Two Heads Are Better Than...?

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Biology 202

2006 First Web Paper

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Two Heads Are Better Than...?

Perrin Braun

One would think that the Oprah Winfrey Show would be an unlikely venue to explore issues of neurobiology, but one particular episode that featured "medical miracles" caught my attention. The show described in great detail a thirteen-hour operation in which Egyptian doctors successfully performed a revolutionary procedure on an infant who suffered from one of the rarest forms of birth defects. Manar Maged was treated for craniopagus parasiticus—meaning that she had a conjoined twin that was connected to her at the upper left side of her skull, sharing an integral blood vessel. This type of defect occurs when an embryo begins the process of splitting into twins, but fails to complete the splitting process when one of the twins fails to fully develop in-utero. The weight of the extra head was preventing Manar from being able to freely move, in addition to creating problems with blood circulation.

However, Manar's twin had never developed a body below her neck and was therefore not able to survive independently of Manar, although the twin was still able to smile, blink, and exhibit some reflexes. In order to separate Manar's 'parasitic head,' the surgical team carefully separated her brain from that of the conjoined twin and disconnected the blood flow to the extra head. A similar surgery was performed in the Dominican Republic, in which a second conjoined twin failed to develop a body, but the operation ended in the deaths of both twins.

There are several issues of both science and morality which arise from the case of the parasitic twin. Although the twin wasn't able to sustain independent life, she was certainly cognizant of her surroundings and exhibit 'human' emotions. Footage from the show even shows the conjoined twin to be sucking on a pacifier while Manar's attention was focused elsewhere. There was absolutely no uncertainty that Manar would have died if her twin had not been removed, but Egyptian religious authorities have argued that the twin was indeed a distinct human being and therefore had its own separate soul. Following the burial of the head, the Maged family named the second twin Islaam in order to grant her dignity and distinguish the twin as a separate human life, but some people have argued that killing the twin, despite the fact that the operation was intended to save Manar's life, was problematic in that doctors were toying with fate. In this sense, this issue is akin to that of abortion, which poses uncertainties regarding the definition of what it means to be living. The parasitic twin was certainly conscious of its surroundings and exhibited behavior that resulted from external stimuli. She was most definitely aware of her environment, making her intentional death even more problematic.

Another problematic subject that arises involves the brain = behavior debate. In the case of the Maged twins, the two children shared the left side of the brain, while the right side of Manar's brain was joined with the right side of her twin. From one perspective, it can be said that since our existence is essentially defined by the physicality of our brain, the twin was parasitic twin was indeed functional in the sense that it contained the neurons that are necessary to exhibit reflexes and facial expressions. Yet, the twin had no body below the neck and therefore had no complete nervous system of its own. If the brain is entirely dependant on the nervous system and the brain = behavior, the subject of whether or not the twin could be described as a separate human entity is in question.

If we can define behavior as having reflexes and possessing a higher consciousness, the twin does exhibit some form of behavior, but where would her sense of self be? Since the conjoined twin did not have a body, one might assume that her I-function might have been located in her brain. However, this assumption becomes a problem when you take into account that the twins shared internal organs, in addition to a part of the brain. Might it be possible that the twins shared an I-function and they were therefore co-dependant on each other in terms of their identity? To date, Manar is thriving and doctors are still monitoring her progress to see whether or not her brain has been damaged by the separation. She is able to move her limbs with ease and her brain has regained activity. Since her conjoined twin was removed in infancy, she will not remember ever having an extra head and will develop into her own I-function as she gains more cognition of her surroundings. What remains to be seen, is how Manar's conception of her self will progress as she grows—if she will think of herself in terms of her dead twin or as a completely independent life.

Works Cited

"Baby stable after second head removed." 21 Feb. 2005. Reuters Limited.
10 Feb. 2006. .

"The Two-Headed Baby Miracle." The Oprah Winfrey Show. ABC. 19 May 2005.

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