00:12, August 08 371 0 theguardian.com

2017-08-08 00:12:03
From the Guardian archive  Chemical castration of detained patient to go ahead – archive, 1988

A 25-year-old man detained under the Mental Health Act in a Surrey hospital is shortly to be injected with an implant of an experimental ‘chemical castration’ drug, which can be used without the patient’s consent after a recent High Court ruling.

The treatment, due to start within the next few weeks, is understood to be the first use of the drug in this way on a patient involuntarily detained in a mental hospital.

The drug, Zoladex, is licensed only for treatment of cancer of the prostate, which mainly affects elderly men. Apart from its effects in drastically reducing sex drive, its long-term side-effects on a young man remain unknown.

The Mental Health Act Commission, the government-appointed watchdog body for those detained in mental hospitals, is concerned about recent changes in the law which make it possible for an experimental drug ‘many times more powerful than a hormone’ to be implanted without the patient’s consent.

Zoladex works by blocking the production of testosterone, leading to impotence and loss of sex drive. Its effects, according to those with knowledge of it, are the equivalent of chemical castration. A tiny sponge is implanted into the patient’s abdomen by injection. The effects last for about a month, then the procedure has to be repeated.

The patient, at Netherne psychiatric hospital in Coulsdon, Surrey, behaves ‘inappropriately towards women’, according to the hospital’s general manager, Mr Martin Barkley.

The man has already been on other drugs commonly used to reduce the sex drive. Mr Barkley says these have made him ‘more settled and more contented’, and medical staff wished to try Zoladex to see whether further improvements could be achieved.

In May, ‘Mark’, a 27-year-old compulsive paedophile, took the Mental Health Act Commission to court and won the right to have the experimental drug as an outpatient after arguing that other libido-lowering drugs had failed to curb his sex drive.

The High Court ruled that Zoladex was not covered by section 57 of the Mental Health Act, which applies to ‘the surgical implantation of hormones for purpose of reducing male sex drive’ and requires that the patient is capable of understanding the nature, purpose and likely effects of treatment and has consented to it. Even then, the treatment must be sanctioned by two independent doctors.

Mark had not won the consent of the commission’s doctor. The High Court ruled that implantation by injection was not surgical and the drug was similar to a naturally occurring hormone. This means it is now covered by the act’s less stringent section 58, which does not require the patient’s consent.

However, if a patient is not capable of understanding the likely effects of the treatment or has not consented to it, a specially appointed doctor must give a second opinion based on the ‘likelihood of the treatment alleviating or preventing a deterioration of his condition’.

An independent doctor, appointed by the Mental Health Act Commission, visited the Netherne patient last week and sanctioned the treatment. Mr Graham Howard, secretary of the commission, said the doctor had issued a certificate of consent because ‘either the patient was unable to consent or did not consent’.

The case is understood to be the first of its kind since the May ruling. The commission has now called on the Government to examine the need for special safeguards for Zoladex. Mr Howard stressed that it was a form of treatment carrying a ‘very great possibility of infertility’.

The main difference between Zoladex, or Goserelin as it is also known, and other drugs which reduce the male sex drive is that Zoladex blocks testosterone production by acting on the pituitary and is thus likely to be more effective. The drug’s manufacturer, ICI, is understood to have no intention of testing it for reducing the male sex drive.

Mark’s psychiatrist, Dr Gerald Silverman, of St Bernard’s hospital in west London, said Mark was still on the drug as an outpatient. He has also treated four other outpatients. ‘So far it is absolutely effective,’ he said yesterday.

Sources with experience of dealing with violent sex offenders point out that any ‘chemical castration’ drug should only be used together with psychiatric counselling. ‘There are cases on record of offenders who have been chemically castrated sexually mutilating their victims at a later stage in an act of revenge,’ one expert said.