EARLIER this week, Singaporeans learnt the sad news that Nepalese twin Ganga Shrestha had died. Eight-year-old Ganga was separated from her conjoined sister, Jamuna, in 2001 after an epic operation here involving over 100 doctors and nurses. The decision to perform the surgery touched off a massive debate over the prudence of trying such complex surgery. Would it have been in the better interest of the girls to let nature take its course? Or attempt the risky procedure that could change their lives, but might also badly affect the quality of that existence? Hindsight - as the public progressively learnt of the twins' past seven years - strangely has not made it easier to decide which side in the debate was right. Nor does it make it any clearer how to make the call on similar cases in the future.
Ganga emerged from the operation with brain damage, while Jamuna, who survives, was left with a hole in her head covered only by a flap of skin. Jamuna also ended up with a weak right arm and leg; unable to walk, she drags herself about with her good limbs. Life was always fraught with difficulties and medical problems for Ganga, and will continue to be so for Jamuna. So those who said the girls would never enjoy anything approaching the ease of normal life were right. But members of the public who chose to generously underwrite the twins' medical expenses might say that hope is precisely that, a punt on the chance of a miracle. Jamuna's survival keeps that hope alive. Still, where we are left is at the point where it all began. Ganga and Jamuna do not give us any map to navigate the maze of morality in life and death decisions. No categorical position emerges clear and defined. So it seems, every new case even remotely resembling that of Ganga and Jamuna will need to be debated. Sometimes, those who propose leaving it to nature will prevail. At others, hope will lead.
Perhaps that is right. The complexity of death and life, and the quality of day-to-day living are too myriad for boilerplates. To defer to ready-made solutions is to abdicate responsibility for moral decisions. This should be borne in mind as society faces questions over life and death that appear more frequently than situations like Ganga and Jamuna's, such as whether to keep alive patients who would not survive without machines. For here, too, every life requires a full debate over nature and over hope. There are lessons to be learnt from the two brave girls from Nepal.
[An ex-colleague has a son who had a high fever when he was very young, and she blamed herself for not realising how severe his illness was. By the time he was admitted to hospital, the prognosis was not good, and the advice was that his chances of survival was slim at best. This ex-colleague prayed for his survival even though she was warned that if he did survive, he might suffer brain damage.
Well he did survive, and there was brain damage. I don't know if the doctors went to extraordinary lengths to save him. When my ex-colleague told me this story, years after it had happened, my thought was that if he had died, my ex-colleague would have been guilt-ridden. She prayed for his survival out of love, fear, hope, and guilt.
We are only human. Perhaps we should step back some time and look with a dispassionate eye, and decide with our head not our hearts?
Or maybe that's easier said than done.]