Just when you thought that surrogate motherhood could not get more bizarre and complicated, a news flash comes from Hyderabad, the centre of the Indian surrogacy industry. This story concerns J. Pearl Linda Van Buren Green, a 35-year-old New Yorker, and her son Emperor Kaioyus Van Buren Green, who are caught in a Bermuda Triangle of "red tapism" somewhere between the Big Apple, Jamaica and the Subcontinent. 

More than 18 months ago Ms Green flew to India with seven vials of frozen semen. Her husband, Eric Dalton Green, lives in Jamaica and could not come to India because he has a fear of flying. Ms Green visited clinics in Goa and Mumbai before hitting the jackpot in Hyderabad. There she found a clinic which provided donor eggs and a surrogate mother, both anonymous. Her son was born on December 7.

Then began her battle with Indian bureaucracy. Because she could not prove that her husband was the biological father, the government turned down her request for the baby's passport. in a huff, Ms Green stormed out of the passport office, leaving her bundle of joy on a bench. The police reviewed CCTV footage and after some inquiries, found Ms Green and returned the baby to her. They decided not to charge her with abandonment. Ms Green is still waiting for identity papers for the baby.

Fertility has become a significant industry in Hyderabad. The Calcutta Telegraph reports that “Many women from Andhra Pradesh’s drought-hit districts choose to become surrogate mothers to earn a few extra bucks for their impoverished families.” One clinic claimed that it has a list of “nearly 400 surrogate mothers” who can be contacted at short notice.

There are 50 or 100 surrogate births a month, although only a handful of these come from overseas. “Most of the clients are women from well-to-do Indian families who want to avoid childbirth so that their lifestyle, or body shape, is not affected,” said IVF specialist Srinivas Prasad. ~ Calcutta Telegraph, Jan 29

New figures show that 75 patients are dying in UK hospitals and care homes each day with conditions potentially caused by neglect. In 2010, over 27,000 people died with bedsores or infected wounds – an increase by more than 50% in a decade. Bedsores occur when patients are not turned regularly, or are left in poor hygiene. They may become infected if not spotted and tended to quickly. While in many cases the sores and infections were not the cause of death, experts said their presence demonstrated that thousands of patients were receiving poor treatment during the last days and weeks of their lives.

The Daily Mail reports that figures from the Office for National Statistics show that in 2010, 155 patients died in hospital from dehydration and a further 48 died from malnutrition. Another 812 died with dehydration and another 301 with malnutrition, although the conditions did not directly cause death.

While some attribute these deaths to poor care, officials who compiled the statistics noted that some illnesses such as Alzheimer’s or certain forms of cancer make it very difficult for patients to eat or drink. However, Katherine Murphy of the Patients Association said: “These figures are a terrible indictment of our precious National Health Service. They represent avoidable deaths. These people needed our care when they were at their most vulnerable.”

A Department of Health spokesman said: “Many patients who suffer or die from malnutrition and dehydration are admitted to hospital with these conditions and have underlying health conditions like cancer that make them more susceptible to these problems. However, every NHS patient has the right to expect that they are looked after properly in hospital.”

A series of scandals over care of the elderly prompted the discovery, and led to an intervention from UK Prime Minister David Cameron this month ordering nurses to attend to patients more often. Last year, a report by the Health Service Ombudsman berated the National Health Service for treating the elderly inhumanely. ~ Daily Mail, Jan 22; Telegraph, Jan 29

Last year, Taiwanese health authorities moved to crack down on illegal abortions, warning that doctors found guilty of the practice could have their licenses revoked. They announced on Tuesday that tougher oversight on illegal gender-selective abortions prevented almost 1,000 terminations of female foetuses last year.

Chiu Shu-ti, director-general of the Bureau of Health Promotion, attributed the improvement to government measures aimed at curbing sex-selective abortions and public-private campaigns promoting gender equality awareness. “To improve the country’s imbalanced sex ratio, the DOH has been publishing birth statistics on a regular basis and monitoring hospitals with irregular numbers since May 2010,” Chiu said. “Thanks to these efforts, 993 baby girls were saved in 2011.”

“The strict measures have paid off,” said Lee Tsui-feng, an official at Bureau of the Health Promotion of Taiwan’s Department of Health. According to government figures, 108 male babies were born for every 100 female babies in 2011, down from 109 to 100 in 2010. The normal sex ratio at birth worldwide I 104-106 to every 100 females.

While sex-selective abortions have always been illegal in Taiwan, the practice is believed to have become widespread, due to a traditional preference for male offspring. Despite last year’s improvement, Lee said it might take another 4 or 5 years to root out illegal abortions entirely. ~ AFP, Feb 1; Taiwan Today, Jan 30

Jesus Navarro needs a new kidney.  He has a willing donor and private insurance -- but he has been denied the transplant because he is an illegal immigrant. Administrators at the University of California San Francisco Medical Center are refusing to transplant a kidney from Navarro’s wife, saying he may not receive sufficient follow-up care, due to his uncertain status.

The decision highlights the tension between immigration policy and health care, and underlines the difficult role medical professionals play in attempts to save the lives of illegal immigrants. Mercury News reports there is anecdotal evidence to suggest that clinics often perform organ transplants on undocumented residents, even when the patients are young. In one case, UCLA Medical Center gave an illegal immigrant woman 3 liver transplants before she turned 21.

Health administrators also reject patients because of their immigration status, but that usually happens when patients lack insurance. “It puts the doctors in a very awkward and torn position,” said University of Pennsylvania bioethicist Art Caplan. “You come into this trying to do good and find yourself stuck in the middle of a fight about immigration.” ~ San Jose Mercury News, Jan 31

The North Carolina legislature has recommended that surviving victims of the State’s forced sterilization program be paid US$50,000 each. About 7,600 people were sterilized between 1929 and 1974 in North Carolina to prevent the feckless poor and the mentally handicapped from bearing children. About 2,000 are still alive. In the YouTube video above Elaine Riddick laments her experience. She was sterilized at 14 when she gave birth after being raped.

In a 1950 pamphlet, the Human Betterment League of North Carolina said that the program was necessary to protect "the children of future generations and the community at large.” "You wouldn't expect a moron to run a train or a feebleminded woman to teach school," it said. ~ Los Angeles Times, Jan 25

After losing a case for damages for the birth of their severely disabled son based on a “wrongful life” claim, a Sydney couple has returned to the courts with a “wrongful birth” claim for A$10 million.

Keeden Waller was born in August 2000 with a rare blood clotting condition. This caused a massive stroke soon after his birth which left him unable to walk, talk or use a toilet. His parents are suing the IVF specialist under whose care he was conceived. Lawrence Waller, the father, suffered from the same condition but somehow the doctor failed to link the parents up with a genetic counsellor.

''There was a duty of care on the part of Dr James to ensure that both he and the Wallers understood that this problem could be passed on and for there to be proper counselling and discussion about the other options they had, including the option of an anonymous sperm donor,'' the Wallers’ lawyer argues.

The doctor’s lawyer contends that he was not responsible for finding out whether a rare genetic condition could be inherited. ‘‘There is no question that Debbie and Lawrence Waller have experienced a tragic event and that the Keeden Waller situation is extremely sad,’’ said their lawyer. ‘‘But they are intelligent adults who were advised to speak to a genetic counsellor. They chose not to take up that advice.’’

The outcome of the case – which is far from certain – is sure to influence compensation to parents of other disabled children.

In 2006 the couple failed in the High Court of Australia when their lawyers argued that the birth was a “wrongful life”. At that time, the court ruled that the IVF specialist did not cause Keeden’s disabilities and that the couple could not claim that it would have been better if Keeden had never been born. ~ Sydney Morning Herald, Feb 1; skepticlawyer, Feb 1

Bioethics is playing a walk-on role in the drama of the Republican primaries. Newt Gingrich has expressed his opposition to abortion and embryonic stem cell research and has called for an investigation of practices in IVF clinics. He believes that human life begins at conception.

Gingrich’s stand on embryonic stem cell research has shifted over the years but he now says that he would ban all embryonic stem-cell research, including research done on surplus embryos created by IVF clinics. In his words, it amounts to “the use of science to desensitize society over the killing of babies.”

He also plans to form a commission to study the ethics of in vitro fertilization. “I believe life begins at conception, and the question I was raising was what happens to embryos in fertility clinics, and I would favor a commission to look seriously at the ethics of how we manage fertility clinics,” Gingrich said at a news conference at a Baptist church in Florida. “If you have in vitro fertilization, you are creating life; therefore, we should look seriously at what the rules should be for clinics that are doing that, because they are creating life.”

Predictably, the notion of questioning IVF was ridiculed. The liberal website ThinkProgress ran the news under the headline: “Gingrich Suggests It’s Immoral For Couples To Conceive Children Through In Vitro Fertilization”. But in Time magazine, columnist Bonnie Rochman thought it had some merit. What is going to be done with the hundred of thousands of embryos in frozen in the storage tanks of IVF clinics?

After his failure to overtake frontrunner Mitt Romney in Tuesday’s Florida primary, Gingrinch’s star seems to be fading. But his effort to back restrictions on tinkering with embryos could influence policy in a Romney Administration. ~ Washington Post, Jan 30

The left-wing candidate in the French presidential election has strongly endorsed the legalisation of euthanasia if he is elected. François Hollande, a Socialist, who will face the incumbent Nicolas Sarkozy, recently revived France’s simmering  euthanasia debate.

"I propose that all adults in an advanced or terminal phase of an incurable disease, which is causing unbearable physical or psychological suffering and cannot be treated, may request, under specific and strict conditions, medical assistance to end their life with dignity. "

A spokesman told Reuters that the exact protocols had not been worked out yet. "We believe that a person who is terminally ill and experiencing intense physical and psychological suffering must receive active assistance to die, but it must be very strictly regulated," she said.

Euthanasia has been fiercely debated in France. In January last year the Senate rejected a bill put forward by M. Hollande. President Sarkozy is firmly opposed. The current Prime Minister, François Fillon, pointed out in last year's debate that working out the exact protocols was devilishly difficult:

“This scheme does not offer the necessary guarantees. The proliferation of definitions of the end of life and procedures introduces ambiguities and sources of legal uncertainty. The implementation of the act of euthanasia is itself surrounded by conditions that are imprecise.”

The first round of the French election will take place on April 22.  Le Monde, Jan 27

Princeton bioethicist Peter Singer and a research assistant, Agata Sagan, proposed a “morality pill” in a column in the New York Times this week. They speculate that moral behaviour is at least in part biochemically determined. Hence, it should be possible to engineer moral behaviour with drugs. Here is the scenario that they paint:

“If continuing brain research does in fact show biochemical differences between the brains of those who help others and the brains of those who do not, could this lead to a “morality pill” — a drug that makes us more likely to help? Given the many other studies linking biochemical conditions to mood and behavior, and the proliferation of drugs to modify them that have followed, the idea is not far-fetched. If so, would people choose to take it?

“Could criminals be given the option, as an alternative to prison, of a drug-releasing implant that would make them less likely to harm others? Might governments begin screening people to discover those most likely to commit crimes? Those who are at much greater risk of committing a crime might be offered the morality pill; if they refused, they might be required to wear a tracking device that would show where they had been at any given time, so that they would know that if they did commit a crime, they would be detected.”

They foresee some objections to their idea. Some people will argue that depriving someone of free will can never be justified. But Singer and Sagan are sceptical of the existence of free will, so they suspect that this is not a sound objection.

Morality pills are not a novel idea. Another Australian utilitarian, Oxford bioethicist Julian Savulescu, believes that it would be a crime not to “enhance” people to act more morally. A couple of years ago he and Ingmar Persson contended that:

“If safe moral enhancements are ever developed, there are strong reasons to believe that their use should be obligatory, like education or fluoride in the water, since those who should take them are least likely to be inclined to use them. That is, safe, effective moral enhancement would be compulsory.”

A very specialised morality pill is already being used in some jurisdictions: chemical castration. This is meant to turn repeat sex offenders into harmless eunuchs. Dmitri Medvedev, the president of Russia, has backed the idea. And an editorial in the BMJ in 2010 gave it cautious approval:

"Given the transparency of benefits and risks, there is no obvious reason why an offender should not be able to make an informed choice about drugs… Physical castration as part of a rehabilitative strategy may even have a place."

Church-affiliated institutions must cover free contraception for their employees, the Obama administration has announced. As a concession to outraged religious groups, Health and Human Services Secretary Kathleen Sebelius said their hospitals, colleges and social service agencies will have an additional year to comply with regulations under President Barack Obama’s health care overhaul. The plan takes effect on August 1, but institutions who have sought an exemption will not have to comply until August 1, 2013 – after the election in November.

Ms Sebelius said that access to contraception was a fundamental part of healthcare: “Scientists have abundant evidence that birth control has significant health benefits for women and their families, it is documented to significantly reduce health costs, and is the most commonly taken drug in America by young and middle-aged women.”

Despite protests, the Obama Administration seems confident that this will not become a religious liberty issue. “This decision was made after very careful consideration, including the important concerns some have raised about religious liberty. I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services,” Sebelius said in a statement.

A number of important religious groups disagree strongly. A spokesman for an Orthodox Jewish group, Nathan Diament, complained about the “underlying rationale for its decision, which appears to be a view that if a religious entity is not insular, but engaged with broader society, it loses its 'religious' character and liberties.”

The National Association of Evangelicals said that employers with religious objections to contraception will be forced to pay for services and procedures they believe are morally wrong. “No government has the right to compel its citizens to violate their conscience.  The HHS rules trample on our most cherished freedoms and set a dangerous precedent.”

"In effect, the president is saying we have a year to figure out how to violate our consciences," said Archbishop Timothy M. Dolan, president of the US Conference of Catholic Bishops. "To force American citizens to choose between violating their consciences and forgoing their health care is literally unconscionable. It is as much an attack on access to health care as on religious freedom. Historically this represents a challenge and a compromise of our religious liberty."

Politically, the move is puzzling. America, a leading Catholic magazine, observed that “the exemption will surely prove an election year headache for the Obama administration as it adds powerful fuel to the fire for those alleging that the administration's policies and practices often trample religious liberty… Clearly a lose-lose proposition in an election year.”

On the other hand, supporters of the measure insist that it is a women's rights issue. Louise Melling, deputy legal director of the American Civil Liberties Union, pointed out in the Washington Post that nearly all women, including many Catholics, use contraceptives at some stage. Furthermore, religious institutions employ many who do not share their faith and many states already require contraceptive coverage. Religious freedom “does not give religious groups the right to impose their beliefs on others,” she said.