Treaters or punishers? The ethical role of mental health clinicians in sex offender programs

Clinicians in sex offender treatment programs are forced to breach traditional mental health ethical principles in order to successfully achieve their outcomes. These breaches include placing the community's interest ahead of those of the offender, restricting confidentiality, and the imposition of involuntary treatment. Unlike breaches in other treatment settings, they are not exceptions to general rules of non-maleficence or beneficence but, rather, must be carried out routinely and universally. Such programs thus take on the characteristics of punishment, rather than treatment, and, unsurprisingly, traditional codes of mental health ethics fail to give any real guidance to clinicians providing them. It is argued that ethical principles justifying and limiting punishment will be of more value in limiting the harms which might be inflicted on offenders participating in these programs while maintaining the integrity of the clinicians working with them.