは危険が伴う。
「本判決は、承諾能力がない者の医的処置についての代行意思決定の 困難性を明確に示している。代行意思決定を認めるならば、 誰が、どのような場合に、どのような権限で、 どのような基準に基づきその医的処置を決定できるのだろうか。 裁判所、医師、代行意思決定者のそれぞれの権限および義務、 それらの関係はどうあるべきだろうか。その手続が重要であろう」 (千葉華月、「シャム双生児分離手術事件判決」、???)
法的には親にprima facieな代理決定権があるが、 病院側は治療拒否に対して裁判所に訴えることができる (1989年児童法)。
しかし、 両親の道徳的・宗教的確信を法と医学によってくつがえすことが許されるか。 (see Warnock 28/Aug/2000 Observer)
エホバの証人の事例
親が決めるべきだという意見:
`Their parents have rights ... in deciding issues as deeply personal and tragic as this one.' (23/Sep/2000 Independent opinion)
"It's far better to let the parents decide. I have to say that if I were making the decision myself and if I were convinced that one child would be saved then I personally would choose the operation. But I don't think my view or anybody else's view should be imposed on parents who conscientiously choose the opposite." (Prof. Raanon Gillon, editor of Journal of Medical Ethics, BBC NEWS `Siamese twins: The reaction' 22/Sep/2000, `Ethics expert: twin decision wrong' 22/Sep/2000)
「なぜ裁判所ではなく親が決めるべきなのか」 についてはあまり根拠が示されていないように思われる。
裁判所が決めるべきという意見:
`Whose job is it to decide questions of life and death but the courts?' ---Lord Justice Ward (22/Sep/2000 Evening Standard)
"The BMA believes that where parents and the healthcare team have different views that cannot be resolved, the court is the right place to consider the arguments and make a decision that reflects the broader values of society." (Dr Michael Wilks, chairman of the ethics committee of the BMA, BBC NEWS `Siamese twins: The reaction' 22/Sep/2000)
裁判官は公平な判断を下せる。
"I think it's a good way [that the courts deciding the case] - to have somebody who is not emotionally attached to the situation, who is not actually going to perform the operation to receive these fairly unbiased opinions and make a fairly unbiased decision as to what should be done." (Dr Harry Applebaum, BBC NEWS `Siamese twins: A surgeon's view, 22/Sep/2000)
問題は誰が決めるかよりも、何の基準によって決めるか。 子の最善の利益というならば、親はつねに子の最善の利益を考えるとは言えないし、 また冷静な判断をしていない場合もあるので、 最終的に裁判所が親の意見も考慮して決定するのが合理的だと思われる。
`The decision to deny permission for an action that would kill their child was perfectly within the scope of their parental authority. Suppose, for example, a child is a suitable organ donor for a sibling. If the parents did not want to subject one child to an operation to save the other, the courts would not order the surgery. In fact, one person may never be legally sacrifaiced for another. While those in favor of separating the twins have focused on the sacrifice that "should not be required of Jodie," this obfuscates a central legal fact: we do not believe that anyone should have to give up his or her life to save another. Therefore, while Jodie should not be sacrificed for Mary, neither should Mary be sacrificed for Jodie.' (Lori P. Knowles, Hastings Center Report, Jan-Feb 2001, p. 51)
cf. Raanon Gillon BBC NEWS `Ethics expert: twin decision wrong', 22/Sep/2000
メアリは腫瘍みたいなものか。
According to this [developmental or biological] view [of human life], Mary's life would hardly be regarded as the life of a human being, let alone one with an immortal soul. It would more plausibly be regarded as an assemblage of human tissues that would never result in a human person, and the removal of which from Jodie could be regarded as analogous to the removal of a tumour, an unwanted and destructive growth of cells, which are undoubtedly human cells, which are undoubtedly human cells, and alive, but are nevertheless not and never will be a human being.
---Mary Warnock (28/Aug/2000 Observer)
メアリはジョディと同じだけの生きる権利を持っているのか。 また、裁判ではそのように取り扱われていたか。
Mary's brain was described as primitive and her status akin to that of a parasite -- descriptions that allow one to see Mary both as a non-person and as morally blameworthy.
(Lori P. Knowles, Hastings Center Report, Jan-Feb 2001, p. 52)
エホバの証人: 輸血、ワクチン注射、臓器移植、角膜移植の禁止
キリスト教: 異教徒に対する臓器提供の禁止(1960-70年代)、 ヒトクローニング全面禁止(カトリック)
メアリ・ウォーノック: 宗教は地動説を受けいれたように現代の医学的知見を受けいれる必要あり。受精した瞬間に人格になるという考えは放棄すべき。
基本的な対立項は、 「二人死ぬより一人だけ死んだ方がマシ」という(功利主義的)意見と 「一人を生かすためにもう一人を殺すのはダメ」という(義務論的)意見だが、 そもそもこの双子は二人なのか、メアリは人格なのか、 メアリを死なせることは積極的安楽死にあたるのか正当防衛なのか、 などいろいろ解釈が揺れる。 また、「功利主義的見解が勝った」という見方が正しいのかも明らかでない。 (パレート最適という見方もなりたつ)
ジョディはメアリの生命維持装置であるというアナロジーは正しいか (Lori P. Knowles, Hastings Center Report, Jan-Feb 2001, p. 52)