Criminal Defence and Sentencing: How Medical Conditions Affect Sentencing in Singapore

Criminal Defence and Sentencing: How Medical Conditions Affect Sentencing in Singapore

A medical condition can affect a criminal sentence in Singapore in three ways. A psychiatric condition that contributed to the offence may support a Mandatory Treatment Order (“MTO”) in place of imprisonment. The same condition may also reduce the offender’s culpability and the weight the court gives to deterrence. Serious physical ill health may be a mitigating factor or, in truly exceptional cases, a ground for judicial mercy. In each case, the outcome turns on what the medical evidence shows, which is why early and effective legal representation matters.

Mandatory Treatment Orders

An MTO is a community order under the Criminal Procedure Code 2010 (“CPC”). It requires the offender to attend psychiatric treatment, and to comply with conditions connected with it, for up to 36 months. It is not available for every offence: the court must first consider whether the case falls within the exclusions to community orders in s 337(1).

Before making an MTO, the court must call for a report from an appointed psychiatrist. An MTO can be made only if the report states that:

• The offender is suffering from a psychiatric condition which is susceptible to treatment;
• The offender is suitable for the treatment; and
• The psychiatric condition is one of the contributing factors for the offender’s commission of the offence.

The offender may submit a report from a psychiatrist he or she has engaged within three weeks of the court calling for the report, or at such other time as the court allows, and the appointed psychiatrist must take it into account.

The court cannot make an MTO contrary to the appointed psychiatrist’s findings, so that window is the offender’s main opportunity to put forward a different clinical view.

Psychiatric Conditions and Culpability

Even where an MTO is unavailable, a psychiatric condition is relevant if it lessens the offender’s culpability. In Ho Mei Xia Hannah v Public Prosecutor and another matter [2019] 5 SLR 978 (“Ho Mei Xia”), the High Court held that the extent of that relevance depends on the nature and severity of the condition and on whether, and how far, it contributed to the offence.

Whether a contributory link identified by a psychiatrist is legally significant is a question for the sentencing court. Two kinds of impairment have consistently been treated as relevant:

• Where the disorder affects the offender’s capacity for self-control and restraint; and
• Where it diminishes the offender’s ability to appreciate the nature and wrongfulness of the conduct.

The case also shows how such an argument can fail. The appellant had persistent depressive disorder, but the court found it mild and not linked to her assault on police officers.

Personality traits, the court added, are not in themselves mitigating. Little weight was given to the defence psychiatrist, who had removed a reference to the appellant’s drug use from his report after being told it was immaterial, and who had urged the court to show “great compassion”, which went beyond his remit as an expert.

Physical Ill Health: Mitigation and Judicial Mercy

For physical ill health, the leading authority is Chew Soo Chun v Public Prosecutor and another appeal [2016] 2 SLR 78 (“Chew Soo Chun”), where a three-judge High Court held that ill health is relevant to sentencing in two distinct ways:

• As a mitigating factor: Where imprisonment would have a markedly disproportionate impact on the offender because of his or her ill health. This generally means a risk of significant deterioration in health or a significant exacerbation of pain and suffering, and the reduction is calibrated to restore proportionality.
• As a ground for judicial mercy: In truly exceptional cases. Humanitarian considerations then displace culpability, and the court may impose the minimum term of imprisonment or a non-custodial sentence.

Judicial mercy has been extended where the offender was terminally ill, or so ill that imprisonment would carry a high risk of endangering his life. These categories are not closed, but there must be clear evidence, and no overwhelming public interest in punishment weighing against mercy.

Showing that the offender is ill is not enough. A condition is neutral if the prison can address it to an acceptable standard, which need not be the best medical standard, or if its consequences, or the risk of them, would be no different outside prison.

In Chew Soo Chun itself, the offender’s cancer and risk of stroke could be managed in prison, but the evidence showed that his major depression and claustrophobia would deteriorate there. The court upheld a six-month reduction, while rejecting a 50% discount.

The Medical Evidence

The burden lies on the offender. In Goh Chin Soon v Public Prosecutor [2021] 4 SLR 401 (“Goh Chin Soon”), the High Court held that the offender must present evidence directed specifically at whether imprisonment would have a significantly adverse impact on his or her health, normally from medical professionals familiar with the offender’s conditions.

Only then does the evidential burden shift to the Prosecution, for example to show that the Singapore Prison Service can address the issues raised.

The appellant was at high risk of heart attack, sudden cardiac death and stroke, but his reports did little more than show that he was ill. Although the Prosecution called no evidence from the Prison Service, his ill health was not treated as mitigating.

Where the medical evidence is undisputed, a reduction can follow. In Leck Kim Koon v Public Prosecutor [2022] 3 SLR 1050, the offender had chronic myelomonocytic leukaemia, a rare form of blood cancer, and the High Court noted that his illness was terminal.

It refused mercy because of the extent of his cheating and the sums involved. It upheld a six-month reduction because imprisonment would likely have a disproportionate impact on him. The prison authorities were prepared to provide adequate healthcare, but declined to comment on whether imprisonment would have that impact.

The evidence must also answer the right question. In Lim Oon Kuin v Public Prosecutor and another matter [2026] 3 SLR 616, two specialists considered the elderly appellant to be at high risk of falls.

One said that a fall could lead to a complication that would “most certainly endanger his life”, and the other said that a fall and fracture “can result in death”. The High Court held that the opinions did not clearly show how the fall risk carried a high risk of endangering his life, and that the “can result in death” opinion was conceptually distinct from what Chew Soo Chun requires: a condition so severe that imprisonment would carry a high risk of endangering life.

Judicial mercy was refused. The court also found insufficient evidence of a disproportionate impact on him, so his fall risk was not treated as mitigating either. His sentence was nonetheless reduced on account of his age under the totality principle.

Early and Effective Legal Representation

The cases show that a medical condition reduces a sentence only when the evidence answers the court’s questions:

• Did the condition contribute to the offence?
• Would imprisonment affect this offender disproportionately?
• Can the prison manage the condition?

That evidence takes time to obtain, and gaps in it are difficult to repair later. An offender’s own psychiatric report must reach the appointed psychiatrist within three weeks of the court calling for an MTO report, unless the court allows more time, and the court cannot then make an MTO contrary to the appointed psychiatrist’s findings.

In Goh Chin Soon, reports that showed only that the appellant was ill did not shift the burden, even though the Prosecution called no evidence in response. In Ho Mei Xia, a report that left out relevant facts and argued for compassion was given little weight.

Effective representation means getting that evidence right from the start. A criminal defence lawyer can identify early whether a condition is legally relevant, instruct the right specialists, put to them the questions the court will ask, and ensure that their reports are complete and independent.

That evidence then supports the mitigation plea, or representations to the Prosecution while the charges are still being considered. If you or a family member is facing criminal charges and has a medical or psychiatric condition, speak to a criminal lawyer in Singapore as early as you can.

No lawyer can promise a particular sentence; the outcome depends on the facts and the evidence.

Facing Criminal Charges and Have a Medical Condition?

A medical or psychiatric condition may be relevant to sentencing, mitigation or eligibility for a Mandatory Treatment Order. Proper medical evidence and early legal advice can help ensure that the court receives a complete picture of the offender’s circumstances.

Jerrie Tan LLC is a law firm in Singapore. Its criminal defence practice advises on mitigation and sentencing where medical or psychiatric evidence is relevant.

Contact Jerrie Tan LLC to discuss your circumstances and arrange a confidential consultation.

This article is general information only and does not constitute legal advice. It does not create a solicitor-client relationship. Outcomes depend on the specific facts of each matter. Please seek advice on your own circumstances.