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Most types of conjoined twins appear to result from incomplete splitting of a single fertilized ovum, but some conformations termed "conjoined twinning" may involve a fusion of closely approximated embryos. The surgical, medical, and social challenges of separations speak to the need to provide thoughtfully integrated health care for conjoined twins and their families. When separation is considered, surgeons need to determine the extent and nature of the conjoinment, including whether there is a shared vascular circulation or shared organs. They also must determine the chances of success for either of the twins and assess their degree of certainty in the matter. This chapter presents two recent cases that demonstrate in more depth the complex ethical and legal arguments that can attend cases of separation in conjoined twins, namely the cases of the Ladan Bijani and Laleh Bijani, and the Michelangelo Attard and Rina Attard.
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