• Alabama's state legislature passed a bill, known as House Bill 379, that will require convicted child sex offenders to undergo chemical castration prior to their release.

• While surgical castration involves the physical removal of the testicles, chemical castration relies on a drug to reduce the person's testosterone activity to pre-puberty levels.

• The use of chemical castration for sex offenders in the criminal justice system raises constitutional and ethical questions.

Alabama's state legislature passed a bill Tuesday that will require convicted child sex offenders to undergo chemical castration prior to their release, raising questions about the legality and ethics of castration.

According to the legislation, known as House Bill 379, a person convicted of a sexual offense involving anyone under the age of 13 will be required, as a condition of parole, "to undergo chemical castration treatment in addition to any other penalty or condition prescribed by law."

The person will be obligated to pay for the cost of treatment, and a refusal to be castrated would be considered a parole violation, the legislation reads. The bill now goes to Gov. Kay Ivey's desk for signature.

State representative Steve Hurst, who introduced the bill, told WIAT, a CBS-affiliated station in Birmingham, that the punishment is appropriate given the severity of the crime.

"I had people call me in the past when I introduced it and said don't you think this is inhumane? I asked them what's more inhumane than when you take a little infant child, and you sexually molest that infant child when the child cannot defend themselves or get away, and they have to go through all the things they have to go through," Hurst said. "If you want to talk about inhumane — that's inhumane."

What is chemical castration?

While surgical castration involves the physical removal of the testicles, chemical castration relies on a drug to reduce the person's testosterone activity to pre-puberty levels. Castration has a long history in the US, with the eugenics movement of the early 20th century supporting both castration and sterilization to address what it viewed as societal ills.

While the procedure dwindled in popularity at the end of World War II, the use of chemical castration for sex offenders has gained steam in the last few decades. California became the first state in 1996 to authorize chemical castration for certain sex offenders, with chemical castration compulsory after the second offense against a child. 

Other states that have statutes in the books related to voluntary or compulsory chemical castration include Florida, Iowa, Louisiana, Montana, and Wisconsin, according to the National Conference of State Legislatures, while Texas has a law that authorizes surgical castration. Georgia and Oregon previously had chemical castration laws, but they were repealed in 2006 and 2001 respectively. It remains unclear how often the treatment is actually used and overall effectiveness.

"Chemical castration is probably a little bit misleading because it really just reduces the hormone levels and it's definitely not a magic bullet to prevent sex offenses," said Trent Holmberg, a general and forensic psychiatrist based in Utah who co-wrote an article in 2003 about castration for sex offenders. "The research suggests there are a lot of side effects to giving hormone suppressing medication to men and we don't have a good sense of exactly how common those side effects are and how debilitating and life effecting, but there is potential that it can cause a number of unwanted side effects and that's one of the big concerns."

While Alabama isn't the first state to put forth legislation on chemical castration, Thomas Douglas, a senior research fellow at the University of Oxford's Uehiro Centre for Practical Ethics, who co-published a study in 2013 on chemical castration of sex offenders, said the bill is the first he knows of in which politicians are explicitly using the treatment as retribution.

"The government wants to introduce it as a form of punishment and giving the offender what they deserve and that's quite unusual," Douglas told INSIDER. "There are several US states and a number of countries in Europe that use chemical castration for sex offenders but usually it is presented as being used for rehabilitation purposes... I think if we start using interventions like this there is a high risk we will abuse them and use it in cases where they are extremely harmful."

He added that there are various longstanding debates surrounding the use of chemical castration in the criminal justice system: for instance, issues surrounding consent and if the state can force people to partake in treatment; whether people who already have restricted freedom of movement should be subjected to interventions involving the invasion of their bodies; and if medical practitioners should ever be required by the state to implement a treatment that might not, from a health standpoint, be in the person's best interest.

"Chemical castration is an interesting test case for whether medical interventions are ever appropriate in criminal justice," he said.

An 'ethics quagmire'

Holmberg described chemical castration for sex offenders as a constitutional issue and "ethics quagmire" for doctors and treatment facilities.

"It puts a lot of people in pretty impossible situations... chemical castration is prescribed medication so the question becomes should the statute allow the offender to refuse treatment and, if not, what position is the physician put in and whether they are comfortable ordering a forced treatment situation," he said. "I think that most would say that's a step too far since it's a political determination of a medical treatment."

Another issue, he added, revolves around cases in which chemical castration is voluntary. "There's the issue of is it really voluntary or is it forced because getting out of prison is in the balance," he said.

Randall Marshall, executive director of the American Civil Liberties Union of Alabama, told INSIDER that he considers the Alabama law to be a clear violation of the Eighth Amendment, which prohibits cruel and unusual punishment. He added that, in the case Ivey does sign the law, it likely won't garner a legal challenge until it is actually implemented.

"It certainly presents serious issues about involuntary medical treatment, informed consent, the right to privacy, and cruel and unusual punishment," Marshall said. "It certainly is a return, if you will, to the dark ages. This kind of punishment for crimes is something that has been around throughout history, but as we've gotten more enlightened in criminal justice we've gotten away from this kind of retribution."

Janice Bellucci, executive director of the Alliance for Constitutional Sex Offense Laws, which advocates for the civil rights of people convicted of sex crimes and their families, agreed, describing chemical castration as "barbaric and ineffective."

"It seems to be what some people would call Old Testament justice and you talk about an 'eye-for-an-eye' or a 'tooth-for-a-tooth,' " she said. "There are many treatment options that could be effective and you certainly would think the state would spend their resources providing treatment to people who have made such a grievous mistake and who have harmed a child, but chemical castration is not treatment. It's punishment."

Hurst, the state lawmaker who introduced the bill, told WIAT that his intent for the law is to "deter something like [child sex offenses] happening again in Alabama and maybe reduce the numbers."

It is unknown if Ivey plans to sign the bill into law. If she does, it will become effective on the first day of the third month following her signature.

Compiled by Olalekan Adeleye

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