Treatment or punishment? Chemical castration of child sex offenders

Chemical castration isn’t the answer to keeping children safe from sexual offenders. l i g h t p o e t/Shutterstock

The use of “chemical castration” has been seen by many as an answer to the public fear of paedophiles, reignited by the recent trial of Brett Cowan for the murder of Daniel Morcombe. The idea is that giving anti-androgenic drugs to stop the production of sex hormones will prevent perpetrators from being able to act on inappropriate sexual desires.

Queensland, New South Wales and Western Australian courts can mandate the use of chemical castration – the administration of drugs to reduce sex drive and the capacity for sexual arousal – for “dangerous sex offenders” on release from prison. In Victoria, anti-androgen treatment can be made a condition of parole by the Parole Board.

Similar chemical castration laws are also in place in nine US states and in the European Union, including the Czech Republic, which has the most draconian system.

But chemical castration isn’t the answer to keeping children safe from sexual offenders. Not only as its efficacy has been overstated, forcing people to take this medication breaches their human rights.

Punishment

The idea of disabling offenders in the bodily area which inflicted the crime has huge symbolic attraction and in the case of sex offenders, an undeniable logic. Damaging the body of the offender has a long pedigree in criminal justice.

But “bartering the body” in exchange for release from incarceration is a relatively new approach. Most decisions about chemical castration are made in prison, so the prisoner must accept the damage to his body in exchange for freedom. The illusion of “choice” inside prisons can be the cruelest and most insidious punishment.

The problem with sex offender treatment involving anti-androgen medication is partly in the use of the word “treatment”. After all, is sex offending an illness that can be “treated”? And can giving someone a drug which will harm his body ever be treatment?

The question of duration of “treatment” is also problematic. If it’s life-long, there is little difference between chemical and physical castration. If not, there’s an expectation of “cure” which is not supported by the literature.

Primum non locere or “first, do no harm” is a fundamental tenet of medical ethics. Administering a substance that has substantial side effects (such as osteoporosis) and many unknown outcomes, in an environment that restricts the individual’s autonomy, raises substantial human rights concerns.

The debate about whether child abusers have lost the right to decide what happens to their bodies is outside the realm of medical decision-making. Chemical castration, like any other deliberate harm inflicted by the state, must be viewed as punishment and governed by considerations of proportionality and finality.

Most decisions about chemical castration are made in prison, so the prisoner must accept the damage to his body in exchange for freedom. sakhorn/Shutterstock

Questionable efficacy

While some studies indicate that preventing the production of testosterone in offenders reduces their sexual drive, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) notes that studies of sex offender treatment are plagued with methodological problems.

Further, a recent British Medical Journal article article reports that there is:

weak evidence for interventions aimed at reducing re-offending in identified sexual abusers of children.

And another review states the:

research is so weak that, were the treatment not so plausible it would have to be regarded as empirically unsupported.

Even among the most enthusiastic proponents of chemical castration, the caveat is that it is probably more effective with those who voluntarily request treatment. These men may well be less inclined to reoffend anyway. One of the prisoners interviewed for my research, for instance, said he agreed to it because he was now a grandfather and wanted “no more victims.”

In addition, androgen-suppressing medication may only be effective in those comparatively rare individuals with “paraphilias”, a psychiatric diagnoses of abnormal sexual orientation. Many sex offenders are opportunistic and may be motivated more by aggression and dominance than sexual paraphilia.

Other considerations

The focus on medical solutions to child sex offending promotes the idea that child sexual abuse is mostly perpetrated by paedophilic strangers. Given that up to 90% of sexual abusers of children are known to the victim, representing all child sex abusers as recidivist paedophiles risks further distortion of public discourse around child sexual abuse.

Another uncomfortable fact about this population of offenders is that, contrary to public opinion, they have among the lowest rates of recidivism. Whether this is because of low rates of reporting, prosecution or conviction, the fact remains that drastic measures applied to a group whose re-offence rates are already low may have little or no effect.

While medication may prove to be a useful last resort for controlling the overwhelming sexual urges of some individuals, a focus on the medication of child sexual abusers detracts from other potentially more effective modes of management for the majority of offenders.

Public debate about the ethical problems posed by punitive medical measures needs to be informed by reliable, independent research about the best ways to protect children. This is currently absent.