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ANALYSIS AND COMMENTARY of Sex Offenders: Prisoners’ Rights Versus Public Safety

Charles L. Scott, MD, and Trent Holmberg, MD

Sexual victimization of children and adults is a significant treatment and public policy problem in the United States. To address increasing concerns regarding recidivism, nine states have passed legislation since 1996 authorizing the use of either chemical or physical castration. In most statutes, a repeat offender’s eligibility for probation or is linked to acceptance of mandated hormonal therapy. Future legal challenges to this wave of legislation will probably include arguments that such laws violate constitutional rights guaranteed to the offender by the First, Eighth, and Fourteenth Amendments. When the promise of freedom is predicated on mandated treatment, the clinician must carefully assess the validity of .

J Am Acad Law 31:502–9, 2003

Surgical castration has been used as a means of social waiting to execute degenerate offspring for crime, or control for centuries. The use of eunuchs (castrated to let them starve for their imbecility, society can men) to guard women’s quarters or act as chamber- prevent those who are manifestly unfit from continu- lains was prevalent in many ancient cultures. During ing their kind. . .three generations of imbeciles are the 18th century, youthful male choir members, enough” (Ref. 4, p 208). These laws, which origi- known as castrati, were castrated to prevent deepen- nated nearly a century ago, persist in 13 states that ing of their high singing voices with the onset of continue to have statutes targeted at .1 Efforts to decrease male are “mental incompetents” or criminals.2 not limited to societies of the distant past. During the With the advent of modern hormonotherapy, the late 1800s, Dr. Harry Sharp of Indiana surgically ability to lower a man’s testosterone through chemi- castrated nearly 180 male prisoners for the purpose of cal means surfaced, and the use of drugs to reduce reducing their sexual urges. As a result of his efforts, sexual recidivism has become known as chemical cas- Indiana began using physical castration to decrease tration. The first reported use of hormonally based recidivism of certain prisoners and became the first to reduce pathological sexual behavior state to legalize the sterilization of “mental in men occurred in 1944 when the progesteronal 2 defectives.” hormonal compound was pre- The eugenics movement of the early 20th century scribed to lower male testosterone.2 During the continued the push for forced sterilization of people 1960s, German physicians prescribed with undesirable traits that scientists believed were in an effort to curb deviant behavior of male para- genetically transmitted. This movement eventually philiacs.5 In 1966, became the first U.S. led to the sterilization of approximately 60,000 men- researcher to use medroxyprogesterone acetate 3 tally handicapped incarcerated women. When the (MPA) in the treatment of sex offenders when he U.S. Supreme Court upheld a state law that sterilized administered the drug to a bisexual transvestite who the “mentally infirm,” Justice Oliver Wendell was in therapy for pedophilic behavior with his six- Holmes noted, “Better for all the world, if instead of year-old son.6,7 Although not approved by the U.S. Food and Drug Administration for the treatment of Dr. Scott is Chief of the Division of Psychiatry and the Law, University of , Davis. He is an Assistant Professor of Clinical Psychiatry. sex offenders, MPA has been used extensively in the Dr. Holmberg is in private practice in Utah. Address correspondence United States for the purpose of diminishing sexual to: Charles L. Scott, MD, Department of Psychiatry, University of California, Davis Medical Center, 2230 Stockton Blvd., Sacramento, fantasies and decreasing sexual impulses. A similar CA 95817. E-mail: [email protected] agent, , has been used throughout

502 The Journal of the American Academy of Psychiatry and the Law Scott and Holmberg

Canada and Europe.6 In recent years, other agents Several important similarities and differences are have been adapted for the treatment of male sex of- noted when comparing elements among these nine fenders in an attempt to diminish their sexual offend- statutes. First, although all statutes apply to individ- ing. These medications include the antiandrogens uals who have been convicted of a sex offense, all nine and , the gonadotropin-releas- states vary regarding the sexual behavior that triggers ing analogue , and the leuteiniz- application of their castration statutes. In , ing hormone-releasing hormone agonists leuprolide for example, a conviction for any 1 of 10 specific sex acetate and goserelin.8 offenses renders an individual eligible for castra- The use of such is understandable tion,26–27 whereas notes only that chemical when considering the high rate of sexual victimiza- castration will be administered to “suitable” offend- tion by offenders against children and adults in our ers who are convicted of “sex crimes.”15–18 Second, society. Between 3 and 6 percent of boys and 12 and in five states, castration is authorized only when the 28 percent of girls in the United States are sexually victim is younger than a specified age. Two states victimized before the age of 18.9 Multiple studies (Louisiana26–27 and Montana14) permit castration indicate that between 10 and 15 percent of women regardless of the victim’s age for repeat offenders and have been raped and nearly 25 percent of adult two states (Florida23–24 and Oregon15–18) allow cas- women have experienced some type of sexual victim- tration regardless of the victim’s age, even for first- ization.10 The magnitude of this problem combined time offenders. with well-publicized sex crimes has increased soci- Third, states differ regarding whether the pro- ety’s awareness regarding potential dangers posed by posed castration is discretionary, mandatory, or vol- sex offenders. The resulting community outcry has untary. Only Louisiana26–27 and Oregon15–18 man- led to the passage of legislation requiring sex offender date for eligible first-time registration, mandatory community notification, offenders. In contrast, five of the nine states mandate civil commitment of sexually violent predators, and, chemical castration for designated repeat sex offend- more recently, castration statutes that include both ers, three allow discretion by the court in whether chemical and surgical treatment options. To date, chemical castration will be required, and Texas28–29 nine states have successfully passed legislation that requires complete voluntary consent for surgical cas- authorizes either chemical or surgical castration. A tration under all circumstances. summary of these nine statutes is described in the Fourth, states are nearly equally divided in their following sections. designation of who pays for the costs of castration treatment and subsequent monitoring. Four of the An Overview of State Castration Statutes nine statutes require the state to pay costs, four re- for Sex Offenders quire the offender to bear some or the entire financial On September 18, 1996, California became the burden, and one state ()19–22 does not first state to authorize the use of either chemical or specify who pays for treatment. Finally, at least four physical castration for certain sex offenders who were of the states identify consequences for treatment being released from into the community.11 noncompliance, ranging from revocation of proba- Although this legislation was considered extremely tion (Louisiana)26–27 to potential incarceration for controversial at the time, eight additional states have up to 100 years ().14 Oregon is the only subsequently passed laws that provide some form of state that specifically includes violation of parole for castration for individuals who have been convicted of those individuals who use chemicals to counteract a sex offense and are being considered for parole or the effect of chemical castration.15–18 Table 1 com- probation. Of the nine states authorizing castration pares and contrasts general elements of all nine stat- for convicted sex offenders, four permit the use of utes authorizing some form of castration. chemical castration only (, Montana, Ore- The nine statutes also vary considerably in how gon, and Wisconsin),12–22 four allow either chemical they address the assessment and treatment of sex of- castration or voluntary surgical castration (Califor- fenders. First, states are not uniform on what specific nia, , , and Louisiana),11,23–27 and one chemical agents are recommended for treatment. Of ()28–29 provides voluntary surgical castration as the eight statutes that authorize chemical castration, the only treatment option. seven specifically identify MPA as a treatment op-

Volume 31, Number 4, 2003 503 Castration of Sex Offenders

Table 1 General Overview of Castration Statutes Discretionary (D) Person/Agency Consequences Victim Age Castration Mandatory (M) Financially of State/Ref. Included Offenses (y) Method Voluntary (V) Responsible Noncompliance California11 Sodomy, aiding/abetting sodomy, Ͻ13 Chemical or D—First offense State Not specified lewd and lascivious act with voluntary M—Second offense force/menace, oral copulation, surgical aiding/abetting oral copulation, sexual penetration (with a foreign object) Florida23,24 Sexual battery Any Chemical or D—First offense State Second degree voluntary M—Second offense felony surgical Georgia12,13 Child molestation; aggravated Ͻ17 Chemical D—First offense Offender pays Not specified child molestation (involving only aggravated child for counseling; physical injury to the child or molestation unclear who sodomy) D—Second offense pays for MPA child molestation Iowa25 Sexual abuse, lascivious acts, Ͻ13 Chemical or D—First “serious Offender pays Not specified assault with intent, indecent voluntary sex offense” “reasonable contact, lascivious conduct, surgical M—Second offense fees” exploitation by a counselor, unless determined sexual exploitation of a minor “not effective” Louisiana26,27 Aggravated , simple rape, Ͻ13 years or any Chemical or M—If specified in Offender pays Revocation of forcible rape, sexual battery, repeat sex voluntary mental health costs of probation, aggravated sexual battery, oral offender surgical treatment plan evaluation, parole, or sexual battery, aggravated oral treatment plan, suspension sexual battery, incest, and treatment of sentence; aggravated incest, aggravated good time crimes against nature earned may be forfeited Montana14 , sexual intercourse Ͻ16-first offense; Chemical D—First offense if State Criminal without consent, incest any age- only victim Ͻ16 and contempt of second offense offender Ն3 years court with older incarceration D—Second offense of 10–100 years Oregon15–18 Pilot program of 40–50 persons Any Chemical M—For all offenders Offender Parole each year convicted of “sex only deemed “suitable” (all costs) violation; crimes” without a medical “subject to contraindication sanctions” if fails to cooperate with program or takes any chemical to counteract treatment Texas28,29 Indecency with a child, sexual Ͻ17 Surgical only V—All offenses State Not applicable assault Aggravated sexual assault Ͻ14 Wisconsin19–22 Sexual assault of a child Ͻ13 Chemical D—All offenses Not described Not described Second degree sexual assault 13–15 only of a child tion, and seven allow the use of other pharmaceutical very differently among these nine statutes. California agents in addition to MPA. requires no medical or psychiatric evaluation of the Whether a medical or psychiatric evaluation is re- offender prior to mandatory chemical castration.11 quired prior to castration (either chemical or surgi- As a result, both male and female offenders, rapists cal) represents a second important area that is treated and child molesters, and psychotic and nonpsychotic

504 The Journal of the American Academy of Psychiatry and the Law Scott and Holmberg offenders are all eligible for mandated treatment, The fourth clinical issue raised by chemical castra- whether or not such treatment is clinically appropri- tion statutes involves whether psychological counsel- ate. The Montana statute does not specifically re- ing is required in conjunction with chemical or sur- quire a mental health or medical assessment, but does gical castration. Georgia is the lone state that specify that the treatment must be “medically safe mandates some form of psychological counseling for drug treatment.”14 The Wisconsin statute is excep- all designated sex offenders.12–13 Louisiana requires tionally vague about the type of evaluation, if any, counseling only if the counseling is specified in the required prior to treatment. This statute notes that individual’s treatment plan but otherwise does not 26–27 the decision to grant supervised release may not be require additional treatment. The remaining based on the fact that the person is a “proper subject” seven states do not require additional therapy other for treatment.19–22 This statement im- than chemical or surgical castration. plies that some form of evaluation is warranted to The specific duration of medication treatment in determine which offenders are appropriate for chem- the eight chemical castration statutes is a fifth impor- ical castration. tant treatment component of these laws. Because six In those six states that mention a pretreatment of the eight statutes mandate that either the state or evaluation, the stated qualifications of the examiners offender demonstrate that the chemical castration is vary. For example, Georgia requires a “psychiatrist or no longer necessary prior to cessation of treatment, 12–13 chemical castration is potentially life-long for some qualified mental health professional,” Oregon offenders. Finally, six of the nine statutes are silent specifies that a “competent physician” is neces- regarding whether liability immunity applies to those sary,15–18 and Texas mandates both a “psychiatrist providers who comply with the standards as set forth and psychologist who have experience in treating sex 12–13 28–29 in their state statute. Both Georgia and Louisi- offenders.” ana26–27 note that providers are not civilly or crimi- How states chose to address informed consent for nally liable if they act in good faith. The Texas sur- both chemical and surgical castration represents a gical castration statute provides the most explicit third important clinical component of this legisla- immunity for providers and specifies that physicians tion. Of the nine statutes, three states (Iowa,5 Flori- 23–24 15–18 are “not liable for an act or omission related to the da, and Oregon ) do not address whether procedure” unless they are negligent in their any element of informed consent is required prior to care.28–29 Table 2 compares and contrasts these clin- administration of a chemical agent. The informed ical questions as addressed in the nine castration consent process in the remaining five chemical cas- statutes. tration statutes requires only that the offender be informed regarding the side effects. Three of these Commentary five states require that the offender acknowledge re- The recent revival of castration legislation to di- ceipt of this information and Georgia specifies that minish sexually deviant behavior is likely to face sev- the offender must have consent to treatment in 12–13 eral challenges under the federal Constitution. Op- writing. ponents of such legislation argue that castration The Texas statute provides the most detailed pro- reduces or eliminates deviant sexual thoughts and cess for obtaining informed consent for surgical cas- fantasies, thereby infringing on the sex offender’s tration. For example, the inmate must be at least 21 First Amendment right to entertain sexual fantasies. years old and must meet with a psychiatrist and psy- The First Amendment protects a person’s freedom of chologist as part of the informed consent evaluation. speech,30 which the Supreme Court has generally A “monitor” with a background in mental health held to include the right to generate ideas, regardless law, and ethics is appointed and assists the inmate of their social worth. In 1969, the Supreme Court with understanding the risks and benefits, to ensure addressed the right of individuals to generate ideas that the consent is informed and voluntary. Further- without government interference as it related to the more, the inmate must request surgical castration in possession of pornography. In the case of Stanley v. writing, may change his mind at any time, and Georgia,31 police found pornographic materials in should he ever withdraw consent, is no longer eligible the defendant’s home and a Georgia court subse- for the procedure in the future.28–29 quently found the defendant guilty of possessing ob-

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Table 2 Clinical Issues and Castration Statutes Chemical Agent Required Medical or Informed Consent Required Provider Liability State/Ref. Specified Psychiatric Evaluation Issues Counseling Cessation of Treatment Immunity California11 MPA or its No Must inform No Until no longer necessary Not specified chemical regarding side (until DOC equivalent effects demonstrates to Board of Prison Terms that it’s not necessary) Florida23,24 MPA Yes—court appointed Not mentioned No Until no longer necessary Not specified “medical expert” for MPA; Court order specifies described for duration; either a voluntary specific term of years or physical for life castration Georgia12,13 MPA or its Yes—psychiatrist or Must be informed Yes Defendant must Not liable civilly chemical qualified mental regarding side demonstrate no longer or criminally equivalent health professional effects and necessary if provider for aggravated consent to acts in good child molestation treatment in faith writing Iowa25 MPA or Yes—“appropriate Not addressed No Until the agency in charge Not specified “approved assessment” of supervising the pharmaceutical required to treatment determines agent” determine if that is no longer treatment would be necessary effective Louisiana26,27 MPA or its Yes—“qualified Must inform Yes Shall continue unless it is Not liable civilly chemical mental health regarding uses (if in treatment determined that the or criminally equivalent professional with and side effects plan) treatment is no longer if provider experience in with written necessary acts in good treating sexual acknowledgement faith offenders” of information Montana14 MPA or chemical No—but treatment Must inform No Until DOC determines Not specified equivalent or must be “medically regarding side that the treatment is no other safe drug effects longer necessary medically safe treatment” drug treatment Oregon15–18 “Hormone or Yes—by a Must inform No “State . . . shall require . . . Not specified antiandrogen, “competent regarding side treatment . . . during all such as MPA” physician” effects and or a portion of parole or offender must post-prison supervision” acknowledge receipt of the information Texas28,29 Not applicable; Yes—physician; Detailed No Not applicable Physician “not surgical psychiatrist and informed liable for an castration only psychologist who consent, act or option have experience in counseling by omission treating sex a psychiatrist relating to the offenders evaluate and a procedure” inmate for psychologist, unless “suitability” and appointed negligent monitor; inmate must request procedure in writing Wisconsin19–22 Antiandrogen or Unclear—decision to Not addressed No Not described Not specified its chemical grant supervised equivalent release “may not be based on the fact that the person is a proper subject” for antiandrogen treatment

506 The Journal of the American Academy of Psychiatry and the Law Scott and Holmberg scene matter. On appeal, the U.S. Supreme Court forded increased freedom as a result of castration reversed the conviction on the grounds that the Con- treatment, the state could not achieve its objective in stitution protects the right to receive information a less restrictive manner.35 and ideas. Writing for the majority, Justice Marshall Convicted sex offenders may also challenge forced stated: castration under the Fourteenth Amendment’s guar- If the First Amendment means anything, it means that a State antee of both due process and equal protection. The has no business telling a man, sitting alone in his own house, Fourteenth Amendment prohibits a state from de- what books he may read or what films he may watch. . . . Our priving its citizens of “life, liberty, or property, with- whole constitutional heritage rebels at the thought of giving out due process of law.”36 In examining what proce- government the power to control men’s minds [Ref. 31, p 565]. dural due process is warranted, the procedures A counterargument to this First Amendment chal- surrounding either chemical or surgical castration lenge emphasizes that these offenders have commit- must be sufficient to protect the offender’s interests 37 ted a sex crime and as a result have demonstrated a against the state. Various U.S. Supreme Court lack of mastery over their fantasies. Because of their cases have addressed procedural protections for an actions, not their thoughts, they have effectively for- inmate refusing treatment and this analysis includes 38 feited their First Amendment rights, and castration is four general considerations. There must first be a justified to help control their behavior. determination that a mental illness or abnormality is 39 A second potential legal challenge involves present. Next, the proposed treatment must be in whether forced castration violates the Eighth the inmate’s medical interest. Third, the mandated Amendment’s ban on cruel and unusual punish- treatment must be essential for the inmate’s safety or ment.32 Three questions that the Supreme Court the safety of others. Finally, there should be no less asks when assessing whether a punishment violates intrusive alternatives to the medical treatment or- 40 the Eighth Amendment include: Is the punishment dered. The California castration statute appears inherently cruel or excessive? Is the punishment or potentially vulnerable under this analysis. In partic- condition proportional to the crime? Can the state ular, under the California statute, mandated treat- achieve its goal through less intrusive means?33 Al- ment is based solely on the offender’s having com- though the U. S. Supreme Court has yet to hear a mitted an enumerated offense, does not require a case that addresses whether castration represents mental disorder or abnormality, and does not pro- cruel and unusual punishment, the South Carolina vide an assessment process to determine the appro- State Supreme Court has ruled on this question. In priateness of castration treatment.11 the case of State v. Brown,34 three defendants pled Substantive due process “involves a definition of guilty to first-degree criminal sexual conduct in con- the protected constitutional interest, as well as iden- nection with a brutal sexual assault. Their sentences tification of the conditions under which competing were suspended, conditioned on the defendants’ state interests might outweigh it” (Ref. 41, p. 291). completion of surgical castration. In reviewing the In Washington v. Glucksberg,42 the U.S. Supreme case on appeal, the South Carolina Supreme Court Court emphasized that the Due Process Clause spe- held that surgical castration was cruel and unusual cially protects those fundamental rights and liberties punishment, as prohibited by the South Carolina that are, “objectively, deeply rooted in this Nation’s Constitution.34 history and tradition” (Ref. 42 at 728). The Court Proponents of chemical castration for sex offend- also noted that the Fourteenth Amendment forbids ers propose that the use of antiandrogens such as the government to infringe on fundamental liberty MPA does not satisfy the three-pronged test for cruel interests unless the infringement is narrowly tailored and unusual punishment articulated earlier. In par- to serve a compelling state interest (Ref. 42 citing ticular, antiandrogens are not considered inherently Reno v. Flores 507 U.S. 292 at 302 (1993)). cruel and assist the offender in desisting from behav- Mandated chemical castration affects the funda- ior that could result in further crimes and future mental right to procreation. In Skinner v. Oklahoma, punishments. Furthermore, the use of chemical Justice Douglas (writing for the Court majority) de- agents is not excessive when considering previous scribed procreation as one of the “basic civil rights of harm and the importance of preventing future sexual man,” which is “fundamental to the very existence victimization. Finally, because the offender is af- and survival of the race.”43 All eight chemical castra-

Volume 31, Number 4, 2003 507 Castration of Sex Offenders tion statutes apply equally to men and women and among other things, that the condition of his proba- therefore the impact of hormonal therapy on future tion that required him to submit to MPA treatment fertility must be considered. Proponents of castration was unconstitutional. The court held that requiring legislation argue that although castration may de- such treatment was an unlawful condition and that crease a male’s fertility, the compelling state interest the use of MPA had not gained acceptance in the involves public protection against sexual victimiza- medical community as a safe and reliable medical tion without a less restrictive means for the govern- procedure. The court expressed grave concerns re- ment to accomplish its goal. More serious substan- garding the ability of the offender to provide in- tive due process claims are raised in reference to formed consent and commented, “Even mentally in- female offenders. Antiandrogens, such as MPA, have competent persons, committed under court process, not been shown to diminish significantly the likeli- enjoy a greater degree of protection from extraordi- hood that women will reoffend, thereby weakening nary medical procedures.”47 the argument that forced chemical castration for fe- With increasing evidence that pharmacologic males furthers a compelling government interest. treatments can reduce sexual reoffending in some Chemical castration statutes may also be vulnera- male offenders, there is less likelihood that the appro- ble to constitutional challenges under the Equal Pro- priate use of these agents will continue to be viewed tection Clause of the Fourteenth Amendment. The as novel or experimental. However, all chemical cas- Fourteenth Amendment prohibits states from “de- tration statutes fail to differentiate between male and nying to any person within its jurisdiction the equal female offenders or age of offender. This broad ap- protection of the laws.”44 Two distinct arguments proach raises serious concerns regarding the actual that castration statutes violate equal protection can indications for treatment in some individuals who be made. First, chemical castration statutes may rep- may be forced to accept treatment. Although most of resent gender discrimination, based not on unequal the statutes require that information about the side treatment, but on unequal effect: the physiologic effects of chemical or surgical treatment be provided gender-related effect of antiandrogen treatment on to the offender, none of the chemical castration stat- women. In males, antiandrogen treatment decreases utes discusses whether the offender must be compe- sexual urges primarily by lowering testosterone levels tent to accept treatment. Finally, because most of that occur at higher levels in men than in women. In these statutes mandate chemical castration as a con- females, medroxyprogesterone acetate reduces dition of parole, opponents of these laws argue that in less than 5 percent of cases and poses unique side the offender’s decision to accept mandated treatment effects in women that include irregular menses and in lieu of additional incarceration is inherently co- breast swelling.45 Second, those statutes that do not erced and therefore not truly voluntary. require an assessment of the offender potentially rep- resent an unconstitutional classification among male offenders. In particular, equal protection rights are Summary violated because sex offenders are required to un- Sex crimes are a significant public health problem, dergo chemical treatment without differentiating be- and efforts to deter offenders and protect the com- tween those offenders who would benefit from treat- munity are worthy. Concerns regarding these legis- ment and those who would not.38 lative efforts include the one-size-fits-all approach for The most apparent ethics dilemma raised by these the treatment of both male and female sex offenders, statutes involves the extent that informed consent the potential of life-long treatment with a require- issues are sufficiently addressed with eligible offend- ment that the offender prove such treatment is no ers. The doctrine of informed consent requires that longer necessary, the failure of some statutes to de- the individual be competent to consent to treatment, termine whether the treatment is appropriate for the that the consent be informed, and that the consent be offender, and the minimal consideration of informed given free of coercion.46 The difficulty in achieving consent in the chemical castration statutes. To date, informed consent for MPA treatment from a con- no case challenging the constitutionality of these victed sex offender was addressed by the court of statutes has reached the U.S. Supreme Court. Future appeals in in the 1984 case of State v. cases will help determine whether these legislative Gauntlett.47 A convicted sex offender contended, efforts have struck the appropriate balance between

508 The Journal of the American Academy of Psychiatry and the Law Scott and Holmberg sex offenders’ rights and society’s right to be free of 18. Ore. Rev. Stat. § 144.631 (2001) 19. Wis. Stat. Ann. § 301.03 (West 2002) their criminal behavior. 20. Wis. Stat. § 304.06 (2002) 21. Wis. Stat. § 980.08 (2002) References 22. Wis. Stat. § 980.12 (2002) 1. Stelzer GL: Chemical castration and the right to generate ideas: 23. Fla. Stat. Ann. § 794.011 (West 2002) does the First Amendment protect the fantasies of convicted pe- 24. Fla. Stat. Ann. § 794.0235 (West 2002) dophiles? Minn Law Rev 81:1675–1709, 1997 25. Iowa Code § 903B. 1 (2003) 2. Miller RD: Forced administration of sex-drive reducing medica- 26. La. Admin. Code tit. 22, § I.337 (2000) tions to sex offenders: treatment or punishment? Psychol Public 27. La. Rev. Stat. Ann. § 15:538 (West 2003) Policy Law 4:175–99, 1998 28. Tex. Gov’t. Code Ann. § 501.061 (2003) 3. Druhm KW: A welcome return to Draconia: California Penal 29. Tex. Gov’t. Code Ann. § 508.226 (2003) Law 645, the castration of sex offenders and the constitution. 30. U.S. Const. amend. I Albany Law Rev 61:285–343, 1997 31. Stanley v. Georgia, 394 U.S. 565, 557 (1969) 4. Buck v. Bell, 274 U.S. 200, 207 (1927) 32. U.S. Const. amend. VIII 5. Bradford JMW, Pawlak A: A double-blind placebo crossover 33. Walker KM: Judicial control of reproductive freedom: the use of study of cyproterone acetate in the treatment of the . norplant as a condition of probation. Iowa Law Rev 78:804–6, Arch Sex Behav 22:383–402, 1993 1993 6. Bradford JMW: Hormonal treatment of sexual offenders. Bull 34. State v. Brown, 326 S.E.2d 410 (S.C. 1985) Am Acad Psychiatry Law 11:159–69, 1983 35. Berlin J: Chemical castration of sex offenders: “A shot in the arm” 7. Lehne GK: The first case of paraphilias treated with Depo- towards rehabilitation. Whittier Law Rev 19:169–213, 1997 Provera: 40-year outcome. J Sex Educ Ther 25:213–21, 2000 36. U.S. Const. amend. XIV 8. Zonana H, Abel G, Bradford J, et al: Pharmacological treatment 37. Parham v. J.R., 442 U.S. 584, 607 (1974) of sex offenders, in Dangerous Sex Offenders: A Task Force Re- 38. Beckham L: Chemical castration: constitutional issues of due pro- port of the American Psychiatric Association. Washington DC: cess, equal protection, and unusual punishment. W Va Law Rev American Psychiatric Association Press, 1999, pp 103–27 100:853–894, 1998 9. Furby L, Weinrott MR, Blackshaw L: Sex offender recidivism: a 39. Kansas v. Hendricks, 521 U.S. 346 (1997) review. Psych Bull 105:3–30, 1989 40. Riggins v. Nevada, 504 U.S. 134, 135 (1992) 10. Prentky RA, Burgess AW: Incidence and prevalence, in Forensic 41. Mills v. Rogers, 457 U.S. 291, 299 (1982) Management of Sexual Offenders. Edited by Prentky RA, Burgess 42. Washington v. Glucksberg, 421 U.S. 702 (1997) AW. New York: Kluwer Academic/Plenum Publishers, 2000, pp 43. Skinner v. Oklahoma, 316 U.S. 535 (1942) 1–8 44. U.S. Const. amend. XIV § 1 11. Cal. Penal Code § 645 (West 2003) 45. Grimes DA: Patient counseling with DMPA. Contracept Rep 12. Ga. Code Ann. § 16–6-4 (2002) Suppl 5:1–14, 1995 13. Ga. Code Ann. § 42–9-44.2 (2002) 46. Schwartz HI: Informed consent and competency, in Principles 14. Mont. Code Ann. § 45–5-512 (2002) and Practice of Forensic Psychiatry. Edited by Rosner R. New 15. Ore. Rev. Stat. § 144.625 (2001) York: Chapman & Hall, 1994, pp 103–110 16. Ore. Rev. Stat. § 144.627 (2001) 47. People v. Gauntlett, 352 N.W.2d 310, 317 (Mich. Ct. App. 17. Ore. Rev. Stat. § 144.629 (2001) 1984)

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