To: [email protected]

Ministry of Home Affairs

This letter co-authored to provide philosophical understanding on the importance of a law like S309, and scientifically-based, mental health statistics on suicide, to help readers make sense of the possible implications of removing the suicide law, S309. To keep this piece readable, the philosophical arguments make up our main text, and the scientifically-based comments are indented. Readers could read the main text (shorter version) first for a basic understanding, then decide if they want to delve into the indented text for further substantiation.

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Keep S309 to Educate, Prevent Every Preventable Suicide; Treat Every Survivor

We refer to the Penal Code Review Committee’s (PCRC) recommendations on the decriminalisation of atempted suicide, reported in The Straits Times: Punishment not the answer for people attempting suicide; Sept 9.1

The article also contains a video featuring Minister Shanmugam’s comments on why he thinks the suicide law S309 should be repealed.

We understand the intention that no one wants to make criminals out of any groups of people. It is an empathetic position rightfully taken.

We also agree with the PCRC that “treatment, rather than prosecution,” is the appropriate response to people who attempt suicide.

We would like to offer perspectives to navigate through our own empathetic positions for individuals, and also for society.

  1. S309 gives legal legitimacy for the State to intervene such that help can be accorded to those at risk of suicide

For example, in the same article above, it says: “While attempted suicide is an arrestable offence, actual prosecutions are rare.”

It further explains: prosecutions are sought for those who “repeatedly attempt suicide” because “only the courts have the power to compel persons to seek treatment” via “mandatory” order.

In other words, S309 has been used for the purpose of getting suicidal persons to seek treatment, without which there could have been no way to get some of them helped.

Would not the State curtail its legal power to mandate persons to be helped, and its ability to intervene to help those at risk, if suicide is decriminalised?

  • Indeed, a look into the PCRC report in para 15 (page 338), records the speculation by local civil society groups that mandatory reporting of suicide attempts “may deter help-seeking”, but provides no further explanation.  The PCRC then states that “there is no need to impose a mandatory reporting requirement” in para 16(c) (page 339) but does not provide the reasoning for why there is no need. In its recommendation in para 35 (page 343), the PCRC provides as the basis of its recommendation, the inappropriateness to impose a mandatory reporting requirement on suicide attempts if the suicide attempt is not subject to punishment.
  • This begs the question of whether decriminalisation of attempted suicide is a sound recommendation in the first place, if a key implication is that mandatory reporting requirements cannot be enforced.
  • The removal of mandatory reporting is likely to lead to under-reporting of suicide attempts by families due to fear of stigma, and by doctors out of respect for patients’ privacy. Under-reporting would also mean non-detection of many cases of abetment of attempted suicide, which the PCRC agrees “must remain a crime.” (Para 16(e) page 339)
  • The likely result of greater under-reporting of suicide attempts means that those who need help are unlikely to ever enter into the system through which help is currently being delivered, because their cases are not flagged in the first place.
  • The likely outcome of a repeal of s309 and elimination of the mandatory reporting requirement on suicide attempts, is that the SPF will deprioritize and deallocate police resources to investigate suicide attempts as attempting suicide is no longer a criminal offence. This weakens our nationwide capability to detect, intervene and help in cases where risk of suicide is high.  
  • Also, the idea that at-risk persons are deterred from seeking help because of the criminality of suicide is empirically baseless. Further studies ought to be done before such a rationale is even considered.
  • As is already the practice, the State exercises compassion and discretion in prosecuting cases of attempted suicide. We could go further, for example, by improving mental health education or to educate public on the intention of S309 – as a law to help rather than to prosecute.
  • There are other plug-gap measures the PCRC had suggested to replace S309, but we find them unthorough and inadequate.
  • For example, the PCRC recommended changing the Mental Health Care and Treatment Act (MHCTA) to cover persons “who attempt suicide andwho are reasonably suspected of having a mental disorder” to refer them to medical practitioners. However, one-third to 80% of all suicide attempts are impulsive acts, according to The New England Journal of Medicine.2 24% of those who made near-lethal suicide attempts decided to kill themselves less than five minutes before the attempt, and 70% made the decision within an hour of the attempt.3 These means many who attempt suicide could be making their decision due to impulsiveness in a moment of distress. They might not necessarily fall under a “mentally disordered” category.
  • Such examples, together with others like the elderly, terminally ill, severely disabled, highly dependent individuals, who might attempt suicide not because of a mental disorder, but because of pressure to relieve the burden on their loved ones, would fall through the gap left by the new system. The police will have no more grounds to intervene in such cases under the MHCTA.
  • Retaining S309 would allow for the referral of those who attempted suicide to medical treatment, without casting any unnecessary aspersions or stigma brought by the new MHCTA system, on the mental health of the individual.
  • The government must convince the public on how they seek to address these grave ramifications (for lives lost is a grave consequence), or S309 ought to be retained.

2: The policy objective of treating distressed individuals at risk of suicide with compassion and dignity, and not as criminals, has been and can continue to be achieved with the retention of S309.

To understand this, we should rethink a prominent fallacy: The idea that the Penal Code discriminates against suicidal people.

The Penal Code does not actually discriminate against any group of persons, for the fact that offences are always drafted as conduct.

Just because someone may be predisposed towards certain conduct does not mean that these conduct must be lawful.

If discrimination is taken to mean targeting specific groups of people that are predisposed to certain behaviour, then laws such as theft, drug-consumption, could be accused of being “discriminatory” towards people suffering from kleptomania or drug-addiction.

So let’s judge each act based on its merit, for its effect on the individual, and on the society?

If an act is harmful, then the aim of criminalising it is to announce to society that these acts are not to be done and to secure that fewer of them are done – for our common good.

  • Indeed, available empirical evidence shows risk that decriminalization of suicide is associated with increase in suicide rates post-decriminalization.
  • There are 3 studies on suicide rates before and after decriminalization:

(PDF) Decriminalization of suicide in New Zealand and suicide rates

Suicide rates in NZ did not exhibit significant changes between before and after decriminalization of suicide in NZ in 1961.

(PDF) Decriminalization of suicide in Canada and suicide rates

But in Canada, the mean annual suicide rate before decriminalization in 1972 was 9.3 per 100,000 per year (1962 to 1971).  After decriminalization, the mean rate was 13.6 per 100,000 per year (1973 to 1982) which is significantly higher.

(PDF) Decriminalization of suicide in seven nations and suicide rates 

For the study of seven nations, which includes New Zealand and Canada, a look at actual numbers showed that the mean suicide rate rose from 9.66 before decriminalization to 11.24 afterwards. This increase was statistically significant. While the study does not claim to prove causality, the evidence points towards strong association between decriminalization of suicide and increase in suicide rates.

  • We can see that decriminalization is likely to reverse the trend of reduction in Singapore’s suicide rates, and goes against the overall stated objectives of reducing suicide attempts and suicides in Singapore.

3: Non-enforcement of S309 would not downplay its importance as a law with educative-preventive function

Another fallacy that needs rethinking is the idea that the law should only serve to prosecute.

This is untrue. Some laws play a symbolic, educative-preventive role.

For instance, S292 criminalises the possession of pornography. Hardly anyone had been prosecuted by it. Our courts symbolically ban 100 pornographic sites to discourage pornography.

Though unenforced, such laws safeguard a larger moral ecology, important for a sound, workable society.

When Ashley Madison tried to establish a Singapore website, they were stopped because our society recognised its unsound ideologies promoting adultery among married spouses.

Had they succeeded, it would have perpetuated actual harm on persons and families.

Miss Serene Ho, who has attempted suicide, said when the police informed her that attempting suicide was a crime, it had a deterrent effect on her. Knowing that attempting suicide was a crime stopped her from trying again. She added that the police had treated her with compassion and encouraged her to seek counselling. She was not charged.4

Every suicide that can be prevented should be prevented – for every life counts, both for the victim and their loved ones. Even if one life is lost – directly or indirectly – by the repeal of S309, it would be an injustice committed. I believe many Singaporeans, upon judging the evidence, would want S309 to be kept for its educative-preventive role, so as to keep suicide rates low, prevent preventable suicides, and to give the State legal legitimacy to intervene in those who need treatment.

 

Sincerely,

Leo Hee Khian

Chong Chan Vee

 

Citations:

  1. https://www.straitstimes.com/singapore/penal-code-review-committee-punishment-not-the-answer-for-people-attempting-suicide
  2. https://www.nejm.org/doi/full/10.1056/NEJMp0805923
  3. https://www.businessinsider.com/many-suicides-are-based-on-an-impulsive-decision-2014-8/?IR=T
  4. https://www.tnp.sg/news/singapore/ways-thwart-teen-suicide-reviewed

 

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