Bioethics Forum Essay

Is Castration of Sex Offenders Ever Ethically Justified?

Louisiana recently became the first U.S. state to permit judges to order surgical castration of sex offenders. Surgical castration as a form of punishment is rare: Madagascar, the Czech Republic, and a Nigerian state use it in their criminal systems.  Several states allow judges to order chemical castration, drugs to significantly diminish sex drive.

Castration of any kind ordered by a court violates informed consent. Surgical castration is not ethically justifiable. The surgery is irreversible, disfiguring, and can cause feelings of humiliation and a lack of dignity. These harms arguably make it cruel and unusual punishment. Chemical castration is reversible and less harmful. Chemical castration for sex offenders can be ethically sound when they choose it in the hope of decreasing aggressive behavior, either in connection with a reduced sentence or not. The ethics are murkier when offenders consent to chemical castration in exchange for a reduced sentence, as part of a plea deal, or as a condition of parole when they otherwise would not wish to have the intervention. In those situations, offenders make a difficult choice and likely feel coerced.

Chemical castration has been linked to reduced recidivism for sex offenders. It suppresses testosterone levels, which have been found to correlate with the risk of both committing violent crimes and recidivism. A study of sex offenders found that those taking testosterone-suppressing drugs for an average of six years had a 28% rate of recidivism compared with 52% for those not taking the drugs. Another study found that men who had committed the most violent crimes had higher testosterone as did those with higher recidivism rates over a nine-year period.

But testosterone isn’t the only influence on recidivism. The previous study also found that psychotherapy mitigated the likelihood of recidivism and negated the impact of testosterone levels. Several reasons for recidivism are well established, including difficulty finding employment and housing, poverty, and the social stigma associated with being a convicted sex offender. Stigma prevents social inclusion and can lead to isolation, a risk factor for reoffending.  

Research shows that reducing sex crimes and other violent criminal behavior requires a community approach. Integration into society is an important component of reducing recidivism. Reentry after incarceration requires commitment from the community, elimination of discrimination in hiring, and reduction of stigma, all while maintaining public safety and reducing the risk of reoffending.  

Deterrence for the sake of decreasing recidivism and ensuring public safety is a common justification for chemical castration. The justification for Louisiana’s new law is that it will reduce repeat offending.  In states that allow chemical castration as a tool of criminal justice, judges may order it or incarcerated people may choose it to decrease prison time. In such cases, judges also require them to give informed consent. Some states require consent in writing to acknowledge an understanding of the side effects of chemical castration. But is such consent truly informed? Voluntariness is an element of informed consent, and it is difficult to say that an act is voluntary when it is in exchange for release from prison.

Castration presents a medical solution to crime and in doing so it medicalizes the crime itself. Some may argue that this is a good version of medicalization. Identifying testosterone as the culprit and altering it could keep people out of prison and improve public safety. However, it is a mistake to shift the blame from human to hormone entirely since that would suggest a lack of personal responsibility.

Castration violates informed consent when a judge orders it. However, years of criminal justice reform advocacy and research lead me to see that chemical castration, when it is as voluntary as possible, could be a tool for decreasing mass incarceration. Let’s say, for example, that a judge offers chemical castration as an option to convicted sex offenders in exchange for reduced sentences or early parole. Some incarcerated people may want to consider it and may even find the choice empowering. Eliminating the option for the sake of protecting the rights of incarcerated people would not be ethically justified if the result is a longer time spent in prison.

Even if chemical castration remains an option in criminal justice, we should not ignore the possibility of rehabilitation of convicted sex offenders. Rehabilitation research shows that many people who commit aggressive sexual crimes show regret, can become integrated into society, and even offer help with the rehabilitation of others who have committed crimes. While the role that rehabilitation should play in criminal justice is debated, it is important to recognize the social aspects of rehabilitation and a social responsibility to provide for the needs of offenders who have spent time in prison and are ready to safely reintegrate into society. Voluntarily decreasing testosterone levels makes sense as it may relieve the sex offender of unwanted aggression, but the practice should be used with other known ways to reduce recidivism. And, above all, it should be the choice of the individual, not the judge.

Anne Zimmerman, JD, MS, is founder and chair of Modern Bioethics and Innovative Bioethics Forum, chair of the New York City Bar Association Bioethical Issues Committee, and editor-in-chief of Voices in Bioethics. Her book Medicine, Power, and the Law: Exploring a Pipeline to Injustice explores the relationships between medicine, science, and technology and the criminal and civil justice.