EARLIER this month, a national daily reported that a woman in Jaranwala committed suicide after poisoning her two minor daughters.

Under Section 325 of the Pakistan Penal Code (PPC), both suicide and attempted suicide are currently considered criminal offences, with the latter punishable either by a jail term of up to a year, or a fine, or both.

All reported cases of suicide or any such attempts are thereby mechanically linked to law enforcement. In practice, it is rare for such FIRs to be registered with the police, but harassing and extorting money from victims of attempted suicide is not uncommon.

The criminalisation of suicidal behaviour is one of the main reasons that people do not seek help for the psychological problem that may have precipitated the act.

The World Health Organisation reported over 13,000 suicides from Pakistan in 2012; extrapolating from this data, a conservative estimate would put the number of suicide attempts at 150,000 to 300,000.

Other research has shown that most Pakistanis who attempt suicide are young (under the age of 30), with women outnumbering men by a ratio of at least 3:1 or 4:1.

Most people who attempt suicide suffer from a mental disorder, such as depressive disorder, and the attempt is commonly precipitated as a result of interpersonal difficulties or some other stressful factor. Most mental disorders, including depression, are treatable. And most people who end up taking their own life have a history of previous self-harm. Therefore, all suicide attempts need to be brought to medical attention. If only the woman, whose case has been mentioned in this article, had been offered timely help, three lives could have been saved.

In 2001, a Mental Health Ordinance was promulgated in Pakistan to replace the Lunacy Act, 1912. Since the passage of the 18th Amendment, Sindh, Punjab and Khyber Pakhtunkhwa have enacted mental health legislation (2013, 2014 and 2017 respectively).

All these acts refer to Section 49 of the MHO, 2001, which states, “A person who attempts suicide shall be assessed by an approved psychiatrist and if found to be suffering from a mental disorder shall be treated appropriately under the provisions of this ordinance”. As a result, a bill to decriminalise suicide attempt was presented in the Senate recently, which was deferred on the grounds that ‘attempted suicide is a crime’ and ‘forbidden in Islam’.

Pakistan is one of the few countries in which attempted suicide is still a punishable offence.

Although all the world’s major religions condemn suicide to varying degrees, Islam is seen as having among the strongest sanctions against suicide — declaring it a major sin.

The basis of this opposition to suicide is rooted in the strong emphasis that Islam places on the sanctity of human life and every Muslim’s sacred duty to respect this right. This condemnation of suicide is also one of the reasons that, overall, the incidence of suicide in Muslim countries is less compared to Western countries.

However, many people point out that there are difficulties in applying religious injunctions against suicide to cases of attempted suicide, especially in those countries such as Saudi Arabia, Pakistan and Kuwait that have incorporated the Sharia into their legal systems. In fact, they say that attempted suicide should not be equated with suicide itself as there are no strong religious principles against such a practice.

In attempted suicide the issue of ‘intent’ is paramount; a person can only be prosecuted once the intent is clearly established. This is not always easily determined, and Islam has strong views against assuming other people’s intentions.

In attempted suicide cases, the rule of ‘insanity’ is also applicable in Islam, wherein a mentally disturbed person is not held to be responsible for his acts. For both these reasons, the prosecution of attempted suicide cases in Muslim-majority countries remains debatable. Even the scope of PPC 325 reinforces that only a confirmed attempt, not any preparation for the commission of suicide, is punishable.

Beyond the religious argument, there are sociological and psychological factors. French sociologist Emile Durkheim (1858-1917) highlighted social factors that influenced social integration and regulation in contemporary societies, putting these within a general theoretical framework that suicide varies inversely with the degree of social integration of the group of which the individual belongs.

From the historical perspective, attitudes towards suicide gradually became less restrictive and closely paralleled the development in society’s attitudes towards individual and personal rights.

The act of suicide, initially considered a criminal and sinful activity, gradually began to be seen as a highly complex and multifaceted problem influenced by socio-cultural and religious factors; a problem that requires a multidisciplinary approach for its prevention. This is the view of suicide that is currently held in most developed countries.

Suicide was recently decriminalised in India, where more than 250,000 people killed themselves in 2012, through the passage of the Mental Healthcare Act.

It states, “[A]ny person who attempts to commit suicide shall be presumed, unless proved otherwise, to have severe stress and shall not be tried and punished”. As per the act, it will be government’s duty to provide care, treatment and rehabilitation to a person, having severe stress and who attempted to commit suicide, to reduce the risk of recurrence of any attempt.

Despite being a criminal offence, some legal scholars even in Pakistan have argued that the court has wide leeway in meting out punishment and can take into account extenuating circumstances — such as a mental condition — that compelled an individual to attempt suicide in the first place, that it is not necessary to inflict a sentence of imprisonment upon a person who on account of family discord, destitution, loss of a relation or other causes decides to take his life.

There is an urgent need for Pakistan to decriminalise attempted suicide, like most Muslim countries have already done. This would allow a compassionate and scientific approach to help those caught up in a predicament where they see suicide as the only option, and where medical intervention can actually prevent the possibility of suicide.

Dr Asma Humayun is a consultant psychiatrist.
Twitter: @AsmaHumayun

Dr Murad M. Khan is professor of psychiatry, AKU and president of the International Association for Suicide Prevention.
muradmk@gmail.com

Published in Dawn, November 27th, 2017