Sun, Mar 07, 2004 - Page 5 News List

`Misadventure' the reason for twins' death, court says


A Singapore court ruled yesterday that "misadventure" was the cause of death for conjoined adult twins from Iran who died during surgery to separate them.

The Coroner's Court had heard three days of testimony on the deaths of 29-year-old Laleh and Ladan Bijani from massive blood loss at Singapore's Raffles Hospital following marathon 52-hour surgery to separate their tightly enmeshed brains on July 8.

"I am satisfied on the evidence before me that there is no one criminally concerned in these two deaths," said state coroner Malcolm Tan.

A coroner's court inquiry is standard procedure when people die under surgery in Singapore.

The team of 28 doctors and about 100 assistants was led by Dr. Keith Goh of Singapore and assisted by Dr. Benjamin Carson of Johns Hopkins University Hospital, who was recently appointed to US President George W. Bush's Council on Bioethics.

Twins joined at the head occur only once in every two million live births. Surgery on adults had been unprecedented.

Singapore doctors had successfully performed the operation on infant girls from Nepal in 2001 and South Korean baby girls joined at the spine last year. US doctors also separated two-year-old Egyptian twins conjoined at the head in October.

Tan said he was satisfied that the doctors had done all they could to save the twins when massive blood loss occurred towards the end of the separation procedure.

"This is not a case where so-called Gods in white have arrogated to themselves the decision to conduct a risky operation on these young ladies," he said

"All the evidence points towards the opposite conclusion," he said, noting that the women themselves had desperately sought a separate existence for each other and the doctors had responded to their plight.

"What they sought to do was to help the girls. All of us mourn that they could not."

Alireza Safaian, an Iranian doctor who adopted the twins and raised them for 27 years, had accused the surgeons of killing the women. A neurosurgeon in Germany, Madjid Samii, who declined to separate them when they were 14 years old, has said he was stunned it was even attempted.

Goh had testified that he had explained to the women the serious risks involved and showed the court a 20-minute video in which he tells the twins, who were both lawyers, that they could die or fall into a coma if the operation failed.

Carson has said he never thought the operation had a reasonable chance of success and that the surgeons had tried to convince the twins not to pursue the operation but the women had insisted.

Bush appointed Carson in February to his Council on Bioethics which advises the White House on cloning and related medical issues.

Many hours into the surgery, Carson had felt strongly that surgeons should stop -- even though the twins had asked doctors earlier to continue at all costs -- because a new circulatory pattern in the twins' brains had been discovered.

But he said a relative of the twins had vetoed the idea.

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