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In November 2009, in response to several high profile sex offences committed against children, Polish President Lech Kaczynski signed a law allowing for the compulsory treatment of some sex offenders with antiandrogenic drugs, commonly referred to as chemical castration. Following a sexual killing carried out by a repeat sex offender in France, the French National Assembly is considering legislation that would make chemical castration mandatory for some sex offenders. Laws in several American states allow compulsory medical treatment of offenders who have committed serious sex offences. Chemical, as well as physical, castration of sex offenders takes place in psychiatric hospitals in the Czech Republic under the legal framework of "protective treatment." Meanwhile, in England the Department of Health is supporting an initiative to facilitate the prescription of drugs on a voluntary basis for sex offenders in the criminal justice system. 1
Demand for the prescription of antiandrogens or physical castration for sex offenders is a common reaction by lawmakers and politicians when a high profile sexual crime is committed. Although castration is ostensibly for public protection, it also carries with it a sense of symbolic retribution. Whether medical or surgical, the procedure requires the participation of doctors, and this gives rise to questions regarding the basis of medical involvement. Some people argue that not only does medical input in these cases straddle the border between treatment and punishment, 2 but that it also shifts the doctor's focus from the best interests of the patient to one of public safety.
Antiandrogenic drugs and physical castration undoubtedly reduce sexual interest (libido) and sexual performance, 3 and they reduce sexual reoffending. Physical castration of sex offenders was carried out in several European countries in the first part of the 20th century, and although morally dubious and not always targeted at high risk cases (many of those castrated were homosexual, mentally ill, or learning disabled), recidivism rates of less than 5% over long follow-up periods are invariably reported, compared with expected rates of...