Ethical evaluation of urology specialists' knowledge and attitudes on the application of medical (chemical) castration for sexual offenders: a perspective from Turkey.

BACKGROUND

Court-ordered medical (chemical) castration has pre-occupied Türkiye's legal and medical communities since the short-lived 2016 by-law that named urologists as key implementers. How do the very physicians expected to administer the intervention actually view it? This nationwide survey probes urology specialists' knowledge, ethical reasoning and practical attitudes toward medical castration for sexual offenders.

METHODS

A nationwide, cross-sectional online survey was conducted between April 2020 and October 2024. A 53-item questionnaire covering sociodemographic data, knowledge, ethical attitudes, and evaluative propositions about medical castration was distributed via professional mailing lists and direct e-mails. A total of 121 urology specialists participated. Data were analyzed with SPSS 26; descriptive statistics, Pearson χ², Fisher-Freeman-Halton exact tests, and Monte Carlo simulations were used, with significance set at p < 0.05.

RESULTS

Just 47/121 (38.8%) could accurately cite the legal basis for medical castration; 33/121 (27.3%) reported detailed procedural knowledge. Legal awareness correlated with ≥ 11 years' practice (χ² = 10.14, p = 0.039) and prior medical-ethics coursework (χ² = 9.17, p = 0.034). While roughly seven in ten (71.9%) felt the option should exist in principle, only 24/121 (19.8%) endorsed mandatory application. A slim majority (53/121; 43.8%) insisted on written offender consent, and 96/121 (79.3%) would mandate pre-treatment counselling on adverse effects. More than half (62/121; 51.2%) feared "medicalising" criminal punishment, and nearly two-thirds voiced concern about becoming agents of the penal system. Support was uneven: higher among academics holding associate professorships (p = 0.012) and in the Marmara region (p = 0.005), yet markedly lower among physicians with children (p = 0.040).

CONCLUSION

Urology specialists in Türkiye exhibit a nuanced, often ambivalent stance: many view medical castration as potentially useful but emphasize voluntariness, informed consent, and multidisciplinary follow-up. Limited legal familiarity and substantial ethical reservations highlight the need for clearer legislation, strengthened ethics education, and alignment with international human-rights standards before wider implementation can be contemplated.