The Unkindest Cut
With surprisingly little
fanfare, four states recently passed laws calling for castration--either
chemical or surgical--of sex offenders. Last month, prompted by two prisoners
who actually wanted the treatment, Texas Gov. George Bush signed a law
letting judges offer castration as an option for perpetrators of sex crimes.
Florida, California, and Montana have all enacted more stringent laws to order
involuntary chemical or surgical castration of these criminals.
The
technology for castration has evolved considerably, and there is evidence that,
in some circumstances, it can dramatically reduce the likelihood a sex offender
will strike again. Nonetheless, there are strong reasons that court-ordered
castration is a bad idea.
Americans remain frustrated with the inability of the
justice system to control rape and child molestation. Dozens of states have
enacted so-called Megan's Laws requiring that the public be notified when
released sex offenders move in nearby, but people complain that it doesn't help
much to know that your neighbor is a pedophile if you can't do anything about
it. More states are turning to doctors to solve the problem for them.
Compulsory
castration has been used as a punishment for crimes in all cultures dating back
thousands of years. In Europe in the Middle Ages, the "eye for an eye"
philosophy of jus talionis included castration as punishment for
adultery or rape. In the 20 th century, castration has been practiced
in the Netherlands, Germany, Estonia, Iceland, Switzerland, and Scandinavia for
rape, pedophilia, and homosexuality. After World War II, its use in Europe was
dramatically scaled back, probably because of the increased awareness of
humanitarian concerns prompted by the Holocaust.
More recently, research has produced powerful
drugs, such as cyproproterone and medroxyprogesterone, which reversibly block
testosterone production. The drugs' primary use in men is to control prostate
cancer, but when injected daily or weekly they reduce testosterone to
castration levels. Side effects include serious allergic reactions and the
formation of blood clots that can kill patients. The drugs also appear to alter
thinking enough to increase suicide rates. The Czech Republic and Germany have
reintroduced castration in this modern, seemingly humane form, although only
among sex offenders who volunteer for treatment.
Surgical castration is less
mutilating than it once was. Orchiectomy, as it is called, is a day-surgery
procedure done under local anesthesia. Each testicle is removed through a small
scrotal incision similar to the kind made during a vasectomy.
Three of
the four new state laws call for sentencing rapists to be castrated, but with
some variations. Florida requires judges to impose either injections or
orchiectomy for repeat rapists. California does the same, but only for repeat
child molesters. Montana allows, but does not require, judges to impose
chemical castration on offenders who commit rape or incest after even one
offense, if it is particularly heinous.
Legislators argue that castration is justified and
appropriate, and that by controlling sex offenders' irresistible urges to rape
or molest again, the operation allows them to be released without endangering
the public. Studies of the European experience suggest they could be right. Of
more than 700 Danish sex offenders castrated after multiple convictions,
relapse rates dropped from between 17 percent and 50 percent to just 2 percent.
A Norwegian study showed the same for selected male and female sex offenders
(the women had their ovaries removed). In smaller studies of cyproproterone in
Scandinavia and Italy, chemical castration was equally effective in some groups
of volunteer prisoners, with the most dramatic reductions among pedophiles.
These studies suggest the
common argument--that rape is all about power, not sex, and therefore
castration won't work--is wrong. Interestingly, a German study found that up to
half of the castrated men still could have erections and sex, but their desire
was weakened or even extinguished. Over 80 percent no longer masturbated; 70
percent gave up sex. As Fred Berlin, a Johns Hopkins University psychiatrist
and expert on treating sex offenders, points out, castration works "mainly in
those who are sexually aroused by their crime ... sadists and pedophiles."
Castration takes the impulse away from those with an aberrant sexual
orientation, often to their relief.
So what objection could there
be to castration of sex offenders? Well, none, if it is carefully applied to
the narrow group of repeat sadistic or pedophiliac rapists who accept the
treatment. But the court-mandated castration proposed in Florida, California,
and Montana raises serious problems.
1 The laws are wrong to apply castration
indiscriminately. The studies show that castration is effective in
criminals with multiple offenses, especially if they are motivated by sex. But
proponents are wrongly using the data to justify mandatory application across
the board. In Florida and Montana, all rapists are targeted, even though
sadists and pedophiles are only a small percentage of the total. Most rapists
appear to be motivated by hatred or anger, not sex. Montana lets judges order
castration after just one offense. Dr. Berlin argues that the laws impose "a
medical intervention in the absence of evidence that forced treatment is likely
... to be effective" and make "no effort to medically assess whether
[castration] is appropriate for an individual."
2 Forced castration is difficult to administer. First,
the state must find doctors willing to do the job. (Heaven's Gate members had
to go to Mexico for the operation because no California doctor would perform it
on them.) California's law suggests letting state workers give the injections
without medical supervision, but the serious side effects, and the need to
ensure that appropriate doses are given, make this approach foolhardy. It also
raises the question of what to do with people who can't take the drug because
of the side effects. Would they have to go back to jail? Bringing in released
convicts for injections is even more difficult. The longest-lasting drug,
medroxyprogesterone, still must be given weekly. Making sure that rapists and
pedophiles turn up week after week for an unwanted, potentially lifelong
treatment may prove impossible.
3 Forced castration is immoral. In 1985, the Supreme
Court recognized this when it ruled that involuntary surgical castration
constituted cruel and unusual punishment. The court may be persuaded to let
chemical castration stand because it is theoretically reversible. If this line
is crossed, politicians would have little to stop them from seeking forced
treatments to control other behaviors, such as adultery (for which castration
has historically been a punishment), prostitution, or the consumption of
pornography. As medicine's arsenal expands (we already have drugs to limit
libido, hunger, and depression), it is conceivable that laws could mandate even
wider uses of medicines to control the population.
Many people see rapists as a special case, though, having
no objections to extreme measures to stop them from raping again. The crime is
so repugnant, they say, that it is hard to treat rapists as people deserving of
any concern. Prisoners, after all, give up their rights for having committed
such crimes. But as bioethicist Arthur Caplan points out, while "prisoners are
excluded from moral life," losing the right to vote, "Americans have not
reduced them to non-human status." Unlike Iran, Turkey, or Nazi Germany, the
United States accepts prisoners' rights to free speech, legal representation,
and health care. We still reject using prisoners for organ transplants or slave
labor. Requiring castration for rape means we have decided it is acceptable to
treat prisoners as less than human.
While the laws elsewhere fail
to counter these fundamental objections, the narrower castration law in Texas
seems more appropriate. It does not mandate castration, instead reserving it
for repeat offenders who seek the treatment. Larry Don McQuay could be the
first to whom it is applied. He admits to molesting children at least 240
times. Having completed his sentence for his one conviction, he is set for
release. Fearing his urges, he wants orchiectomy. It should be done.
