Title: Editorial: The ethics of anti-androgen therapy
Author(s): Seymour L. Halleck
Affiliation: University of North Carolina School of Medicine
Citation: Halleck, S.L., “Editorial: The ethics of anti-androgen therapy,” American Journal of Psychiatry, vol. 138, no. 5 (May 1981), pp. 642-643.
The author writes that if sex deviates are to be treated rationally, the clinician must do more than merely provide medication and observe behaviors. He must also weigh the benefits and risks of treatment as they affect society and the individual.
Benefits to society from effective treatment include greater public safety at less expense. However, a risk is that the definition of deviance may be expanded gradually to place relatively harmless people under powerful social control. Society may be especially tempted to expand the use of anti-androgens if deviant sexuality is linked to androgen activity.
Benefits to the individual may include freedom from painful symptoms, increased ability to remain within the law, and freedom from imprisonment. Risks include potentially excessive harm in the form of physical incapacity or psychological suffering due to side effects of the drug.
Historically, doctors who have used biological methods to treat criminals have tended to exaggerate both the dangerousness of the deviant person’s behavior and the social benefit that results from eradicating it. At the same time, they have often underestimated the harm that the treatment causes the deviant person. Criminologists have learned to anticipate repressive uses of new medical treatments.
Doctors must pay scrupulous attention to risk-benefit assessments. They must determine what kinds of sexual deviance are dangerous enough to merit temporary castration, carry out long-term follow-up examinations to ascertain harmful side-effects, and seek objective means of determining benefits to the individual.
They must struggle with the critical issue of consent. A sexual deviant may be offered a reduced or eliminated prison sentence if he agrees to anti-androgen treatment. Can anyone in such a situation give competent, informed, and voluntary consent to a potentially disabling treatment? Can benefits reported by the patient be relied upon when he faces painful and coercive alternatives? A circuit court in Michigan has already ruled that an incarcerated person cannot volunteer for a procedure such as psychosurgery.
However, it is possible that science has progressed enough that use of anti-androgens in some cases may be sufficiently effective and benign to justify their use. Their current use will inspire calls for increased use of biological treatment by those who desire more social control, as well as objections from civil libertarians.
The author concludes that this controversy is too important for psychiatrists to ignore the ethical issues by saying they are just practicing medicine. He advocates the immediate development of ethical guidelines for the use of anti-androgens.