The Ultimate Choice

At dawn last Friday, Reitha and Ken Lakeberg gathered quietly with family and friends in the intensive-care unit of Children's Hospital in Philadelphia. As tears began to well, the Lakebergs made plaster imprints of the tiny hands of their daughters Amy and Angela, then picked them up and hugged and kissed them. Born seven weeks ago, the girls were Siamese twins, joined breast to belly, with a fused liver and a shared heart. As they cuddled the girls, Reitha, 24, and Ken, 26, knew that they would not see Amy, "the ornery one," alive again. Her fingernails had been left bare while her sister's had been painted pink by nurses to help doctors easily distinguish the girls. For surgeons would soon try to save Angela by sacrificing Amy. Even Angela had only the slimmest chance -- less than 1% -- to survive for more than a few weeks. Still, as Ken had plaintively asked one doctor, "people win the lottery every week. Why can't we?"

Before the babies were wheeled into the operating room at 8:05 a.m., Angela made a waving gesture in the air, inspiring her mother to say, "That's right, Angela, thumbs up." The painstaking task of separating the babies was expected to take all day, but after only 5 1/2 hours, the doctors reappeared, and the news was good. "Angela is stable, comfortable, and we hope that will continue to be the case," said Dr. James O'Neill Jr., the lead surgeon. At the same time, relatives were making funeral preparations for Amy.

No one could know yet if the Lakebergs would ultimately beat the odds and win their painful personal lottery. But it was clear that the couple's ordeal had drawn the nation into a gripping human and medical drama -- and set off a searing ethical debate. Does love demand that parents of a dying child seek any solution, no matter how long the odds of success? Or is it more loving, in some cases, to let nature take its course? Does duty demand that doctors always intervene, or should they set limits? And does it make sense for a society to spend hundreds of thousands of dollars on an almost certainly doomed effort while millions of Americans go begging for the basics of health care and while the government preaches the gospel of cost containment? Where do love, responsibility and justice lie?

The Lakebergs' time of hard choices began just before Christmas. About 13 weeks into Reitha's pregnancy, the Wheatfield, Indiana, couple learned through an ultrasound test that she was carrying Siamese, or conjoined, twins. Such cases are rare; they happen when a fertilized egg splits incompletely during early cell division. About 40 such sets of twins -- or 1 in 50,000 births -- occur in the U.S. each year. Few of the pairs live long enough for separation to be considered. The Lakebergs' doctors had put the likelihood of one twin surviving at no more than 20% and suggested an abortion.