This chapter presents the Case of Ladan and Laleh Bijani. On 8th July 2003 Ladan and Laleh Bijani, Iranian conjoined twins aged 29, died in Singapore following a separation operation which lasted more than 48 hours. The chapter offers an overview of some of the many ethical issues raised by this and similar cases. Most obviously, the question of to what extent a patient can be subjected to a risk of death in order to attempt to improve her quality of life is one which can and does arise in many other contexts. Similarly, questions about the extent to which patients should be thought of as authoritative when making quality of life judgments are ubiquitous. The Bijani twins’ case then is markedly different from some other widely discussed cases of separation, notably Re A, because in the Bijani case there was no question of “sacrificing” one twin to save the other.