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Indian medical experts shun chemical castration for rapists

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f64 (Published 04 January 2013) Cite this as: BMJ 2013;346:f64
  1. Soumyadeep Bhaumik
  1. 1Kolkata, India

The violent gang rape of a paramedical student in a moving bus in New Delhi and her subsequent death, resulting in widespread outrage around India, has led to calls for chemical castration as a punishment for rapists. Various political and civil society groups and reportedly the central government too are considering such a law, which they say would curb the rising rates of rape throughout the nation.

The gang rape sparked massive protests in New Delhi and outrage in parliament and led to a joint statement by the United Nations and Unicef condemning the incident.1 The government has increasingly been trying to calm public anger.2

Chemical castration, in which an anti-androgen (usually medroxyprogesterone acetate) is injected periodically to lower a man’s testosterone concentrations, is being seen as a quick fix solution to douse public anger, but medical experts do not believe that it would reduce the incidence of rape.

“Chemical castration may be useful for treating repeat sexual offenders, but most rapes are usually one-off assaults done by men who have the opportunity to take advantage of a woman perceived to be helpless and defenceless by the offender,” said Aniruddha Malpani, a fertility specialist and medical director of the Malpani Infertility Clinic and HELP (Health Education Library for People) in Mumbai.

He continued, “While chemical castration may help in treating serial rapists and paedophiles, what about the others? While these ‘solutions’ make for great sound bites . . . by diverting energies to exploring these, one might squander the chance to find more effective solutions.”

Chemical castration is legal in a few US states and in Poland, Moldova, Estonia, South Korea, and Russia. In most of these nations it is used on paedophiles or repeat pathological sexual offenders.

In India proponents of chemical castration are suggesting that it be used on offenders in all rape cases of the most violent type. Periodic injection of anti-androgens raises various problems, however, such as the difficulty in tracking offenders, tolerance to treatment, the cost and infrastructural issues, and human rights and medical ethics questions.

Tapas Kumar Bose, head of the department of forensic and state medicine at the College of Medicine and J M N Hospital, in Kalyani, West Bengal, said, “If the law is amended to include chemical castration, it is likely to face legal challenges as a violation of fundamental human rights. Proponents would argue that socially harmful behaviour needs to be curbed for the larger public good, but the fundamental rights of even a prisoner cannot be ignored.

“Curbing the sexual drive of a person is a form of torture, and any physician taking part in this is [acting] against the basic tenets of medical ethics as laid down by the Geneva Declaration and the Universal Declaration of Human Rights.”

Article 4 of the universal declaration prohibits “torture or cruel, inhuman or degrading treatment or punishment.” Chemical castration is also associated with various adverse effects,3 such as fatigue, behavioural abnormalities, insomnia, nightmares, dyspnoea, nausea, leg cramps, irregular gall bladder function, diverticulitis, aggravation of migraine, hypertension, phlebitis, and thrombosis. Its use might therefore put further strain on India’s medical infrastructure, besides the ethical issues of involuntary treatment and concerns over informed consent.

Malpani added, “The solutions are not likely to be medical, because the problem is largely non-medical.”

Notes

Cite this as: BMJ 2013;346:f64

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