As the HMO medical director, I would deny the Lakeberg Siamese twin surgery based on several deciding factors. One of the main influences on my decision would be the extremely low chance of survival of not just one but both of the twins. As the possibility for survival is disproportionate to the cost of the surgery it is seemingly senseless to perform the surgery. However, from the viewpoint of the Lakeberg family, who are operating autonomously, the 1% chance that the surgery will work is a chance they are willing to take as the twins have a low rate of survival as it is. On the other hand, such autonomy can potentially have a negative impact on a greater number of patients with a higher survival rate than the twins. For that reason, especially