Why do bioethical dilemmas flourish in Florida? After the right-to-die case of Terri Schiavo rivetted the nation in 2004, another unusual and far-reaching case has surfaced in the courts. This time the issue is a woman's right over her own body.

Last year a Tallahassee hospital secured a court order to confine a pregnant woman to her bed to protect her baby.

Samantha Burton, a 29-year-old mother of two, was 25 weeks pregnant. Her membranes had ruptured, she had contractions and the foetus was in breech position. Her doctor, Jana Bures-Foresthoefel, thought that there was a danger of infection or miscarriage. She ordered Ms Burton to stop smoking and to stay in bed. Ms Burton demurred. She was unhappy with Tallahassee Memorial Hospital and wanted to go home.

Instead, hospital lawyers showed up and handed Ms Burton a phone. She found herself defending her plans with Circuit Judge John Cooper. Judge Cooper supported the hospital and ordered her to stay. Under Florida law, he declared, a child's welfare overrides its parent's. He even barred her from seeing another doctor.

In the end, the court order did not save the baby. Ms Burton had an emergency caesarean three days later but the baby was still-born. Then she was allowed to go home.

This was not the end of the story. Ms Burton was very angry. In the words of her lawyer, "She wound up basically nothing more than an incubator for the state. The court order made only the fetus a patient." As a matter of principle, she wants the judge's order retrospectively rescinded. Otherwise, says her lawyer, "Any time a woman gets pregnant the state could come in and run her life."

The American Civil Liberties Union says that the court order was unconstitutional. "Ms. Burton's bodily integrity, privacy, and autonomous decision-making were given no consideration, let alone respected," wrote the ACLU in a brief. "The state failed to consider the fallibility of the single medical opinion presented in this case or the reality, unfortunately demonstrated in this case, that forced medical interventions cannot guarantee the preservation of fetal life."

The First District Court of Appeal is still considering the case, which is beginning to attract nation-wide attention. Writing in the Huffington Post, freelance bioethicist Jacob M. Appel described it as one of the “most egregious abuses perpetrated against a patient by her caregiver since the triumph of the patients' rights movement in the 1970s.” ~ Tallahassee Democrat, Jan 18; Huffington Post, Jan 24

The UK’s controversial fertility regulator is again in the hot seat over its decision to allow clinics to destroy embryos with relatively minor genetic defects. The Human Fertilisation and Embryology Authority (HFEA), has published a list of 116 inherited conditions which fertility clinics can screen out without requiring special permission, says the London Times. These include conditions carried by successful people without great difficulty such as thalassaemia (tennis great Pete Sampras) and Marfan syndrome (Abraham Lincoln). It is considering adding another 24 conditions to the list.

If a condition is on the list, UK fertility clinics will be able to screen embryos for it and destroy it, if the parents ask them to do so.

The head of the HFEA, Professor Lisa Jardine, was indignant at how the news was reported. In a letter she complained that the London Times article was “inaccurate and misleading and could cause confusion and distress for… families”. She insisted that parents did not make such decisions lightly and that the embryos were “just three days old and made up of about eight cells”. ~ London Times, Jan 24

A Scottish MP has introduced a bill for assisted suicide. Margo MacDonald, a campaigner for euthanasia who suffers from Parkinson’s disease, claims that her End of Life Choices Bill would allow Scots who wanted to end their lives to die at home, rather than travel to a suicide clinic in Switzerland. "Dying is part of living, it's the last act of your life, and if we accept the responsibility of how we live our lives, then I really fail to see where there is any demarcation of how we should die," she told Parliament.

Ms MacDonald says that her bill has a number of safeguards to ensure that it will not be abused. People must have resided in Scotland for at least 18 months; they have to consult a doctor and have a psychiatrist confirm that they were not suffering from depression; their decision has to be confirmed after two weeks and they cannot die until two days after that.

However, Wesley J. Smith, a veteran critic of euthanasia who scrutinised the bill, claims that it has serious flaws. A 16-year-old could take advantage of it without parental consent; as no method is specified, a gun could be used; and anyone, not necessarily a doctor, could dispatch the person requesting death. ~ Scotsman, Jan 29

In a twist on the old adage that you can’t escape death and taxes, the Swiss are to vote on a “death tax” on foreigners who visit the country to take advantage of its liberal assisted suicide law.

Dignitas, a Zurich-based group, helps foreigners commit suicide. They normally arrive 2 or 3 days before their demise. Apart from ethical considerations, many Swiss see this as bad public relations.

So opponents of this so-called “suicide tourism” propose imposing a fine of 50,000 Swiss francs (US$47,000) on Dignitas if it helps kill a person who has not lived in Switzerland for at least a year. A referendum on the proposal is scheduled for November 28.

Daniel Suter, Zurich president of the Swiss Federal Democratic Union party, which is behind the vote, says: “we believe this will cut down the number of suicides dramatically. There needs to be an end to death tourism. We anticipate the fine will be passed on to the person committing suicide by the suicide organisation. Effectively foreigners will be discouraged from coming to Zurich to die.''

However, Ludwig Minelli, the founder of Dignitas, seems unconcerned by the move. Even if the referendum proposal passes it will be challenged in the Swiss courts and in the European Court of Human Rights. ~ Irish Independent, Jan 23

In a interview on the weekend, British novelist Martin Amis proposed that “euthanasia booths” be placed on “every corner” where the elderly and the demented can go out quietly, with dignity, receiving a “martini and a medal”.

England would soon face a “civil war” in Britain between the younger and older generations in 10 or 15 years' time, he believes. “They'll be a population of demented very old people, like an invasion of terrible immigrants, stinking out the restaurants and cafes and shops," he told the Guardian. His solution? "There should be a booth on every corner where you could get a martini and a medal.”

Critics have labelled Amis’ comments ‘glib’ and ‘offensive’.

Alistair Thompson, of the Care Not Killing Alliance, described Amis’ comments as “very worrying”. "How on earth can we pretend to be a civilised society if people are giving the oxygen of publicity to such proposals?"

Fellow novelist Joan Brady told the Guardian on Monday that she viewed Amis’ comments as ‘flippancy’ and ‘prostitution’, questioning Amis’ ‘trivialising’ of “a subject of enormous magnitude just to flog a book”. Her husband was killed by a degenerative disease.

Amis contends that his comments were more ‘satirical’ than ‘glib’. He also told the Guardian, “What we need to recognise is that certain lives fall into the negative, where pain hugely dwarfs those remaining pleasures that you may be left with. Geriatric science has been allowed to take over and, really, decency roars for some sort of correction." ~ Guardian Jan 24, Jan 25

A Canadian baby on a life-supporting ventilator has become the centre of the latest controversy over futile medical treatment. Isaiah May, the first child of Isaac and Rebecka, was born in Alberta on October 24. His umbilical cord had been wrapped around his neck and his brain was starved of oxygen. Doctors said that he had “irreversible brain damage.” But, although he is silent and mostly unresponsive, he began to put on weight and move. “He looks like a normal baby," says his mother.

However, his doctors felt that continuing treatment was not in Isaiah’s best interests. They told the young parents that their child was brain dead and would always need a ventilator. On January 13 they sent the Mays a letter stating that they intended to remove Isaiah from the ventilator on January 20.

“Your treating physicians regretfully have come to the conclusion that withdrawal of active treatment is medically reasonable, ethically responsible and appropriate. We must put the interests of your son foremost and it is in his best interests to discontinue mechanical ventilation support,” the letter states.

However, the Mays are determined to fight for the life of their son and want to exhaust every chance ofsurvival. This week they succeeded in getting an injunction to delay the removal until February 19. They plan to seek more medical advice and to have more tests done. ~ Global Edmonton, Jan 27; CNNews, Jan 20

Just over two weeks ago, CNN's celebrity doctor and one-time dandidate for surgeon-general in the Obama administration, Dr Sanjay Gupta, joined the flock of journalists converging upon Haiti. Upon arrival, Dr Gupta examined a 12-year-old girl suffering from a head injury. The incident was filmed and made into a four-minute clip that immediately became the lead item on the CNN website.

Dr Gupta’s fame and popularity have caused some to question his motives in filming this piece of medical work.

On his way to Haiti two weeks ago, Dr Gupta clarified in a Twitter post that although journalistic aims drove his work in Haiti, he would provide medical assistance if necessary. He said, “Many have asked: of course, if needed, I will help people with my neurosurgical skills. Yes, I am a reporter, but a doctor first.”

Bioethicists were not impressed. "The reporters who have been practicing well-televised drive-by medical care in Haiti are demonstrating an appalling abuse of medical and journalistic ethics,” said Dr Steve Miles, of the University of Minnesota Center for Bioethics. And Dr Carl Elliott, from the same centre, was even more scathing. “It's worse than self-promotion. It's exploiting the suffering of Haitians for the PR goals of their employers. They should not be reporting on their own work. That's a classic PR tactic: using humanitarian aid as a public relations device, in order to drive up ratings for their network.” ~ MinnPost, Jan 22; LA Times, Jan 14

“Heartbreak mums facing a baby crisis over low sperm levels” was the headline in the Mirror, a London tabloid. According to figures supplied by the British Fertility Society, there is such a shortfall of sperm donors in the UK that women are being forced to go overseas to fertility clinics or to resort to mail-order fresh sperm. The Society says that UK clinics require 500 sperm donors to service their patients, but at present there are only 400. Supply has shrunk since the recent abolition of donor anonymity.

Dr Pacey is aghast at the use of fresh sperm because there are no guarantees that it is free of HIV or other STDs. “These fresh sperm delivery services just full me with horror,” he told the London Telegraph. “There is no way on earth that they can guarantee they are infection free when they do not quarantine sperm at all.”

The UK’s fertility regulator, the Human Fertilisation and Embryology Authority is now considering allowing payment for sperm to overcome the shortage. ~ London Telegraph, Jan 22

The UK National Health Service (NHS) has apologised to a man who was mistakenly told that he would likely suffer with a hereditary brain disease. Mr C was told in his early 30s that he had the incurable Huntington’s disease, and that it would likely be passed on to his daughters.

Huntington’s disease (HD) is a neurodegenerative condition, usually with onset at middle age. Classic symptoms include mental decline, difficulty with speech, loss of motor function and shifts in personality. Despite extensive research, it remains incurable.

Mr C lodged a complaint with the Scottish Public Services Ombudsman, who investigated this case from the NHS Lothian area. The ombudsman discovered that Mr C and his family all suffered a great deal of anxiety as a result of the diagnosis, and that this caused them to make “certain life choices”. Mr C’s wife and one of their two daughters terminated pregnancies, and one daughter was unable to finish her university degree after the HD diagnosis.

The technology available for retesting when Mr C was diagnosed with HD carried a 4% probability for misdiagnosis. Newer and more accurate testing technology was introduced in 1993, but Mr C was not retested until 2007. This later test showed up negative, meaning that Mr C never had the disease at all. It also shows that he fell into the 4% of cases in which the original tests provided incorrect diagnoses.

The nursing director for NHS Lothian, Melanie Hornett, said that the board was “deeply sorry” for the hardship that the incident caused Mr C and his family. "This was an exceptional case and we have implemented the recommendations of the report to prevent a repeat of a similar incident." ~ BBC News Jan 21

Discouraging news for women over 30 who want to have a child comes from the UK. According to a study in the journal PLOS One, by the time a woman reaches 30, she has used up nearly 90% of her reserves of eggs. By the time she is 40, only 3% remains. Scientists at the University of St Andrews and Edinburgh in Scotland tracked the growth of the ovarian reserve from conception to 50. They found that the number of eggs declines far more rapidly than most women realise. "Our research shows that they are generally over-estimating their fertility prospects,” says Dr Hamish Wallace, one of the authors.

The study also dumps cold water on the intriguing theory that new eggs are produced in adults when germline stem cells in bone marrow reach the ovaries. Research on mice suggested that this might happen in humans, but the study is sceptical: “our model provides no supporting evidence of neo-oogenesis in normal human physiological ageing”. ~ London Telegraph, Jan 27; PLOS One, Jan 27