Another day, another announcement of the results of the independent reviews that seem to have become the hallmark of the Starmer Labour government. This time, it is about prison reform and how to deal with the overcrowded and broken penal system in the UK. Among the many recommendations made by former justice secretary David Gauke is one that has my ethical hackles up: mandatory chemical castration for sex offenders.
Before anyone gets up in arms, I am not sympathetic to these criminals. They ruin lives and get off easy in our current judicial system. However, chemical castration is not the answer. It is certainly viewed as a viable ‘solution’ for paedophilia by the public, though there is little evidence of its effectiveness in their rehabilitation. It violates key medical ethics tenets on a patient’s right to choose, what is known as patient autonomy, and it will do nothing to stem the rising tide of misogyny in Britain.
Patients, regardless of whether they are in prison or not, have the right to make their own decisions about their health. It doesn’t matter if these are “good” or the “right” clinical decisions; what matters is that it is the right one for that particular person. This is why one person might choose aggressive chemotherapy for terminal cancer over palliative care. Neither decision is wrong. It is about what works within that person’s life, values and beliefs.
But there are certain conditions necessary to support patient autonomy, without which it is unlikely the person is truly making a free decision. Chiefly, people have the right to make their own informed decisions without constraint or coercion, and they must freely give consent to the healthcare they engage in.
Within the prison system, autonomy falls at this first hurdle. Prisoners are not free of constraint or coercion. They are, by definition, being held against their will and so do not consent to much of their daily life. They cannot choose where they live, what they do or who they see. They are also living within a system that has known coercion, largely to do with the individual culture and unwritten rules of a particular prison, whereby if they step outside those rules, punishment or worse is their reward.
Because of this, healthcare for and research on prisoners is tightly controlled, as prisoners are not seen as being able to freely consent. Even when they agree to a procedure or treatment, there remains the unanswerable question of whether they really wanted to do that in the first place.
This is where the proposal of mandatory chemical castration gets my ethical goat. Chemical castration is a life-altering medical procedure. It requires consent from those who wish to take part. Prisoners, by definition, at least in ethics, cannot give this consent as they are not able to meet the basic criteria of autonomy. The UK would thus be engaging in a medical procedure against the will of prisoners, and as that procedure is currently subject to ongoing medical trials, it is dangerously close to violating the Nuremberg Code on consent for permitted medical experimentation on human subjects, if it is not already doing so. This is not a great look for the country or the government.
Speaking of the Nuremberg Code, this proposal also violates a second point: that experimentation must provide useful results for the good of society that cannot be procured by any other means. At present, there is no reason to believe that chemical castration will effectively deal with the overwhelming rise of misogyny that is driving such violent sexual offending in the UK.
Without addressing the root cause of sexual violence, it is very likely that the violence will continue; only the nature of it will change. It will continue because its origins remain. Much more thought needs to go into how to craft policy that results in societal change in the UK that sees misogyny consigned to the dark corners of history. Until then, chemical castration is unlikely to change much about why sexual offenders offend in the first place.
This newest recommendation, and the fact that the government seems to be seriously considering it, has all the trappings of the “back-of-a-fag-packet” policy-making that has dominated government decision-making over the last few months, as it reels from political losses and tries to come to terms with the fact that it inherited a country with little means to fix what is broken.
Chemical castration won’t raise taxes, won’t educate men about misogyny, won’t provide the psychological support offenders need and won’t improve or enlarge the existing prison system. It will damage people’s lives, likely increase violence against women and will definitely violate our enshrined ethical rights. It is set to become yet another failure for a disappointing Labour government, which is intent on winning votes at the cost of a functioning country.
