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The Independent
22-05-2025
- Health
- The Independent
Chemical castration will not fix the root issue of why so many men loathe women
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 voters at the cost of a functioning country.
The Australian
25-04-2025
- Health
- The Australian
Australian public hospitals routinely silence whistleblowers
Australia is often described as having a world-class health system. There's no doubt that we do. But in our public hospitals, the pursuit of excellence comes at a price. That price is often invisible to patients; though sometimes the cracks in the system are bleedingly obvious. For patients, the system pressures are manifest in excessive wait times, too speedy discharge, or for the very unlucky, lives ebbing away in the back of a ramped ambulance. The trends are accelerating. On a widespread basis, doctors have had enough. They are overburdened, despondent and scared. The Australian this week launched an investigative series, which we have dubbed Life Support, to explore what is driving the huge pressures on Australian public hospitals. What is at stake is not only clinicians' welfare as public health systems teeter on the brink. Also at stake is patients' health – and their lives too. In England, the Starmer Labour government has moved to dismantle the National Health Service's administrative body, NHS England, which manages health services across the country, slashing the jobs of half of the agency's workforce. NHS England is a body tasked with doling out money to the NHS's network of hospitals and primary care clinics according to executive instructions. For the past 15 years, it's been given a large degree of latitude and independence, but it came at a cost of increasing duplication and bureaucracy. Patient safety scandals have been documented with alarming regularity. Current or former staff in public hospitals or patients can contact Natasha Robinson by email at robinsonn@ or by Proton Mail at health_editor_australian Though Australia's federation has no equivalent of England's nationalised health service, with devolved management of hospitals in most states, doctors working in Australia's public system believe many of the ills of the NHS are also present here, especially in terms of workplace culture and interrelated threats to patient safety. There comes a point when clinicians can no longer live with themselves when forced to work in unsafe systems. It's become clear to many doctors and nurses in public hospitals across Australia over the past decade that changing systems from the inside is next to impossible. Increasingly, they refuse to stay silent. 'This is a volcano which may well erupt,' says Dr Deborah Yates, who worked in public hospitals in Sydney for 25 years before abandoning ship, broken and grief-stricken, after treating the disadvantaged for decades. The recent psychiatry dispute in NSW, in which half the workforce of staff specialists handed in their resignations, was a harbinger of just how fed up many sections of the public sector workforce are. That was followed in NSW by a three-day strike by doctors across the gamut of specialties – something that hasn't occurred in the state in more than three decades. But it's not just a NSW trend. Governments and administrators in all states are doing their best to keep the real state of public hospital breakdown hidden. They routinely attempt to silence the doctors and nurses who seek to expose it. In Adelaide just a few weeks ago, senior emergency doctor Megan Brooks took the difficult decision to stare down SA Health's attempts to silence her through its code of ethics and give evidence to a coroner about the severe state of ambulance ramping at the Royal Adelaide Hospital. In Perth, it was frontline doctors who wore the blame for the July 2024 death of three-year-old Aliyah Yugovich, who was wrongly given an anti-seizure drug before dying of the flu. Accountability up the chain has been minimal. The Australian next week will reveal a similar case of a doctor being silenced over a serious threat to patient safety in Queensland. As a reporter, unpacking these matters, which are always complex but also have system-wide drivers, is difficult. There's always the sense that however huge the iceberg, public reporting may never be enough to trigger a new direction for a ship as big as the public health system. But it doesn't mean we shouldn't try. Read related topics: HealthStress
