IN many societies, there is a clear need for new methods to prevent or control crime. Traditional means such as physical incarceration oftentimes do not act as a deterrent, nor do they succeed in bringing about rehabilitation or in preventing recurrences.

Instead, they may sometimes produce unwanted side effects at both the individual and societal level. With these negative outcomes or side effects in mind, neuro-intervention is now increasingly being seen as a more effective and humane way to address crime.

CHEMICALLY CASTRATING SEX OFFENDERS

Neuro-interventions involve the use of chemicals to treat criminally offending members of society. One such use was invoked into law in the United States territory of Guam in the Pacific recently. Their legislature passed a Bill authorising compulsory chemical castration for convicted sex offenders before they are released back into society. Statistics by the Federal Bureau of Investigation (FBI) shows that Guam has the second highest rate of rape among all the territories and states in the USA. Proponents of the bill found these numbers to be very alarming, and so thought they had little option regarding what to do.

Chemical castration is often seen as an easier alternative to life imprisonment or the death penalty in some jurisdictions because it allows the release of sex offenders while reducing or eliminating the chance that that they would repeat the offence. The first use of chemical castration occurred in 1944, when an anti-testosterone drug, diethylstilbestrol, was used with the purpose of lowering men’s testosterone level. Testosterone hormone is closely linked with the sex drive in humans. In 1966, John Money became the first person in the USA to prescribe medroxyprogesterone acetate (the main ingredient in the long-acting contraceptive injection Depo-Provera) as a treatment for a patient who was having paedophilic urges. That drug subsequently became one of the mainstays of chemical castration in the USA. Despite its long history and established use, however, the Food and Drug Administration (FDA) in the USA has never approved the drug as a treatment for sexual offenders.

RESEARCH IN CHEMICAL CASTRATION

In an experiment in 1981, 48 males with long-standing histories of sexually deviant behaviour were given medroxyprogesterone acetate for as long as 12 months. Forty of those men were recorded to have diminished desires for deviant behaviour, less frequent sexual fantasies, and greater control over their sexual urges. The research also recorded a continuation of this more positive behaviour after the administration of the drug had ended, with no evidence of adverse side effects, and so it recommended that this drug, along with counselling, was a successful method of treatment for serial sex offenders.

In 2009, Poland legislated forcible chemical castration of child molesters, and in 2010, a man in the United Kingdom agreed to undergo chemical castration as part of the terms of his sentence. In July 2011, South Korea enacted a law that gives judges the power to sentence sex offenders who have attacked children under the age of 16 years to chemical castration. Also, after the outrage that followed the gang rape of a woman in Delhi, India, that Government submitted a draft proposing chemical castration along with an imprisonment of up to 30 years for rape convicts. All this notwithstanding however, the Wellcome Trust in the United Kingdom, a global charitable foundation that funds research to improve human health, is currently funding a study of the bioethical issues involved in any compulsory castration of sex offenders.

THE MATTER OF HUMAN RIGHTS

The matter of chemical castration pits two important concepts and obligations against each other – protecting the safety and welfare of the public versus protecting the human rights of the offender so that he is not treated in any way that may be less than human. Such concerns are characteristic of debates around the world on the matter. So, whilst a government task force in the Australian state of New South Wales is currently contemplating whether judges should compel sex offenders to undergo the treatment, the Royal Australian and New Zealand College of Psychiatrists is reportedly opposed to mandatory or compulsory biological treatments for child sex offenders.

They say their Code of Ethics stipulates that psychiatrists should seek valid consent from their patients before undertaking any procedure or treatment.

Further, one expert on sex offenders quoted a fundamental tenet of medical ethics, which states “first, do no harm”. She said administering a substance that has substantial side effects such as osteoporosis (weakening of the bones) and many unknown outcomes, particularly in an environment that restricts the person’s right to make decisions regarding themselves, raises substantial human rights concerns.

Many opponents think that neuro-interventions can be highly intrusive, and may threaten fundamental human values such as bodily integrity and freedom of thought. Further, they argue that humanity has a track record of misguided and unwarrantedly coercive use of psycho-surgery and other neuro-technological ‘solutions’ to criminality that have been frowned upon in the past. In balancing all of these issues, therefore, what are your thoughts on this matter?

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the ethicist at the Caribbean Public Health Agency – CARPHA. (The views expressed here are not written on behalf of CARPHA).