NvB: Bored in Brno?

Here's a scenario: you're mentally ill, a murderer, an alcoholic, have a "learning disability," and you've committed a sex crime. You're arrested, placed in a mental institution, and then sentenced. What does society tell you? "You are a danger to society and we don't like you, but we don't give the death penalty; however, there is obviously something wrong with your genes and we don't think that you should be able to reproduce—not just not allowed, but actually unable. So, we will see to it that you can't."

We don't cut off your right hand here, no, that's for heathens and we are civilized and refined Europeans! Don't worry, we have an eminently humane solution, we only cut off . . . well, let's call it "protective treatment."

Apparently, if you are male, fit this description, and in the Czech Republic, this could happen. The solution? chemical castration, but let's just call it libidinal suppressant treatment. And, with your consent (though there are doubts about whether this is freely given or not) you can elect the surgical procedure. At least, is what I took away from a report by Alix Kroeger at the BBC.

I hope that I'm not the only one who finds this slightly disturbing. It sounds to me more like population engineering and thinly veiled eugenics. (Recall, for example, statements of senators about proposed birth-rate quotas back in 2005?) How is it countenanced in Europe—after the horrors of WWII, the treatment of Roma, and no doubt scores of other small but questionable treatment of human rights in central Europe.

At least one group has raised concern about the situation. Kroeger cites the release of a report by the European Committee for the Prevention of Torture and Inhuman and Degrading Treatment or Punishment (CPT) to the Council of Europe dated 12 July 2007. Report authors, who visited a ward of the "Brno Psychiatric Hospital" with eleven sex offenders undergoing "protective treatment," stated (section II.D.5, paragraph 103):

At the outset, the CPT wishes to state clearly that it has serious reservations concerning the specific medical intervention of surgical castration as applied to certain sexual offenders (see paragraph 107). The Committee has grave doubts as to whether such an intervention should be applied in the context of persons deprived of their liberty.

The observers seemed to find the conditions lacking sufficient assessment and oversight by qualified doctors. Moreover, there were no statistics offered on how many patients receive such treatment or any follow-up information, such as how often patients who received such treatment were convicted as repeat offenders, meaning there is no way to tell if such treatment is at all effective. Nor are there standardized procedures followed in advising patients who elect surgical castration, an irreversible procedure. This appears to be in contradiction of a 1996 law on the treatment of individuals' health. Most notably, there appears to be an overlap (if not conflict) of interest by oversight panels, which the CPT noted in comments about what patients who elect the surgical procedure are told (Par. 108):

the patients received information about the potential adverse effects of surgical castration and, in all cases examined, final authorisation for the intervention was given by the panel of experts (often consisting of the medical ethical committee of the hospital that was to carry out the operation). Moreover, patients who had undergone such an operation told the CPT’s delegation that they had had the opportunity to withdraw from the treatment, even after they had made their request. One of the patients interviewed explained that an outside consultancy had been offered to him to help him make his decision, but that he had declined this. However, it would appear that the surgeon carrying out this treatment at Brno Teaching Hospital and at least one of the sexologists are also members of the above-mentioned panel of experts. The CPT considers such dual functions inappropriate.

What I thought most disturbing is that it appears that the CPT observers concluded that there was no way for patients considering these procedures could have any freedom of choice (Par. 109):

Medical interventions, and in particular medical interventions which have irreversible effects on persons deprived of their liberty, should as a rule only be carried out with their free and informed consent. Given the particularly vulnerable position of persons deprived of their liberty in this regard, it should be ensured that the patient’s consent is not directly or indirectly given under duress and that the patient receives all the necessary information when making his decision. Furthermore, the Committee considers that the concept of ‘free and informed’ consent is hardly reconcilable with a situation in which the options open to an individual are extremely limited: surgical castration or possible indefinite confinement in a psychiatric hospital.

There are certainly important and complex ethical questions involved here—but I'm afraid that the Czech position does not seem very stable. Despite the touted laissez-faire attitude toward sex in the Czech Republic, it makes me wonder whether there is not a lot of strangely repressed and rather dark currents in the Czech psyche. I'm reminded of Věra Chytilová's 1998 film Pasti, pasti, pastičky ("Traps, Traps, Little Traps," which was billed as a "feministopessimistic black comedy") in which the main character castrates two men after they rape her when she has flagged them down to ask for help repairing engine trouble. The opening credits roll over shots of pigs squealing and being castrated. Another example: recent statistics from the Child Crisis Centre show that one in four Czech girls were sexually abused and one in seven boys. This seems rather high. And what about the blind eye turned to the sex trade around Brno? And really, are all those straight men in it just for the money?


The full report is posted here. A more humorous view was posted at the Porkchop blog.

Tags: europe, czech, society, ethics

Posted 15 July 2007 at 19:45.