February 23, 2024

BMJ editorial backs castration of sex offenders

Disputed by Italian doctors

Simmering away in the pages of the British
Medical Journal is a debate over the merits of surgical or chemical castration
for convicted sex offenders. The Journal takes a surprisingly positive view of
the proposal. On the whole, argue psychiatrist Don Grubin and criminal
psychologist Anthony Beech, it may not be a bad idea, if the offender gives his

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… Physical castration as
part of a rehabilitative strategy may even have a place.

A number of issues arise in considering the
wisdom of castration. Is the offender capable of giving informed consent when
the alternative may be the rest of his life in prison? Is the doctor acting
only in the best interests of his patient, and not of society? Is punitive
mutilation consistent with his Hippocratic Oath not to do harm? Apparently the
English Department of Health believes that these and other issues can be overcome,
as it is supporting the prescription of drugs on a voluntary basis
for sex offenders.

However, two Italian doctors from the
Gemelli Clinic in Rome, Giuseppe Vetrugno and Fabio De Giorgio, comment in a recent letter to the BMJ that they
are “perplexed” to discover that a health department “has approved a stark
reversal of what should be the natural outlook in the practice of medicine”. “The
physician is never to act against the interests and the wellbeing of the
patient. The physician is the trustee of the patient who seeks to be healed,
meaning that the healer’s sole professional responsibility is to cure the
patient,” they argue.

In the BMJ’s arguments they detect “pseudo-humanitarian alibis that utilise,
under a logic of greater or lesser returns, a form of punishment already
questionable in its own right, employing it in the name of a indeterminate
collective good”. ~ BMJ, Jan 10

Michael Cook
informed consent