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 consent:

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