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CNN Live Sunday

Interview With Dr. Norm Fost

Aired July 06, 2003 - 16:19   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


SEAN CALLEBS, CNN ANCHOR: The Bijanis are well acquainted with the risk involved in their operation. Not only could it completely change their lives, one or both of the sisters may not survive. So is the surgery worth the gamble? The sisters say without question, yes.
And joining us on the phone right now to discuss it further is Dr. Norm Fost. He's a medical ethicist at the University of Wisconsin. Dr. Fost, thanks very much for joining us. Let's talk about the differences what the Bijanis are going through at this hour, and so many of the other surgeries to separate conjoined twins joined at the head. Infants, that's a much different situation.

DOCTOR NORM FOST, UNIVERSITY OF WISCONSIN: Yes. The most obvious difference is first, these are highly intelligent, competent patients who are making a voluntary decision for themselves. The other cases all involved infants in which parents or, in one famous case, the courts actually decided. So in this country, anyway, we think that competent people should be able to decide for themselves whether they want to undertake risks like this. This is unique in that sense.

CALLEBS: Indeed. A bit about the sisters. They're both either law school students or law school graduates ...

FOST: Graduates, yes.

CALLEBS: They had their friends with them this morning as they went out of post-op. They were very upbeat. What does this tell but their mindset as they went into surgery? Because they went through hours of psychological counseling before this.

FOST: Yes. I think the quality of the consent that they're giving to this is of the highest possible order. It's not just the last few days, weeks, or months. They've been thinking about this for years, even decades. We've been told they went to Germany five years ago to get opinions on this.

They've been talking with the doctors in Singapore for many months. They're highly educated, as you pointed out. So these women know exactly what they're getting into, and whatsoever known about the risks they're aware of them, and there's very little question that this is a fully informed decision.

CALLEBS: Let's talk about some of the ethical considerations, if indeed one of the sisters passes away either during or after the surgery. FOST: Well, in many of the other cases these have been presented as cases of sacrifice, in which one person is asked to give up his or her life for the other. That's not quite what's going on here, because it's pretty clear, from what I've read, that both of these women want to do it for themselves. They're not doing it for the other. They're doing it because each of them wants to lead independent lives.

They have very different personalities. They have very different interests. One, in fact, went to law school sort of involuntarily because her sister wanted to go, and she sort of had to go along. But she would like to pursue a career as a journalist. Obviously, they have no capacity or very little capacity for intimate relationships. So they're doing it for themselves. I don't think this is different from the other cases in that one is being asked to take risks on behalf of the others. They both feel it's in their interest to do this.

CALLEBS: A certain degree is also been made about the fact that it's not life-threatening. They don't need the surgery at this point for any kind of life-threatening disorder. However, from what I do understand, they're both feeling a certain degree of pressure in the cranium that's causing headaches, migraines, and later in life could lead to very serious problems.

FOST: Yes. Good ethics starts with good facts. And I didn't learn until this morning myself that their prospects are not entirely for normality in the physical sense. As you said, there's some evidence that they either already have or are highly likely to have increased intracranial pressure down the road, which could cause severe symptoms and even damage and require surgery in the future anyway. So it's not like they face completely normal lives neurologically as well as psychologically.

CALLEBS: And this is going to take several hours if not indeed days. We know that you along with many others are going to be following this, and of course, we all wish them the very best at this hour. Thanks very much.

FOST: You're welcome.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com







Aired July 6, 2003 - 16:19   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
SEAN CALLEBS, CNN ANCHOR: The Bijanis are well acquainted with the risk involved in their operation. Not only could it completely change their lives, one or both of the sisters may not survive. So is the surgery worth the gamble? The sisters say without question, yes.
And joining us on the phone right now to discuss it further is Dr. Norm Fost. He's a medical ethicist at the University of Wisconsin. Dr. Fost, thanks very much for joining us. Let's talk about the differences what the Bijanis are going through at this hour, and so many of the other surgeries to separate conjoined twins joined at the head. Infants, that's a much different situation.

DOCTOR NORM FOST, UNIVERSITY OF WISCONSIN: Yes. The most obvious difference is first, these are highly intelligent, competent patients who are making a voluntary decision for themselves. The other cases all involved infants in which parents or, in one famous case, the courts actually decided. So in this country, anyway, we think that competent people should be able to decide for themselves whether they want to undertake risks like this. This is unique in that sense.

CALLEBS: Indeed. A bit about the sisters. They're both either law school students or law school graduates ...

FOST: Graduates, yes.

CALLEBS: They had their friends with them this morning as they went out of post-op. They were very upbeat. What does this tell but their mindset as they went into surgery? Because they went through hours of psychological counseling before this.

FOST: Yes. I think the quality of the consent that they're giving to this is of the highest possible order. It's not just the last few days, weeks, or months. They've been thinking about this for years, even decades. We've been told they went to Germany five years ago to get opinions on this.

They've been talking with the doctors in Singapore for many months. They're highly educated, as you pointed out. So these women know exactly what they're getting into, and whatsoever known about the risks they're aware of them, and there's very little question that this is a fully informed decision.

CALLEBS: Let's talk about some of the ethical considerations, if indeed one of the sisters passes away either during or after the surgery. FOST: Well, in many of the other cases these have been presented as cases of sacrifice, in which one person is asked to give up his or her life for the other. That's not quite what's going on here, because it's pretty clear, from what I've read, that both of these women want to do it for themselves. They're not doing it for the other. They're doing it because each of them wants to lead independent lives.

They have very different personalities. They have very different interests. One, in fact, went to law school sort of involuntarily because her sister wanted to go, and she sort of had to go along. But she would like to pursue a career as a journalist. Obviously, they have no capacity or very little capacity for intimate relationships. So they're doing it for themselves. I don't think this is different from the other cases in that one is being asked to take risks on behalf of the others. They both feel it's in their interest to do this.

CALLEBS: A certain degree is also been made about the fact that it's not life-threatening. They don't need the surgery at this point for any kind of life-threatening disorder. However, from what I do understand, they're both feeling a certain degree of pressure in the cranium that's causing headaches, migraines, and later in life could lead to very serious problems.

FOST: Yes. Good ethics starts with good facts. And I didn't learn until this morning myself that their prospects are not entirely for normality in the physical sense. As you said, there's some evidence that they either already have or are highly likely to have increased intracranial pressure down the road, which could cause severe symptoms and even damage and require surgery in the future anyway. So it's not like they face completely normal lives neurologically as well as psychologically.

CALLEBS: And this is going to take several hours if not indeed days. We know that you along with many others are going to be following this, and of course, we all wish them the very best at this hour. Thanks very much.

FOST: You're welcome.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com