An Australian health tourism company is offering a new package for couples seeking a sex-selective IVF. Sex selective treatment is banned in Australia, but couples can now holiday in Thailand whilst having the procedure done.

For A$12,000 Global Health travel is offering 11 days in a luxury Bangkok hotel while couples undergo IVF treatment to choose a baby boy or girl. Cells are taken from the three-day-old embryo for gender screening, and a boy or girl is implanted before the pregnant woman flies home a few days later.

''Some people bring their whole family and make a holiday of it,'' Global Health Travel managing director Cassandra Italia said yesterday. ''It isn't something just the wealthy are doing, and we get 10 to 20 inquiries a month.''

There have been calls for the Australian National Health and Medical Research Council (NHMRC) to revise prohibitions on the use of IVF for sex-selection. A NHMRC spokesperson said that the guidelines won't be reconsidered until 2015. For now, Australian couples will have travel to countries like Thailand, the US or Cyprus where the procedure is legal. Now thanks to advances in travel medicine they can now make a holiday of it. 

Remember the battle over what brain-damaged Florida woman Terri Schiavo would have wanted if she were conscious? The case for removing life support rested on the claim that she had said that she would have wanted a feeding tube to be removed. With more cases like hers coming before the courts, lawyers are advising people to make living wills. But how valid are statements, oral or written, made in the past about present preferences?

A recent article in the Journal of Medical Ethics tackles this difficult topic. In “Significance of Past Statements: Speech Act Theory”, Joanne Gordon contends that past utterances do not always express a person’s preferences for how she would like to be treated. They can only be intended to provoke a psychological reaction in her listeners.

Gordon uses speech act theory -- a philosophical theory about the nature and significance of verbal utterances -- to analyse statements about end-of-life care. People may not intend that their statements express a treatment preference. Rather, they want to create a particular impression -- to comfort, to shock, to inspire, and so forth. For example, the statement “I don’t want to be dependent on others” may not necessarily express a treatment preference. Rather, "an individual could conceivably be acting insincerely to generate a perception of himself/herself as a fiercely independent". Gordon also offers the example of comments made to a loved one in residential care:

“'I hope when I’m older I end up somewhere nice like this' or 'I’d love to be waited on hand and foot'...It seems reasonable to suggest that [the speaker] may not possess any such positive thoughts or attitudes about dependency but is using these words purely to bring about a comforting or reassuring effect."

Gordon concludes that "Speech act theory shows us that statements can also be ‘hollow’ groups of

words, which we frequently use with the sole purpose of bringing about psychological effects on our audiences in everyday social interactions." She concludes that greater attention be given to the context in which utterances are made, their consistency of other statements, their overall personal narrative. 

In late February last year, two Italian academics working at Monash University in Australia flicked a match into a highly combustible pile of old abortion debates, caricatures of pointy-headed academics, news-hungry journalists and recycled Go-Home-Peter-Singer posters.

Whoosh!

Alberto Giubilini and Francesca Minerva’s article in the UK-based Journal of Medical Ethics was “After-birth abortion: why should the baby live?” It wasn’t a very original argument for the morality of infanticide – Peter Singer and Michael Tooley had made the same point decades ago – but the arresting title tossed even more petrol on the blaze. The authors contended that the same reasons which justify abortion are also sufficient to justify killing a child up for an unspecified time after birth.

“If criteria such as the costs (social, psychological, economic) for the potential parents are good enough reasons for having an abortion even when the fetus is healthy, if the moral status of the newborn is the same as that of the foetus and if neither has any moral value by virtue of being a potential person, then the same reasons which justify abortion should also justify the killing of the potential person when it is at the stage of a newborn.”

BioEdge may have been the first to pick up the story, but it went viral when it appeared on The Blaze, the website of American shock-jock Glenn Beck. There it attracted hundreds of comments. Many of these were not supportive -- fairly typical was: “These people are evil. Pure evil. That they feel safe in putting their twisted thoughts into words reveals how far we have fallen as a society.” From there it moved into all the major news media. There were well over 2,000 comments in the London Telegraph. The authors were attacked in the US Congress.

Since it may have been the first time that many readers of The Blaze and even many journalists had ever heard of bioethicists, the publicity may have been a major setback for the public image of bioethics. The controversy continued for weeks. Giubilina and Minerva received hundreds of emails, some of them containing death threats.

Now that the dust has died down, the Journal of Medical Ethics, a redoubt of utilitarian ethics, has responded to the crisis with a special issue containing 31 commentaries from a range of ethicists, some of whom have argued for years that infanticide can be a moral action; others who believe that even suggesting it is a vile stain on academic integrity. Editor Julian Savulescu introduces the issue with these words:

 “Infanticide is an important issue and one worthy of scholarly attention because it touches on an area of concern that few societies have had the courage to tackle honestly and openly: euthanasia. We hope that the papers in this issue will stimulate ethical reflection on practices of euthanasia that are occurring and its proper justification and limits.”

Some bioethicists who feel at home in the utilitarian common room of the Journal of Medical Ethics described the imbroglio as an attack on academic freedom. Udo Schüklenk, of Queen’s University, in Ontario, who is also the editor of Bioethics, a distinguished international journal, complained bitterly that “bioethics journals are under increasing and sustained fire from political activists” of all stripes, from “the left, feminists, disability activists [to] religious conservatives”.

He singles out two gadflies who “busily scan bioethics journals for evidence of the secular liberal bias they claim exists … and also attack, pretty much immediately, papers—and by extension the journals that publish them—that they disagree with.”

The first is Wesley J. Smith, the editor of the Human Exceptionalism blog on the website of the US magazine National Review Online. The other is the editor of BioEdge, whose “outputs are routinely picked up by search engines such as Google's news service, thereby arguably providing the site with a larger real-world impact than most bioethics journals could dream of”.

Of the two, although he regards both as “agitprop”, Dr Schüklenk prefers BioEdge which, he says, “is less caught up in the US culture wars, so there is less of a permanent doomsday flavour to its outputs”.

But the controversy also brought to light a difficult issue for editors of bioethics journals. How should they deal with inflammatory theories and articles? Infanticide is not the only topic which is taboo in the media. No doubt an article defending non-voluntary euthanasia for patients in a permanent vegetative state would provoke a similar response. “When all is said and done, this is an academic freedom issue. It has to do with ensuring both that we are able to ask difficult questions, and that we are able to defend conclusions that most people will disagree with.”

Malcolm Oswald, of the University of Manchester, made a novel suggestion. He proposed that bioethics papers be tagged “green papers” or “white papers”. The latter would be purely theoretical discussions; the former practical policy proposals. “Had it been labelled as ‘green’, readers could have understood what Giubilini and Minerva explained later: that it was a discussion of philosophical ideas, and not a policy proposal advocating infanticide.”

Giubilina and Minerva subsequently explained that their article was published as a thought-experiment, not a serious public policy proposal. Schüklenk says that this loss of nerve is a serious failing.

“Bioethics analyses offering practical conclusions are not theoretical games,” he writes. Peter Singer and Michael Tooley, two bioethicists who have defended the moral legitimacy of infanticide, have never asked not to be taken seriously. “Respect for free speech has a flipside, requiring of us to take responsibility for the views that we defend. On what other grounds could we expect our views to be taken seriously. What kind of debate could we reasonably have with discussants who—when cornered—will say ‘I didn't really mean it’?” 

Not everyone in the “pro-life” camp is singing from the same song sheet in the controversy over infanticide. In this month's Journal of Medical Ethics two leading foes of abortion debate the reasonableness of arguments for infanticide.

One, the well known American legal philosopher Robert P. George, of Princeton University, describes Giublini and Minerva's argument as “moral madness”. The other, controversial Catholic theologian Charles Camosy, of Fordham University, argues that the authors make not only reasonable but strong arguments. He dismisses George's claim as “unchristian”. The debate was sparked by George's comments in the blog Mirror of Justice last year.

In his article, “Infanticide and Madness”, George appeals to a fundamental intuition that killing an unwanted newborn is evil. To argue against this intuition, is outrageous. 

"Whatever errors of fact and judgment are made possible by the complexities of human development or a prenatal child’s hiddenness in the womb—though in the age of the sonogram, the child is hidden only from those who wish to avert their gaze—it should be plain to see that killing an infant because he or she is unwanted is evil. The advocacy of that, or of its moral permissibility, is what should take one aback, not a declaration by me or anyone else that such advocacy should be denounced as moral madness."

George goes on to condemn those who sent threatening mail to the authors following the publication of the article.

Charles Camosy, author of the 2012 book, Peter Singer and Christian Ethics: Beyond Polarization, takes a more conciliatory approach. Camosy contends that without a Judeo-Christian ethical background it is difficult to see that pre-rational human beings are still persons. It is not unreasonable for secularists to argue for infanticide:

"if it is not madness to claim that ‘a non-rational human being is a non-person’ before birth, then neither is it madness to make the same claim about human beings after birth." (See 'Concern for our vulnerable pre-natal and neo-natal children' in the same JME issue).

Interestingly, Camosy does not engage with George's appeal to a fundamental human, rather than simply Christian intuition, namely that the killing of an unwanted infant is morally depraved. Camosy is perhaps aiming only at a theological critique of the matter. 

The infanticide debate in the Journal of Medical Ethics has garnered comments from the grand old men of infanticide, the Australian Peter Singer and the American Michael Tooley. They have been defending it for decades.

Singer and Tooley attack the "anti-abortion mindset", claiming that the irrationality of "pro-life" groups caused the aggressive reaction to the Giubilini-Minerva article. They are philosophically illiterate. Singer rather condescendingly analyses the aggression of opponents:

"Their problem, apparently, is that most of them do not know how to argue against anyone who agrees with them that the fetus and newborn infant have the same moral status, but then denies that merely existing as an innocent living human being is enough to give a being a right to life."

Similarly, Tooley regards most people who disagree with his views as irrational:

"...in the case of many people, their views on the moral status of abortion are part of a ‘package deal’, part of some very general point of view to which they are deeply committed... In such cases, the person may find it very difficult to consider, dispassionately, arguments dealing with abortion, since he or she may view such arguments as threatening his or her general worldview".

For those suffering from this psychosis Tooley prescribes a dose of Socrates and self-reflection:

"My hope is that readers who find the conclusions for which Giubilini and Minerva argue problematic will ask themselves whether their own views may not be connected, for example, to deeply held religious beliefs that make it very difficult to take seriously the Socratic challenge in this case."

“After-birth abortion: why should the baby live?” by Alberto Giubilini and Francesca Minerva, was merely an infanticide thought-experiment. The special issue of the Journal of Medical Ethics includes a contribution from a paediatrician who actually has done it. Dr Eduard Verhagen, a paediatrician at University Medical Centre Groningen in the Netherlands, says that, in his experience, infanticide is sometimes preferable to second-trimestre abortion.

The so-called Groningen Protocol (GP) in the Netherlands allows euthanasia of newborns under strict conditions if there is “hopeless and unbearable suffering” and both parents give “informed consent”. Dr Verhagen claims that there were fewer instances of newborn euthanasia after the publication of the GP – but for reasons not connected with it. With more prenatal screening, more women opted for terminations of pregnancy in difficult cases like spinal bifida. The number of newborn euthanasia cases actually fell from 15 in 2005 to 2 in 2010.

The GP is, of course, very controversial. In an article in The Lancet in 2008, a paediatric oncologist and bioethicist at the Cleveland Clinic, Erik Kodish, angrily repudiated it. “The very notion that there is an ‘accepted medical standard’ for infanticide calls for resistance in the form of civil disobedience,” he wrote.

However, in some cases, “after-birth abortion” might be the most sensible treatment, Verhagen believes, as it allows the parents and the doctors to make a more accurate diagnosis and to discuss treatment opinions. “If all stakeholders conclude that the prognosis is very grim, the babies condition is judged as one with sustained and intolerable suffering, and the parents request for euthanasia, why should that not be permissible as an alternative to second trimester termination?”

In any case, Dr Verhagen points out, the official opinion of the American Academy of Pediatrics is that it is morally permissible to withdraw or withhold hydration and nutrition from newborns in some cases. These include ”children in a persistent vegetative state or children with anencephaly”. This is a form of euthanasia, but the child lingers for a long time while it starves to death. “If the parents wish to shorten that course, and organise their child's death more in the way they have envisioned it, shouldn't euthanasia be available for them?” 

Of course, bioethicists writing in the Journal of Medical Ethics are not the only people who have suffered for their views on abortion. A new Australian university group, Life Choice, has struggled to get approved because of its opposition to abortion.  

Life Choice’s aims are “to promote the dignity of human life from conception to natural death, through reasonable and informed discussion on the issues of abortion and euthanasia in Australian society."

But it has faced fierce opposition at the major universities in Sydney. The group was almost disaffiliated by the University of Sydney Union. The president of the Student Representative Council declared that "a woman's right to chose comes before freedom of speech". For similar reasons the student union at the University of NSW refused to endorse the society.

The issue has generated a storm of media coverage, including several articles in The Australian and the Sydney Morning Herald.

Surprisingly, the group has found a supporter in Peter Singer. "I have been an advocate of legal abortion since I was an undergraduate myself, when abortion was illegal; but I am also a strong supporter of freedom of speech," Professor Singer said. "A university, in particular, should be a place where ideas are able to be freely expressed. Students should be challenged to defend the ideas they take for granted."

Five people have been convicted of organ trafficking in Kosovo by the European Union court which runs the legal system in the quasi-independent territory. The controversial case ended with a jail term of 8 years for a prominent urologist in Pristina, Lutfi Dervishi, for "organised crime and human trafficking".

His son Arban was sentenced to seven years and three months. The other three received terms of between one and three years. EU prosecutors hope to charge 8 more suspects with organ trafficking.

The charges all relate to transplants done in 2008. The donors were recruited from eastern European and Central Asian countries with fees of about 15,000 Euros. The recipients, mostly Israelis, paid 100,000 Euros. The donors "were cast adrift after the removal of organs without proper medical care or any medical attention, like waste," EU prosecutor Johnathan Ratel told the media.

The case has international ramifications. The EU prosecutors were unable to extradite two of the main suspects in the Medicus case (named after the clinic where transplants took place), a Turkish transplant surgeon, Yusuf Sonmez, and the alleged mastermind, an Israeli named Moshe Harel.

The Serbian media has covered the case closely and has highlighted sensational allegations that Kosovar gangsters with links to high government officials sold organs from Serb prisoners of war during the 1990s. Kosovo and Albania have hotly denied these claims. 

This is not the way the era of assisted reproduction was supposed to work. An unnamed woman in the UK has been jailed for five years after artificially inseminating her 14-year-old adopted daughter in order to get another child.

The harrowing case came to light after the secretive Court of Protection released a judgement by Mr Justice Jackson. He said that he had "an abiding sense of disbelief that a parent could behave in such a wicked and selfish way towards a vulnerable child".

The case came to light when the 48-year-old mother behaved strangely in the hospital after her daughter had given birth. She tried to prevent her from breastfeeding, saying, "we don't want any of that attachment thing". The staff noticed how reluctant the daughter was to hand the baby to her mother and when she attempted to remove the baby from the ward they contacted child protection workers.

The mother was clearly a strange and domineering woman. Her divorced husband had not seen her for 10 years. The woman did not want to give birth herself because she had diabetes and did not want to pass on the disease to her children. So she had herself sterilized and adopted three children, two before her divorce and one afterwards as a single mother. She home-schooled them and raised them in seclusion, or as the judge put in, in a “toxic cocoon”.

However, the woman was not happy with only three children and applied to adopt a fourth. When her application was denied she ordered her 14-year-old virgin daughter to bear a child for her. The girl told the court:

‘Mum said to me, “A, the only way I can have a fourth child is for you to get pregnant”. ‘I was shocked, pretty shocked at first. And then I suddenly thought, “Maybe if I do this then everything will be over. Mum will be happy like she was before”. ‘And I also thought from a selfish point of view, “If I do this . . . maybe she will love me more”.’

The woman’s system was crude. She forced the girl to inseminate herself "alone in her bedroom, using syringes of semen and douches prepared by the mother". This happened seven times. Once she bought semen from a casual visitor, but the other time it came via post from the Danish sperm bank Cryos.

Mr Justice Jackson said there were "no effective checks on a person's ability to obtain sperm from Cryos" and that no "meaningful medical involvement is demanded", except for the approval of a doctor (which the mother forged).

The girl may have miscarried once at 14, the judge believes, but finally, at the age of 16, she gave birth to a boy.

The case was a clear failure of adoption procedures and child welfare authorities. The woman was reported several times to the authorities, but no effective action was taken. The local Safeguarding Children Board said in a statement, "Nothing can change what has happened to the children in this truly terrible case. It is clear that public bodies must highlight the major public policy issues which arise from this case."