Iranian conjoined twins, Ladan, left and Laleh Bijani. PHOTO - TASR/AP

SINGAPORE – Two conjoined, adult Iranian sisters undergo an unprecedented operation in Singapore on Sunday to separate them at the head, raising the ethical question of high-risk surgery when a life is not at risk. Law graduates Ladan and Laleh Bijani, 29, will be seated for an operation expected to last at least 48 hours, Raffles Hospital said. Both have said they are willing to take the slim chance of success for the opportunity to lead separate lives. „We‘ve been praying every day for our operation. We are excited about it as we‘ve waited 29 years for it,“ they said in a statement released by the hospital.

Twins joined at the head occur only once in every two million live births, and successful separation is even rarer. Singapore doctors performed the operation in 2001 on infant girls from Nepal, but experts say an operation on adults is unprecedented. German doctors turned the Bijanis away in 1996, deeming the operation too dangerous. But experts say the operation is possible because they have anatomically separate brains. Neurosurgeon Keith Goh, who will lead the surgical team, told Reuters he had tried to talk the twins out of the operation by spelling out the risks. But the twins, who have been in Singapore since November undergoing tests and psychological counselling, have not been deterred — Ladan wants to be a lawyer in her home town of Shiraz, while Laleh wants to be a journalist in Tehran.

Dr Richard Ashcroft, head of medical ethics at London‘s Imperial College, said there would be no controversy if the sisters were at risk of dying without the operation. Others pointed to the possibility that one life could be sacrificed for the other if things go wrong.

„The ethical argument here is not only will potential harm come, but what if it comes to a point where one needs to make a judgment call, as to essentially sacrificing one for the other,“ said Dr Calvin Fones, associate professor at the National University of Singapore‘s department of psychological medicine. He said the question was whether it was justifiable to risk two lives for potentially only one life. „We also assume that both are like-minded in wanting to express the willingness and both are equal in terms of their willingness, but in real life this is often not the case and sometimes opinions also change. Hence the difficulty.“

The operation also raises the question of whether those involved might be under pressure from the worldwide curiosity the case has aroused. „Ideally in medicine, medical decision-making both for the

patient and the physician is a very independent and private one,“ Fones said. „This is obviously not the case because the whole world, the media is interested.“ Reuters