Indian government is envisaging compulsory
treatment of some sex offenders with antiandrogenic drugs, commonly referred to
as chemical castration.
Laws in several American states allow compulsory
medical treatment of offenders who have committed serious sex offences.
Chemical, as well as physical, castration of sex offenders takes place in
psychiatric hospitals in the Czech
Republic under the legal
framework of “protective treatment.” Meanwhile, in England the Department of Health is
supporting an initiative to facilitate the prescription of drugs on a voluntary
basis for sex offenders in the criminal justice system.
Demand for the prescription of antiandrogens or
physical castration for sex offenders is a common reaction by lawmakers and
politicians when a high profile sexual crime is committed.
Whether medical or surgical, the procedure
requires the participation of doctors. It also shifts the doctor’s focus from
the best interests of the patient to one of public safety.
Antiandrogenic drugs and physical castration
undoubtedly reduce sexual interest (libido) and sexual performance, and they
reduce sexual reoffending.
Physical castration of sex offenders was carried
out in several European countries in the first part of the 20th century.
Nowadays drugs are usually used alongside
psychological treatment).
The main drugs used are cyproterone acetate (in
the United Kingdom, Europe, and Canada); medroxyprogesterone (in the United
States); and increasingly the more expensive but possibly more potent
gonadotrophin releasing hormone agonists such as leuprolide, goserelin, and
tryptorelin.
Although these drugs act in different ways, they
all reduce serum testosterone concentrations in men to prepubertal
values.
Castration, however—whether chemical or
physical—is associated with serious side effects, including osteoporosis,
cardiovascular disease, metabolic abnormalities, and gynaecomastia. Physical
castration is mutilating and irreversible, and it carries the potential for
serious psychological disturbance, although some offenders request it
nonetheless.
Is there a clear medical rather than social
reason for prescribing powerful drugs.
When the intensity or ability to control sexual
arousal is the presenting feature—whether it manifests as frequent rumination
and fantasy or strong and recurrent urges—then treatment directed towards the
biological drive makes sense.
Treatment protocols can then be based on
the medical indication (remembering that drugs other than the antiandrogens,
such as selective serotonin reuptake inhibitors, can also be effective,
particularly when sexual rumination is the presenting problem) rather than on
risk.
When drugs work the clinical effect is often
dramatic, with offenders reporting great benefit from no longer being
preoccupied by sexual thoughts or dominated by sexual drive. These drugs can
also allow offenders to participate in psychological treatment programmes where
previously they may have been too distracted to take part. 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. [Source BMJ, 2010]