In the aftermath of the case of the Maltese Siamese Twins, it is appropriate to reflect on the moral issues involved and to try to extract a few lessons relevant to parental rights, confidentiality and respect of patient rights and values where bilateral agreements between countries exist. The case was first brought to the public through the media. Under an Anglo-Maltese health agreement, the couple (from Malta's sister island Gozo) was sent to the United Kingdom for more advice on the management of their twins as soon as it was realized they were conjoined. Upon the birth of the twins the parents, after considering the options of separation opted not to allow their daughters to be operated and to allow them both to die a natural death. The medical facts showed that one of the twins (Jodie) would survive a series of operations if her twin (Mary) were sacrificed.(The names given were fictitious and used only for media purposes.) The twins were joined at the caudal end-the ischiopagus type. 1 Mary, who did not have a viable heart/lung complex, and no viable brain, was living upon the life support provided by her sister. In fact Mary's blood supply came through a single blood vessel originating from the circulatory system of Jody. They had a common bladder and abnormalities of the gastrointestinal tract. It was not clear what the mental status of Jodie would be, however it was certain that she would undergo intensive therapy and a series of operations to correct the anatomical defects. In a similar case reported by the British media, such a sister had survived this treatment and now leads a normal life. 2