Andrew Jacobs’s October 20 article in The New York Times provides a disturbing look at the long arm of China’s censorship regime, and demonstrates how international writers are now being forced to make the kinds of difficult decisions that writers must make every day in China.

But we should also recognize the much more serious cost of those decisions for China’s writers. As detailed in PEN’s May 2013 report Creativity and Constraint in Today’s China, many Chinese authors refuse to self-censor at great personal risk to themselves and their families. In the case of Nobel Laureate Liu Xiaobo, for example, his wife Liu Xia, a noted photographer, has lived under suffocating house arrest for the past two years for merely being married to him. The writer Liao Yiwu fled China, eventually seeking asylum in Germany, because he faced the impossible choice of having to self-censor his work or risk arrest for publishing a memoir of his four years in prison.

In the first half of 2013, there were 33 Chinese writers languishing in prison; of these, 17 were imprisoned for what they wrote or blogged using digital media. Liu Xiaobo, former president of the Independent Chinese PEN Center, was sentenced to 11 years in prison for writing seven sentences deemed subversive by Chinese authorities.

Despite these dire consequences, Chinese writers can circumvent censorship regimes by publishing multiple versions of the text on different platforms and in different markets.

“Chinese writers are able to get their books published in full outside the country even if the book is censored in China,” explained Tienchi Martin-Liao, President of Independent Chinese PEN Center. A writer can publish an uncensored version of the book in Hong Kong or Taiwan, and they can upload chapters onto the Internet or through microblogs. Readership of the uncensored text in China, however, tends to be much smaller than if the book had been published by a Chinese publisher.

“But there are some times when a censored version is unacceptable,” Tienchi added. “In 2005, I translated a book by [Jiri Grusa] from the German into Chinese on his experience of censorship in Czechoslovakia. Liu Xiaobo wrote an introduction, but Chinese publishers would only publish the text if we removed Liu Xiaobo’s essay.” Tienchi refused to allow the book to be published because fighting censorship was the whole reason for the book.

This is an important moment for the future of free expression in China, which comes under scrutiny today at the United Nations Human Rights Council Universal Periodic Review — the process during which each member country’s human rights record is examined every four years. Along with members of Independent Chinese PEN Center, PEN American Center submitted recommendations, among others, that China end both on- and off-line censorship; unconditionally release all writers in prison; and respect the rights of linguistic minorities.

Decisions about self-censorship today are increasingly an international problem that affects writers around the world. As writers search for new audiences and new markets, we may be forced to wrestle with difficult questions about balancing self-censorship with the free flow of ideas. These questions become all the more urgent each day that Chinese writers suffer in prison for exercising the human right to free expression.