Re A (conjoined twins) | |
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Court | Court of Appeal of England and Wales |
Decided | 22 September 2000 |
Citation | [2001] 2 WLR 480, [2000] 3 FCR 577, [2000] HRLR 721, [2001] Fam Law 18, [2000] Lloyd's Rep Med 425, [2001] Fam 147, [2000] EWCA Civ 254, 9 BHRC 261, (2001) 57 BMLR 1, [2000] 4 All ER 961, [2000] Lloyds Rep Med 425, [2001] 1 FLR 1, [2001] UKHRR 1 |
Case history | |
Prior action | Declaration of lawfulness to proposed surgery in the High Court |
Court membership | |
Judges sitting | Lord Justice Ward, Lord Justice Brooke, Lord Justice Robert Walker |
Case opinions | |
Appeal dismissed; however reasoning of single judge disapproved, decision made on fresh basis. | |
Keywords | |
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Re A [a] (conjoined twins) [2001] 2 WLR 480 [1] is a Court of Appeal (England and Wales) decision on the separation of conjoined twins. The case raised legal and ethical dilemmas. It was ruled it would be permissible to sever and thus kill in a palliative, sympathetic manner the weaker twin to save the much stronger one. [2] The case was among those where it would be lawful to conduct surgery against the wishes of the parents. The parents' faith was held not to be overriding, nor general applicability of the outcome to all such cases.[ clarification needed ]
Rosie and Gracie Attard, who were born in Manchester on 8 August 2000, were conjoined twins who were joined at the abdomen. [3] [4] During legal deliberations, they were given the public pseudonyms "Mary" and "Jodie", respectively. [5] The medical evidence showed that Gracie was the stronger sibling, sustaining the life of Rosie. Rosie had severe brain damage, very little heart function and no functioning lungs, and survived only due to a shared common artery supplied by Gracie. If surgically separated, Gracie was assessed as having a 94%-99% survival rate, but Rosie was guaranteed to die. If left conjoined, then their life expectancy was estimated to be around six months. [1]
Their parents, Rina and Michelangelo Attard of Xagħra, Gozo, Malta, had strong Roman Catholic beliefs. They did not consider abortion on learning that the twins were conjoined, and on their birth decided not to separate the girls, even if it meant both would die. [6] [4]
At first instance, Mr Justice Johnson was left to decide the case without any direct precedents to bind or guide him. [7] He relied primarily on Airedale NHS Trust v Bland where it was declared acceptable to remove life support. He ruled separation would not be murder but a case of "passive euthanasia" in which food and hydration would be withdrawn. [8]
The Court of Appeal agreed in outcome but rejected this analysis. The three appellate judges gave contrasting legal reasoning. Lord Justice Ward invoked the concept of self-defence suggesting that "If [Gracie] could speak she would surely protest, Stop it, [Rosie], you're killing me." [8] Lord Justice Brooke relied upon R v Dudley and Stephens and invoked necessity as a defence. Lord Justice Robert Walker focused upon the morally understandable intention of the surgeons, and the great body of profession opinion, in concluding that surgery could go ahead. [7]
The 20-hour-long operation to separate the twins took place on 7 November 2000. [3] [6] As expected, Gracie survived the operation and Rosie died. Rosie's remains were later buried in her hometown of Xagħra. [7] [4]
In 2014, when Gracie was 14 years old, she was living a reasonably normal life, had a younger sister, and was thinking about studying to become a physician. [6] In 2020 she was described by surgeon Adrian Bianchi, who had stayed in touch with the family, as "stable, intelligent, independent" and "intent on establishing a professional career". [4]
Whilst the House of Lords of the United Kingdom is the upper chamber of Parliament and has government ministers, for many centuries it had a judicial function. It functioned as a court of first instance for the trials of peers and for impeachments, and as a court of last resort in the United Kingdom and prior, the Kingdom of Great Britain and the Kingdom of England.
Conjoined twins, popularly referred to as Siamese twins, are twins joined in utero. It is a very rare phenomenon, estimated to occur in anywhere between one in 50,000 births to one in 200,000 births, with a somewhat higher incidence in southwest Asia and Africa. Approximately half are stillborn, and an additional one-third die within 24 hours. Most live births are female, with a ratio of 3:1.
In the criminal law of many nations, necessity may be either a possible justification or an exculpation for breaking the law. Defendants seeking to rely on this defense argue that they should not be held liable for their actions as a crime because their conduct was necessary to prevent some greater harm and when that conduct is not excused under some other more specific provision of law such as self defense. As a matter of political expediency, states usually allow some classes of person to be excused from liability when they are engaged in socially useful functions but intentionally cause injury, loss or damage.
Mary Howarth Arden, Baroness Mance,, PC, known professionally as Lady Arden of Heswall, is a former Justice of the Supreme Court of the United Kingdom. Before that, she was a judge of the Court of Appeal of England and Wales.
The Pan Am Flight 103 bombing trial began on 3 May 2000, more than 11 years after the destruction of Pan Am Flight 103 on 21 December 1988. The 36-week bench trial took place at a specially convened Scottish Court in the Netherlands set up under Scots law and held at a disused United States Air Force base called Camp Zeist near Utrecht.
The Xagħra Stone Circle, also known as the Xagħra Hypogeum or the Brochtorff Circle, is a Neolithic funerary complex located in Xagħra, Gozo, Malta. It consists of a series of caves which were used to bury the dead, and which were surrounded by a walled enclosure. It mainly dates back to around 3000 to 2400 BC, although the earliest tombs at the site date back to 4100 to 3800 BC. The caves collapsed sometime before 2000 BC, and the site was later used for domestic and agricultural purposes.
Xewkija is an administrative unit and village of Malta, on the island of Gozo. The population of Xewkija is 3,300 as of March 2014.
Sir Alan Hylton Ward is a former judge of the Court of Appeal of England and Wales.
In English law, the defence of necessity recognises that there may be situations of such overwhelming urgency that a person must be allowed to respond by breaking the law. There have been very few cases in which the defence of necessity has succeeded, and in general terms there are very few situations where such a defence could even be applicable. The defining feature of such a defence is that the situation is not caused by another person and that the accused was in genuine risk of immediate harm or danger.
Robert Walker, Baron Walker of Gestingthorpe,, was a British barrister and Justice of the Supreme Court of the United Kingdom. He served as a Non-Permanent Judge of the Hong Kong Court of Final Appeal between 2009 and 2023.
This page list topics related to Malta.
English criminal law concerns offences, their prevention and the consequences, in England and Wales. Criminal conduct is considered to be a wrong against the whole of a community, rather than just the private individuals affected. The state, in addition to certain international organisations, has responsibility for crime prevention, for bringing the culprits to justice, and for dealing with convicted offenders. The police, the criminal courts and prisons are all publicly funded services, though the main focus of criminal law concerns the role of the courts, how they apply criminal statutes and common law, and why some forms of behaviour are considered criminal. The fundamentals of a crime are a guilty act and a guilty mental state. The traditional view is that moral culpability requires that a defendant should have recognised or intended that they were acting wrongly, although in modern regulation a large number of offences relating to road traffic, environmental damage, financial services and corporations, create strict liability that can be proven simply by the guilty act.
The doctrine of necessity is the basis on which extraordinary actions by administrative authority, which are designed to restore order or uphold fundamental constitutional principles, are considered to be lawful even if such an action contravenes established constitution, laws, norms, or conventions. The maxim on which the doctrine is based originated in the writings of the medieval jurist Henry de Bracton, and similar justifications for this kind of extra-legal action have been advanced by more recent legal authorities, including William Blackstone.
In the small Mediterranean island nation of Malta, the predominant religion is Roman Catholicism.
Xewkija Tigers F.C. is a football club from the village of Xewkija in Gozo, Malta. The club was founded in 1939, and currently plays in the Gozo Football League, First Division.
Child destruction is the name of a statutory offence in England and Wales, Northern Ireland, Hong Kong and in some parts of Australia.
Hussey v Palmer [1972] EWCA Civ 1 is an English trusts law case of the Court of Appeal. It concerned the equitable remedy of constructive trusts. It invokes the equitable maxim, "equity regards the substance and not the form."
The High Court of Justice in London, known properly as His Majesty's High Court of Justice in England, together with the Court of Appeal and the Crown Court, are the Senior Courts of England and Wales. Its name is abbreviated as EWHC for legal citation purposes.
The Basilica of the Nativity of Our Lady is a Roman Catholic parish church in Xagħra, Gozo, Malta, dedicated to the Nativity of Mary. The present building was constructed between 1815 and 1855, on the site of a smaller church which had been built in the 17th century. The dome was added in 1892. The church became a collegiate church in 1900, and a basilica in 1967.
The 1813–1814 Malta plague epidemic was the last major outbreak of plague on the islands of Malta and Gozo. It occurred between March 1813 and January 1814 on Malta and between February and May 1814 on Gozo, and the epidemic was officially declared to be over in September 1814. It resulted in approximately 4500 deaths, which was about 5% of the islands' population.