20 years of combating torture: CPT General Report 2008-2009 Report on the ad hoc visit to the Czech Republic in March/April 2008 and response of the Czech authorities (surgical castration of sex offenders) 51. One of the main objectives of this visit was to examine the application of testicular pulpectomy (surgical castration) on sentenced sex offenders. The CPT’s delegation interviewed nine sex offenders who had undergone surgical castration, and five who were in the preparatory stages of the process to be castrated. In addition, the files of 41 sex offenders who had been surgically castrated between 1998 and 2008 were studied, and interviews on the treatment of sex offenders were carried out with medical practitioners, scientists and government officials. 52. In its report, the CPT recognises that the treatment of sex offenders in the Czech Republic follows treatment plans which are based on an extensive diagnostic evaluation and can include psychotherapy. However, in the light of the facts found during the visit, the Committee reiterates its opposition to one aspect of the system applied, namely surgical castration. The CPT’s objections to the use of this intervention as a means of treatment of sex offenders are manifold. Firstly, surgical castration has irreversible physical effects, and direct or indirect mental health consequences. Further, there is no guarantee that the result sought (i.e. lowering of the testosterone level) will be lasting. As regards re-offending rates, the CPT found that that the claimed positive effects were not based on sound scientific evaluation. In any event, the legitimate goal of lowering re-offending rates must be counterbalanced by ethical considerations linked to the fundamental rights of an individual. It is noteworthy that surgical castration is not in conformity with recognised international standards, and more specifically, is not mentioned in the authoritative “Standards of care for the Treatment of Adult Sex Offenders” drawn up by the International Association for the Treatment of Sex Offenders. Moreover, given the context in which the intervention is offered, it is questionable whether consent to the option of surgical castration will always be truly free and informed. As was found during the visit, a situation can easily arise whereby patients or prisoners acquiesce rather than consent, believing that it is the only available option to them to avoid indefinite confinement. Irreversible medical interventions should never be carried out on prisoners and other detained persons, unless there is a clear medical necessity. When these fundamental objections are combined with the fact that effective alternative therapies for the treatment of sex offenders are currently available, the case against surgical castration becomes overwhelming. In the CPT’s view, surgical castration of detained sex offenders amounts to degrading treatment; in its report, the Committee calls upon the Czech authorities to end immediately the use of this intervention in the context of the treatment of such persons. 28