A Sydney court of appeal has ruled that sex is not binary, ie, just male or female. From now on, certificates for births, deaths and marriages in the state of New South Wales must accommodate people who do not identify with either sex.

The case was brought by Norrie, who was born as a man but now identifies as neuter after sex-change surgery. In 2010 he was allowed to place “sex not specified” on his official documentation. But this permission was quickly withdrawn by the Administrative Decisions Tribunal. Norrie appealed and won.

''This is the first decision that recognises that 'sex' is not binary - it is not only 'male' or 'female' - and that we should have recognition of that in the law and in our legal documents,'' said Emily Christie, one of Norrie's solicitors. Lawyers predict that the case could be persuasive In other Australian jurisdictions.

According to the Sydney Morning Herald, “The decision has both symbolic and practical significance. Unlike passports, which currently allow for someone to declare their sex as '’X'’, registry documents such as birth certificates are ''cardinal documents'', meaning they create a person's identity. They are thus recognised by government departments, courts and other legal authorities.” The New South Wales government is currently studying whether to bring the decision to a higher court.

The ethics of using killer robots is adding a new subspeciality to bioethics. This week the United Nations Human Rights Council debated the use of lethal autonomous robots in Geneva. UN special rapporteur Christof Heyns, a South African legal expert, called for a moratorium while legal and ethical issues are knotted out.

"War without reflection is mechanical slaughter," he said. "In the same way that the taking of any human life deserves - as a minimum - some deliberation, a decision to allow machines to be deployed to kill human beings deserves a collective pause worldwide."

Mr Heyns says that LARs could be as big a step in warfare as gunpowder or nuclear weapons. But it would be qualitatively different, since machines, not humans, would be deciding whether or not to kill. He also worries that LARs could make war more likely, as nations would not feel inhibited by the fear of wasting the lives of their own soldiers. In a report to the Human Rights Council, he writes:

“There is a qualitative difference between reducing the risk that armed conflict poses to those who participate in it, and the situation where one side is no longer a ‘participant’ in armed conflict inasmuch as its combatants are not exposed to any danger. LARs seem to take problems that are present with drones and high-altitude airstrikes to their factual and legal extreme.”

One important issue posed by the LARs is the lack of a clear chain of responsibility. Drones are also mechanical killers, but at the moment the decision to kill is taken by a human being. Mr Heyns says:

"Their deployment may be unacceptable because no adequate system of legal accountability can be devised. LARs can potentially be also used by repressive governments to suppress internal domestic opponents. "Do we want a world in which we can be killed either as combatants or as collateral damage by robots with an algorithm which takes the decision? It's this issue of diminishing human responsibility that concerns me."

Human Rights Watch has been campaigning to ban the use of killer robots. It issued a report last November calling for a pre-emptive ban.

The Maine House of Representatives has decisively rejected a bill to legalize physician assisted suicide , just days after Vermont legalized it. The Patient Directed Care at End of Life bill was defeated 95-43. The legislation would have lifted criminal sanctions on doctors.

The bill was sponsored by the independent Rep. Joseph Brooks. Brooks gave an emotional address to the house about the slow death of his own father. Rep. Deborah Sanderson who used her mother’s death to argue the opposite case: “I sat with my mom the last five days of her life. I slept in a wheelchair by her bed,” she explained. “The night before my mother passed, my mother said, ‘It’s not like what I thought it would be.’ She said, ‘It’s peaceful.’”

The Maine Medical Association opposed the bill, as did the Maine Osteopathic Association, which called it "very dangerous public policy." Both groups strongly support better palliative care. Assisted suicide was defeated in a 1990 referendum.

Health experts have long lamented the complexity of patient consent forms. A new University of Michigan study may provide a solution to this barrier to achieving genuine informed consent.

The study, published in JAMA Paediatrics,  was conducted on 640 parents of children scheduled for elective surgery. It involved a fictional trial of the pain relieve drug “Painaway”. Parents were randomized to receive information about the trial presented in 1 of 16 consent documents containing different combinations of 5 selected communication strategies (length, readability, processability [formatting], graphical display, and supplemental verbal disclosure).

The trial showed that “positive message attributes” — text written at the eighth-grade reading level, bigger type, graphic display, oral explanations and shorter forms — led to a 75% better understanding risks and benefits of the trial. Parents had 50% better odds of understanding documents that included pictures displaying risk information in graphic form. The odds of comprehension dipped by 75% when forms were written at the 12th-grade reading level. Documents that were just a few pages longer were 71% less likely to be understood than shorter forms.

The research shows it is important to combine as many comprehension-aiding techniques as possible when crafting informed-consent documents, said Alan R. Tait of the University of Michigan Medical School. “These are simple things to do. These are not expensive. These are easy fixes, easy to incorporate, and yet they make a big difference.”

In an accompanying editorial, Dr Mark Schreiner, of the Children’s Hospital of Philadelphia, said that consent forms have been becoming increasingly technical and legalistic. "Instead of brevity, consent forms remain verbose, increasing in length by approximately 1.5 pages per decade, with some well in excess of 20 pages" he said. Many health institutions have been reluctant to shorten and simplify forms due to concerns about increased liability.

Princeton ethicist Peter Singer (at about 16 minutes in video) provoked an uproar at last week's Women Deliver 2013 conference in Kuala Lumpur, a major international talkfest featuring the acting head of UN Women, Lakshmi Puri, former New Zealand prime minister Helen Clark, former Finland president Tarja Halonen, African Women’s Development Fund CEO Theo Sowa, and Princess Mary of Denmark.

Singer denied the absoluteness of reproductive rights. He argued that there are "imaginable circumstances" when these rights could be overridden. He compared children to cattle grazing in a field, and said that overriding procreation may be necessary to avoid environmental catastrophe:

“Turns out that the right to graze as many cows as you like on the common was not an absolute right… Obviously this is what I think we ought to be saying even about how many children we have… I hope we don’t get to a point where we do have to override it… but I don’t think we ought to shrink away from considering that as a possibility.”

Babtunde Osotimehin, executive director of the UNFPA, objected, “There is no way we will come to a point where we are limiting the rights of people in this way.” Osotimehin emphasised that “global population growth is actually coming down” and that predictions of worldwide famine and overpopulation disaster were way off the mark.

A US court has overruled government health policy and fast-tracked a lung transplant for a Pennsylvania girl with cystic fibrosis. On Wednesday US District judge Michael Baylson overruled the regulation that prevents children under 12 from getting adult lung transplants regardless of how ill they are. The rule was waived for Sarah Murnaghan, a cystic fibrosis patient at the Children's Hospital of Philadelphia's intensive care unit, who is believed to only have weeks to live.

Murnaghan's family - and many bioethics lobby groups - have for weeks been petitioning US Secretary of Health and Human Services Kathleen Sibelius to waive the rule for Sarah. Sibelius believes that it would be wrong to change the policy so rashly for one patient. She said that that transplant experts believed the procedure to be extremely risky, and that the policy should not be revised without a proper HHS review.

Bioethicist Authur Caplan said that it is troubling, and perhaps precedent-setting, for a judge to overrule that medical judgment, and predicted a run to the courthouse by patients who don't like their place on the waiting list. "I'm not sure I want judges or congressmen or bureaucrats trying to decide what to do with organs at the bedside," Caplan said.

At the hearing, Dr Samuel Goldfarb, one of the girl’s doctors at the Children’s Hospital of Philadelphia and the head of its heart and lung transplantation programs, testified that she was critically ill and had worsened in the past 24 hours. A machine has helped her breathe since she entered the hospital about three months ago, and she will probably need more invasive assistance within a week. Without new lungs, she would probably die within weeks. He said that 12 was an “arbitrary” age for the change in policy.

Ever fancied your own Mr Snuffleupagus? The dream may not be that far away.

Russian scientists claim to have discovered liquid woolly mammoth blood in a frozen carcase in Siberia, which would make cloning a real possibility. An expedition earlier this month, led by scientist Semyon Grigoryev, uncovered the remains of a 60-year-old female mammoth on a remote island in the Arctic Ocean. "This find gives us a really good chance of finding live cells which can help us implement [our] project to clone a mammoth," Grigoryev said. However, many scientists are sceptical. Dolly, the famous cloned sheep, was born after 277 attempts.

The discovery has reignited debate over the ethics of cloning. At a conference at Stanford Law School last week, experts debated the ethical, legal and political implications of “de-extinction”.

Beth Shapiro, of the University of California at Santa Cruz, expressed concerns about the difficulty of cloning and the inevitable creation of countless deformed and terminal-ill animals. “I think we should consider deeply why we want to de-extinct things" she said. Kate Jones of University College London said that “Conservation biologists worry that if people think we can revive species they won’t care about protecting what’s left".

The scientific community also questions the involvement of disgraced South Korean scientist Hwang Woo-Suk. Hwang's Sooam Biotech Research Foundation is one of two institutes working with the blood samples. In 2005 Hwang made international news when he faked landmark discoveries in human embryo cloning research. He was subsequently charged with fraud and embezzlement. 

It used to be said that "the British Empire was acquired in a fit of absence of mind". Similarly, adventurous bioethicists seem to be continually pushing back the frontiers of their discipline. The latest conquest, or at least challenge, is climate change. Writing in the journal Bioethics, Cheryl Cox Macpherson, of St George's University School of Medicine, in Grenada, points out that climate change will harm public health systems and that bioethicists have a responsibility to warn policy makers. 

“Bioethics could boost understanding of the benefits and harms; promote transparency about actions and policies that allow climate change to worsen; expose potential conflicts of interest that affect the conduct and interpretation of risk assessments; generate insights about sociocultural conditions that impinge on autonomy and worsen emissions; and ground new conceptions of social responsibility. At the very least, bioethics should inform and facilitate public and policy dialog about how climate change threatens health and things societies have valued for centuries.”

It is hard to imagine a more inhumane policy than China’s one-child policy. But there is one: the two-child policy imposed on Myanmar’s Rohingya Muslims. Late last month government authorities in the largely Buddhist country reaffirmed a 2005 policy which punishes Rohingya women who bear more than two children with hefty fines and loss of legal rights for the children.

After a long silence on the issue, Nobel Peace Prize laureate Aung San Suu Kyi has condemned the measures. She has told the media that if reports of the policy were true, it was illegal. "It is not good to have such discrimination. And it is not in line with human rights either.”

According to al-Jazeera, a government spokesman, Win Myaing, explained that the regulations were meant to dampen sectarian tensions. The Rohingya live mostly in two town, which are islands in a sea of Buddhists. "The population growth of Rohingya Muslims is 10 times higher than that of the Rakhine (Buddhists)," he said. "Overpopulation is one of the causes of tension."

The Rohingya number between 800,000 and 1 million, most of them living near the border with Bangladesh. They have been the target of legal discrimination and sectarian violence. Human Rights Watch has accused the Myanmar government of conducting a campaign of “ethnic cleansing” against the Rohingya.

Tensions between Buddhist Burmese and the Muslim Rohingya go back centuries but were greatly heightened during the British colonial period and the Japanese occupation in World War II. Since 1982 Myanmar has not even acknowledged that they are citizens.

In 2005 local authorities began to enforce a two-child policy. Rohingya couples who wish to marry must seek government approval – a process which can take up to two years. They must agree to have no more than two children. More children are punishable with fines and imprisonment. As a result unsafe abortions are common among women who become pregnant before they are legally married or who are carrying a third child.

According to Human Rights Watch, “Rohingya children born out of wedlock or in a family that already has two children do not receive any status whatsoever from the government, making them ineligible for education and other government services, unable to receive travel permissions, and they are later not permitted to marry or acquire property. They are subject to arbitrary arrest and detention.” 

America's foremost expert in the psychology of suicide this week offered an alarming account of what he calls "the suicide epidemic" in Western nations. In an interview with Newsweek Professor Thomas Joiner of Florida State University drew attention to alarming new data about suicide rates amongst middle-aged adults - the number of suicides in this group has increased by 30% in just one decade. The new figures are even worse when narrowed to white middle-aged men, for whom the rate has jumped by more than 50%. In wealthy countries, suicide is the leading cause of death for men in their 40s and top-five killer of men in their 50s.

Joiner identified a number of factors. One of the main ones is a decline in the sense of community in Western societies. "Low belonging", he said " is [usually the initial cause] of the desire to die". He believed this explains why suicide rates rise by a third on the continuum from married to never been married. It also accords with the fact that divorced people suffer the greatest suicide risk, while twins have reduced risk and mothers of small children have close to the lowest risk.

Joiner called for a paradigm shift in the way society perceives suicide. Currently suicidal tendencies are seen as the product of a weakness of character, he said. This perception produces shame in people which leads them to not seek treatment. “We need to get it in our heads that suicide is not easy, painless, cowardly, selfish, vengeful, self-masterful, or rash,” Joiner said. “And once we get all that in our heads at last, we need to let it lead our hearts.” Suicide is the rare killer that fails to inspire charity drives and new university research centres for study and treatment. Joiner is convinced that this needs to change.