Alabama castration bill won’t fix the problem

Recently passed legislation in the state of Alabama (HB379) mandates that “as a condition of parole, a court shall order a person convicted of a sex offense involving a person under the age of 13 years to undergo chemical castration treatment, in addition to any other punishment for that offense.”

That language appears to suggest that “chemical castration” is being mandated as both treatment and punishment. There is precedent for mandated medical interventions, as evidenced by the fact that for decades children were required to receive a smallpox vaccination. There is no precedent, nor should there be, for utilizing a mandated medical intervention as a criminal sanction. 

The Alabama legislation allows a parolee to “elect to stop receiving the treatment at any time.” However, according to that legislation, should he elect to do so, that would “constitute a violation of his or her parole and he or she shall be immediately remanded to the custody of the Department of Corrections.”

Were it clear that such treatment was medically necessary, and that discontinuing it would cause the individual in question to become a danger to others, arguably asking that person to make a difficult decision between an unwanted medication and prison might be justifiable. 

However, the legislation is unclear regarding what condition is being treated by chemical castration. The legislation also does not stipulate a method for determining whether discontinuation of that treatment would constitute danger in a given instance. The legislation mandates that an individual continue receiving such treatment until the court, and not a physician, “determines the treatment is no longer necessary.”

The legislation does not require a parolee to be evaluated by a qualified medical professional to determine whether a condition requiring such treatment even exists. The legislation states that “a medical professional shall inform the parolee about the effect of the treatment and any side effects that may result from it.”

However, the act makes no provision for determining whether an individual mandated to receive such treatment has any ongoing medical problems that might be worsened by it, or whether he or she is taking prescribed medications, the effectiveness of which could be impaired. Of note, the legislation does not mandate the availability of such treatment prior to consideration of parole to an individual who may benefit from it, even when such an individual might be anxious to receive it. 

The Alabama legislation stipulates that “chemical castration treatment” refers to the use of a medication that “reduces, inhibits or blocks the production of testosterone.” Testosterone is a hormone that can affect the intensity of sexual drive. 

However, not everyone convicted of a sex offense against a person under the age of 13 has done so because their sexual desire had been too intense, or perhaps misdirected toward children. An intoxicated individual could commit a sex offense in association with impaired judgment and disinhibition, for instance.

Or, a mentally ill individual, in need of antipsychotic medications, could commit a sexual offense in association with the disturbed thought processes associated with his disorder. Many other examples could easily be cited. The Alabama legislation does not mandate a comprehensive mental health assessment to determine what psychiatric disorders, if any, may be present in the case of a given parolee. Doing so is a necessary prerequisite in determining what sort of medical treatment may be needed. 

There is a group of individuals for whom sex-drive-lowering medication (chemical castration) can be helpful in some instances. While growing up, people do not decide to be attracted to the opposite sex (heterosexuality), the same sex (homosexuality), or even to children (a pedophilic sexual makeup). Rather, in maturing, people discover the nature of their own sexual desires and interests.

Given the power of the biologically based sexual drive, when that drive becomes misdirected toward children, either because of constitutional or experiential factors, it will still recurrently crave satisfaction. Not enough is yet known about the biology underlying differences in sexual makeup to enable physicians to prescribe a medication that can alter the qualitative nature of pedophilic sexuality. However, lowering testosterone (chemical castration) can decrease the intensity of unacceptable sexual cravings, with the intent of facilitating enhanced sexual self-regulation.

Prison cannot punish away sexual cravings for children, nor can it enhance the capacity to successfully resist acting upon them upon release. There is a need for a meaningful collaboration between legislative bodies and the scientific-medical communities in order to establish public policies and treatment protocols that can better ensure community safety. In conjunction with that effort, it should be appreciated that people who are sexually attracted to children need and deserve access to appropriate mental health treatment. Unfortunately the Alabama legislation falls far short of achieving that goal.

Fred S. Berlin, M.D., Ph.D., is an associate professor in the Department of Psychiatry and Behavioral Sciences at The Johns Hopkins University School of Medicine. He is an attending physician at The Johns Hopkins Hospital, and the director of the Johns Hopkins Sex and Gender Clinic.