Issue 18 / 20 May 2013

ONE of the most chilling scenes I have seen at the cinema was in the 2006 film Little Children.

Convicted paedophile Ronnie turns up at the local swimming pool with mask and snorkel to join the crowds of shrieking children in the water. It’s a classic image of the predator, circling below the water line with children’s legs thrashing all around him.

When the watching parents become aware of his presence, though, the point of view shifts. A panicked exodus from the pool leaves Ronnie alone in the water, surrounded by ranks of glaring adults and silent children. Suddenly, it is not clear who is more vulnerable here.

It’s a big ask to get any of us to empathise with somebody who has committed crimes against children, especially sexual ones. But, to paraphrase Winston Churchill, one measure of a society might be how it treats its most feared or despised members.

A paper published recently in the Journal of Medical Ethics examines the ethics of psychiatrists suggesting surgical castration as a treatment to convicted sex offenders.

If the patient believes the procedure offers his only realistic chance of being released into the community, does that automatically make it coercive, asks Professor John McMillan, a bioethicist from the University of Otago in New Zealand.

The Council of Europe’s anti-torture committee last year called for an immediate end to the practice in the Czech Republic and Germany, where surgical castration may be conducted at an offender’s request.

The Czech and German governments have strongly rejected the criticism, defending their use of testicular pulpectomy, which involves removal of part of the core of the testes. The procedure has little effect on the external appearance of the genitals but reduces testosterone levels, with side effects including infertility, general feminisation of the body and increased risk of osteoporosis.

Professor McMillan acknowledges there are good reasons to be concerned about the potential coerciveness of the Czech and German systems, but he believes in some cases castration may be a reasonable choice, offering the possibility of “reconfiguring a life that has gone badly awry”.

There aren’t a lot of studies on whether castration actually reduces recidivism, although the available evidence does tend to support this, he suggests.

Preventing reoffending is, in any case, more a social aim than a therapeutic one. For psychiatrists to see castration as a therapeutic option, they would need to believe it could bring psychological benefits to the patient.

Again, there isn’t a lot of evidence to go on, although one study cited by Professor McMillan found 70% of sex offenders who chose surgical castration were satisfied with the results.

Few issues are harder to discuss dispassionately than the sexual abuse of children and how we deal with the perpetrators, but we need calm discussions like those found in this paper.

The alternative can be the savage and vengeful response portrayed in Little Children. Reviled by his community and seeing no hope of change, Ronnie castrated himself in a local park.

Jane McCredie is a Sydney-based science and medicine writer.

One thought on “Jane McCredie: A last choice

  1. Q131953@amamember says:

    I recall reading of the Italian adventure into Ethiopia in the 1930’s. The Ethiopians captured a good number of Italian soldiers but were unable to feed them so simply castrated them and sent them back to the Italian lines. It was found that the sexual libido and capacity of these otherwise fit young men varied from zero to essentially normal. So castration of sex offenders may not be as effective as some would hope. (One of the reasons the Chinese removed the penis as well as the testes on their harem eunuchs).

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