Running head: CHEMICAL CAUSTRATION

Chemical Castration
Tania LeSurf
Stenberg College

March, 2014
Chemical Castration
Intro 250
What is chemical castration? Its a practice which has been used for the past 50 years to
help reduce inappropriate sexual behaviors in male patients. The preferred drug of choice is
medroxyprogesterone acetate, also known as Depo-Provera or MPA, birth control contraception
initially created for women, which is given orally or via intramuscular injection to men. Where
the ethical dilemma arises is whether it is ethically right to impose such drastic measures on
involuntary psychiatric male patients. Should patients who are mentally incompetent be
subjected to such radical approaches? How can one justify giving female birth control to male

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patients? Elderly men suffering from Dementia and who exhibit sexually inappropriate behaviors
are used as guinea pigs to test the effectiveness of MPA. Is this practice right? This paper will
explore what this therapy involves and to which demographics it is concerned with and how the
psychiatric nurse can use therapeutic skills to care for the sexually inappropriate patient. The
writer will provide a brief history on its use, the writer will also touch upon some of the ethical
considerations involved and what alternatives might be examined in order to avoid chemical
interventions. The writer will provide her own opinion on this topic and will also invite the
reader to explore his/her own feelings.

Firstly, the writer will define for you, the reader, what the definition of chemical
castration is. As per the (Collins dictionary, n.d.) the definition is, the use of drugs to reduce
libido. Why might patients in psychiatry require such interventions? Individuals who are preoccupied with inappropriate sexual thoughts such as pedophiles, rapists, symptoms of dementia
and those who engage in frotteurism are all possible candidates for receiving hormone therapy.
Sterilization among male prison inmates began in the 1800s in order to decrease their sexual
urges, (Burchill, n.d). Another well -known account was in 1952 when a man by the name of
Alan Turing was convicted in a court of law for gross indecency related to his homosexual
behaviors. His punishment was to begin the treatment regime of chemical castration, he refused
to go through with it and committed suicide in 1954 (Horn, 2013).Alan had been a great scientist
and inventor and was pardoned from his convictions by Queen Elizabeth II in late 2013.
The reason medroxyprogesterone is used is because it causes a , ,breaking down and
eliminating testosterone and inhibiting the production of luteinizing hormone through the
pituitary gland, which in turn inhibits or prevents the production of testosterone.(Birken &

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Kafka, 2007, p. 1). The benefit of this treatment is that with the reduction of testosterone (which
is known to be the hormone of arousal in men), there is a marked reduction in sexually
inappropriate behavior. (Birken & Kafka, 2007). Dementia among elderly males is another area
where the use of MPA is helpful. Studies have shown that whereas sexual activity
decreases in elderly people, sexual interest does not... (White & Holroyd, 2006, p. 1).
Acts of frotteurism, rubbing against a non-consenting person (Stuart, 2009, p.
487) is also common and is not accepted behavior. Staff often have difficulties curbing
this behavior, these behaviors can be a threat to the welfare of other patients.
Repeated offences can lead to difficulty finding or maintaining appropriate living
placement.(White & Holroyd, 2006, p. 1). It can be most distressing also for families to
see their Father or Grandfather, for example, inappropriately rubbing a female resident,
the reactions can have damaging effects to not only the residents but to families as well.
MPA has been used in younger patients, including pedophiles and individuals with
other mental illnesses and sexually inappropriate behaviors.(White & Holroyd, 2006,
p. 2). The most common doses of MPA are 100mg orally once a day and 1000mg via
intra-muscular injection and have been proven to be relatively safe in geriatric men.
(White & Holroyd, 2006, p. 2). The most common side effects for younger adult males
are fatigue and an increase in body weight and of course, a decreased libido.

Ethical considerations revolving around the use of MPA includes its

administration to male patients going against human rights, especially for patients who
are in-voluntary ,incarcerated inmates and those who are cognitively impaired with a
Dementing illness such as Alzheimers, Consider if an inappropriate behavior (e.g.

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public sexual activity) is occurring because of lack of support for less risky sexual activity
(e.g. provision of private space) and take steps to remedy the lack of support.(Breen,
Carlson, Clements, Everett, & Young, 2009, p. 31). Is it ethically right to unknowingly
give female birth control to people unknowingly? One could argue that they dont know
any different and if the treatments help reduce the unwanted behaviors thenwhy not?
(Burchill, n.d) makes a valid point when he questions whether MPA is a medical
necessity or if it is a punishment and also questions if, it may violate the dignity of
man and the evolving standards of decency.(Burchill, n.d, p. 12). All Registered
Psychiatric Nurses licensed in British Columbia, Ensures psychiatric nursing decisions
are consistent with the persons choices or the choices of a substitute decision maker,
where applicable College of Registered Psychiatric Nurses (2010). . In the United
Kingdom there are sexual offenders who voluntarily chose to be chemically castrated,
So far 11 men have put themselves forward for the pioneering project(Barrett, 2008,
para. 1). The UK project has had great success and has now moved forth with public
clinics where nurses are, dedicated to handing out the medication to pedophiles and rapists
who volunteer for the treatment.(Barrett, 2008, para. 4). Poland has made it mandatory to enforce
the administration of such drugs to pedophiles after the public was made aware of, the case of a
45-year-old man accused of fathering two children by his young daughter.(Barrett, 2008, para. 7).

The alternative option to curb sexually inappropriate behavior is physical

restraints. The use of these is very invasive, can cause embarrassment, pain and really is
quite barbaric in nature. This practice is used as a last resort however despite best
practice, Canadian homes and chronic-care hospitals used belts and other restraints on
almost a third of residents: more than triple the rate in the United States and higher
than the three other countries surveyed, the U.S.-led study found.(Barrett, 2008, para.

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3). The psychiatric nurse must always think about practicing beneficence and

maleficence with respect to the best interest of her patients and others, the CRPNBC
states that all psychiatric nurses, Provides opportunities for persons to make choices
and decisions even when the capacity for self-determination is reduced. ("CRPNBC,"
2010, p. 4). What should the nurse do if she does not feel she can support the current
treatment the physician has prescribed? Advocating for her patients is one of the
responsibilities of being a psychiatric nurse as per the CRPNBC, all psychiatric nurses,
Advocates for fair and equitable access to services and benefits and for equal treatment
and protection of all persons. She might need to address her concerns with the patients
physician.

When considering alternatives to using chemical castration, one might consider the
advantages of exploring other options the patient might agree with. The nurse should begin with
initiating a therapeutic relationship with the patient, Effective communication is, therefore,
more than delivering quality, patient-centered care. It is also the vehicle through which patients
involvement is optimized.(Middleton, 2009, para. 4). Understanding the patients feelings,
thoughts and insights into illnesses and behaviors can help the nurse develop specific care plans.
The nurse and the patient need to discuss healthy forms of sexual behaviors and the nurse should
also reflect upon Maslows hierarchy of needs and how it is relative to basic human needs,
According to Maslows hierarchy of needs, sexual intimacy is a basic human need along with
the other physiological needs to eat, drink and breathe (Breen, Carlson, Clements, Everett, &
Young, 2009, p. 13). Another very important ethical opinion worth considering is that, All
people, whether capable or incapable of sexual consent, are ethically allowed to engage in sexual

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activity that involves reasonable risk of harm, as they would in their own homes. (Breen et al.,
2009, p. 26). Options might include supporting the patient who is feeling the need to be sexual.
The nurse might do so by educating the patient on the benefits of masturbation in a private area,
staff supported the idea that sexual expression among residents with dementing illness is
perfectly healthy and may contribute to their positive quality of life (Series, n.d, para. 14) The
nurse could have a conversation with the client and explain to him he should go to the restroom
or to his bedroom alone and the nurse will provide him with lubrication. The nurse can create a
care plan with this intervention in place and can evaluate the effectiveness of same on a weekly
basis. The patient should be able to understand this intervention is appropriate sexual behavior
and can be utilized when in the community. Resorting to privacy and engaging in safe sexual
health is a positive means to providing the patient with autonomy and independence with his
own care.
In conclusion, this paper has examined several areas related to chemical castration. The
writer has discussed (briefly) the definition of this practice and has provided the reader with
some history related to it as well. This paper has discussed the demographics of people subjected
to this treatment and has also mentioned ethical considerations involved with its use and has
regarded alternatives as well. This reader feels, (in her own opinion) that the use of chemical
castration is inappropriate and should not be used partly because the long term effects have not
been well researched. This reader feels the development of care plans which are done in
collaboration with the patient (or the substitute decision maker in the case of cognitively
impaired individuals) is the best approach when dealing with sexually inappropriate behaviors.
This writer feels the ethical implications involved with the delivery of chemical castration is
great and is morally wrong. Sexually inappropriate behaviors can be very challenging for nursing

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staff and other patients however treating these behaviors by administering female hormones does
not seem to be a practice which supports the best interest of the patient. Staff convenience is
often a motivating factor when when deciding which intervention should be utilized. Nurses
faced with behaviors such as inappropriate sexual acts want immediate discontinuation of
behavior, the use of restrains and of other chemical restraints is sometimes utilized. This writer
feels that giving birth control hormones to men in response to same is very wrong. These writer
hopes the reader has been enlightened with a sense of some understanding surrounding this
ethical issue and that the reader is able to surmise his/her own opinion.

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References

Barrett, D. (2008, December 27). Sex offenders volunteer for chemical castration drug
treatment. The Telegraph. Retrieved from http://www.telegraph.co.uk/news/uknews/lawand-order/3966139/Sex-offenders-volunteer-for-chemical-castration-drugtreatment.html#top
Birken, P., & Kafka, M. P. (2007). Pharmacological Interventions with Adult Male Sexual
Offenders. Current Options in Psychiatry, 20(). Retrieved from
http://www.atsa.com/pdfs/PharmacologicalInterventionsAdultMaleSexualOffenders.pdf
Blackwell, T. (2009, March 19). Canada highest user of restraints on elderly. SPON-Social
Policy in Ontario. Retrieved from http://spon.ca/canada-highest-user-of-restraints-onelderly/2009/03/20/
Breen, S., Carlson, M., Clements, G., Everett, B., & Young, J. (2009). Supporting Sexual Health
and Intimacy in Care Facilities: Guidelines for Supporting Adults Living in Long-Term
Care Facilities and Group Homes in British Columbia, Canada. Retrieved from
http://www.sfu.ca/uploads/page/04/FacilitiesLicensing_SupportingSexualHealthandIntim
acyinCareFacilities2.pdf
Burchill, J. (n.d). ENIGMA Human Rights and Chemical Castration. Retrieved from
http://www.academia.edu/4626409/Enigma_-_Human_Rights_and_Chemical_Castration
Collins dictionary. (n.d.). http://www.collinsdictionary.com/dictionary/english/chemicalcastration
Horn, E. J. (2013, June 23). Alan Turing Biography: Computer Pioneer, Gay Icon []. Live
science. Retrieved from http://www.livescience.com/29483-alan-turing.html

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Middleton, J. (2009, June 19). Good communication helps to build a therapeutic relationship.

Nursing Times.net. Retrieved from http://www.nursingtimes.net/nursing-practice/clinicalzones/educators/good-communication-helps-to-build-a-therapeuticrelationship/5003004.article

Series, H. (n.d). Hyper sexuality in dementia. Advances in Psychiatric Treatment.
http://dx.doi.org/ 10.1192/apt.11.6.424
Stuart, G. W. (2009). Principles and Practice of Psychiatric Nursing (9th ed.). United States of
America: Elsevier Inc.
The Code of Ethics. (2010). Retrieved March 16, 2014, from https://www.crpnbc.ca/wpcontent/uploads/2011/02/2013-05-29-CRPNBC-Code-of-Ethics-Formatted.pdf
White, S. A., & Holroyd, S. (2006). The use of medroxyprogesterone acetate for the treatment of
sexually inappropriate behavior in patients with dementia. The Journal of Psychiatry and
Neuroscience, 31(2), 1-7. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1413960/