Conjoined twins are a rare occurrence, with an incidence of about 1 in 250,000 live births. Approximately 60% are stillborn. Though they can be joined at the hip, abdomen, chest, or head, the majority are joined at the chest, and share a heart. Although they are fascinating to the public, conjoined twins present complex and challenging ethical, medical, and legal issues to all of those involved in their care. Among the issues discussed here are: right to life, presumed consent, physician duty, quality of life, allocation of resources, and futile care. This paper also discusses the pros and cons of separation and then offers alternative solutions.