Chemical castration for paedophiles approved

BMJ 1996; 313 doi: (Published 21 September 1996) Cite this as: BMJ 1996;313:707

Convicted paedophiles are to be forced to undergo chemical castration as a condition of their parole, under new measures approved in California.

Last week the California Assembly approved the move by 51 to 8. It was passed by the state senate in August, by a similar margin, and now awaits only the signature of governor Pete Wilson, who supports the move. California will be the first state to force convicted paedophiles to undergo chemical castration, but Florida, Texas, Massachusetts, and Washington are considering similar measures.

Under the terms of the law, which takes effect on 1 January 1997, castration would be optional for first time offenders and mandatory for repeat offenders. Men will be offered the choice of permanent castration through surgery or temporary castration through weekly injections of Depo-Provera, which is already used as a female contraceptive. In men Depo-Provera reduces testosterone concentrations and thus sex drive. Testosterone concentrations return to normal when administration of the drug ends.

Dr Fred Berlin, founder of the Johns Hopkins sexual disorders clinic in Baltimore and author of some of the studies on which the legislation was based, criticised the approach because it did not first require medical or psychiatric assessment to see if the individual had a condition that would respond to this treatment.

Dr Berlin cited his own experience in following up 600 people in treatment, 400 of them paedophiles. They received group therapy plus family or individual therapy; only 15% were also undergoing treatment with antiandrogens. Only 8% of the subjects relapsed over a five year period. Thus, “the overwhelming majority did well without medication.”

Dr Berlin suggested that state officials start with a voluntary programme, which can be expanded should it prove successful. He added: “This may be helpful if it gets us to recognise paedophilia as a public health problem. But you cannot punish this behaviour away—something in these people is broken and needs repair. We must make them take responsibility for their behaviour, but we also have to give them the tools to be able to do that.”

“I think this will lower the reoffence rate somewhat, but not nearly as much as they think it will,” said Dr Robert Dickey, head of the sexual behaviours clinic at the Clarke Institute of Psychiatry, University of Toronto. He noted that the treatment has a number of drawbacks. Depo-Provera has potentially serious side effects, including thromboembolism, and may cause weight gain, fatigue, malaise, mild depression, hypertension, hyperglycaemia, and rare changes in liver enzymes. Also, a high volume of injection is required. Most men will probably receive 400 mg to 500 mg Depo-Provera per week, which amounts to an injection of 2.5 ml into each buttock each time and probably contributes to the high dropout rate seen with this treatment.

Dr Dickey added that there is no guarantee that the treatment will work. Individuals vary in their response, and men given oral doses as high as 700 mg/day have still reported regular sexual arousal and fantasies. “You are relying on their self reports, which raises issues with respect to monitoring,” he said.

The law is expected to be challenged on constitutional grounds.—NORRA MACREADY, freelance journalist, Irvine, California

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