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Doctors of Egyptian Conjoined Twins Face Dual Dilemma - 2002-08-13

Last week (August 5-6), the world watched in fascination as U.S. doctors successfully separated twin girls from Guatemala who were born joined at the head. Now Egypt is watching a similar drama of its own. But in addition to the medical challenges posed by this case, there is also a cultural and religious dilemma.

Ahmed and Mohamed Ibrahim are 14-month-old twins who were born in rural southern Egypt conjoined at the head. A team of 30 doctors and nurses was brought together last week to determine if the two boys could be successfully separated. Although there is a danger one or both might die, the medical staff voted yes.

But that was just the first hurdle to overcome. The doctors then faced winning approval from the Islamic clergy. Egypt's Muslim society wants to embrace modern medical technology, but without giving up deeply held religious beliefs.

Last month the issue of the Ibrahim twins was discussed on a nationally broadcast program. Afterward, state television was deluged with 30,000 letters and calls, most saying the condition of the twins was God's will and they should not be separated.

At issue is the fact that doctors cannot predict the chances for a successful surgery, because small parts of the boys' brains overlap.

Despite the degree of public opposition to separating the boys, doctors say no cleric of importance is known to have demanded an outright ban on the dangerous surgical procedure.

The head of Cairo's Abu el-Reesh Hospital's neonatal surgical intensive care unit consulted Egypt's top government-appointed cleric. Grand Mufti Sheik Mohamed Ahmed el-Tayeb gave written approval for the separation, provided that doctors believed at least one twin would survive and as long as the surgery wasn't experimental.

Islamic scholar Abd al Moati Bauomy said the case does provide a quandary. The retired dean of the Faculty of Islamic Jurisprudence at Cairo's Al Azhar University said in the end, those closest to the twins should seek an Islamic solution that does the least harm.

He said there are general Islamic commands that guide everyone, and if there are two points of view from two religious authorities a person should go with the one that makes the most sense to him. It's a personal decision, he said.

But Dr. Milad Hanna, a religious expert at the al Ahram Center for Political and Strategic Studies in Cairo, disagrees. He said he doesn't think doctors should have to waste their time seeking religious decisions on such matters.

"At the moment there is a wave by which religious text is almost governing the country," he said. "I would blame, not those who would have asked, I would blame the government, which is allowing this cultural concept; because the constitution here in Egypt says, very explicitly, that this is a democratic country. Therefore, I think there needs to be a cultural revolution in Egypt so that we'll be more secular, more scientific thinking, otherwise we are going backward, not forward."

Doctors say the only hope for the twins to have a normal life is to perform the separation.

The boys' 30-year-old father has decided the operation should go ahead.

The procedure, which has not yet been scheduled, will be performed at Medical City Hospital in Dallas, Texas, where the doctors and the hospital are donating their services.