Nagaenthran K Dharmalingam is a 33-year-old Indian Malay man who was arrested at the age of 20 for allegedly trafficking around 42.72 grams of heroin in April 2009. Nagaenthran initially, at the time of the arrest, confessed to the crime by admitting to the fact that he was carrying drugs for a friend named King (Chiang, 2019).

However, he later denied any knowledge of the package's contents being drugs. Nagaenthran claimed that King had assaulted him and threatened to kill his girlfriend if he did not transport the drugs. Despite this retraction, the High Court did not accept his defence. Hence, he was ruled to assume full responsibility for his criminal conduct.

In November of 2010, He was sentenced to death by hanging. Throughout his legal proceedings, there were serious concerns about his intellectual disability. The evidence suggests that he had an IQ of 69, which is internationally recognised as intellectually disabled. His defence put forth his inability to make judgments, control impulses, or assess future consequences, those that are in line with the recent academic literature (Egger, 2021; Egger et al., 2021; Pinals et al., 2021; Rattat & Collié, 2020; Spaniol & Danielsson, 2021).

Despite the attempts from his defence, he was found to be ineligible for re-sentencing, which under new laws could be considered as diminished responsibility, stating he was not "substantially mentally or intellectually disabled". He understood his actions (Wikipedia contributors, 2025).

After over 10 years on death row, Nagaenthran's mental condition has significantly deteriorated over time. His family and lawyer report that he appears disoriented, incoherent, smiles irrelevantly, and may not fully grasp his forthcoming execution or the meaning of his death sentence (Chhoa-Howard, 2022). Banay (2021) continued to mention in her blog post that he reportedly believes he is in a garden and not on death row. His lawyer described talking to him as speaking with a "four-year-old child".

Presenting a hypothetical situation for analysis.

A death warrant has been issued. Nagaenthran's execution is imminent after rejecting numerous appeals and two clemency petitions (Wikipedia contributors, 2025; Chhoa-Howard, 2022; Dzulkify, 2021; Koh, 2019). There have been significant international voices from human rights organisations, UN experts, and public figures, arguing that his execution would be unlawful under international law due to his intellectual disability and the nature of the crime (Banay, 2021; Chhoa-Howard, 2022; Hancock, 2021; Ng, 2021; Paddock, 2021).

The ethical analysis of this case scenario will be done under the assumption that the Singapore Prison Service (SPS), to facilitate familial connections and provide emotional support to inmates and their families once an execution date is set, appoints a government consulting psychologist for the provision of mental health assessment and services towards Nagaenthran (Singapore, 2022). However, Nagaenthran faced his sentence on 27 April 2022, 13 years after his arrest, at around dawn in Changi Prison.

A professional counselling psychologist (hereby referred to as the 'counsellor') has been assigned by the SPS to provide mental health assessment and services for Nagaenthran in the days leading up to his execution. Their role is to provide support and evaluation. This provision was issued even amidst controversies regarding the adequacy of mental health support for death row inmates, as well as past instances where lawyers were questioned for objecting to the disclosure of psychiatric records (Lum, 2021; Wikipedia contributors, 2025).

Ethical challenge analysis.

Singaporean counselling psychologists refer to the code of ethics presented by the Singapore Association for Counselling (2018), which has been created based on the ACA's report. However, considering the assignment's requirements, we will analyse the case against the ethical guidelines provided by the American Counselling Association (2014). The case of Nagaenthran presents the counsellor with a wide range of moral dilemmas. These moral dilemmas arise due to the unique circumstances of his case, i.e., intellectual disability, mental deterioration, and the context of his death sentence.

Client's capacity for informed consent and comprehension.

Nagaenthran's documented intellectual disability (IQ 69, akin to a four-year-old) and severe mental deterioration make it incredibly difficult, if not impossible, to obtain truly informed consent for counselling and other mental health assessments. His lawyers/prison guards often mentioned that he appeared not to understand what was happening to him fully, his mental state may have been impacted, and his current cognitive function could be severely impaired after years in detention.

This directly challenges the ethical principle of autonomy (one of the six key ethical foundations of the ACA (2014)). Section A.2 emphasises the need to foster the client's right to control the direction of their life. When a client cannot understand information or even expresses an inability to make voluntary decisions, the counsellor's ability to obtain meaningful consent is compromised. Section A.2.d provides the partial solution by suggesting that the counsellor must consult, to give consent or assent to conduct the sessions and services, the parental or familial representatives, ergo acting on the rights to protect Nagaenthran and make decisions on his behalf. Section B.5.b mentions that the counsellors must provide the parents or legal guardians of Nagaenthran with all the information concerning the nature of the counselling relationship and the services, assessments, and procedures it entails.

Confidentiality vs. legal mandate.

Along the lines of Section B.5.b, since the SPS has assigned the counsellor, it implies that the courts could use the assessment findings. This creates a conflict between the ethical imperative of Nagaenthran's confidentiality and the legal obligation that the counsellor must disclose the findings. If the assessment indicates mental competency, even if borderline, it would inevitably facilitate his execution. This directly opposes the protective nature of the counselling relationship; hence, additional considerations must be applied (Section B.2.a).

The ethical duty of confidentiality binds counsellors. Nevertheless, it is not absolute; Section B.2.d mentioned that disclosure is required when the court has ordered it. It is also mentioned that a counsellor must seek written, informed consent from the client. This is impossible due to the inability to comprehend (as discussed in the previous Section). Hence, the counsellor must act on Section B.5.b, A.2.d, and A.2.e in a very cautious manner. The steps would entail (a) disclosure of the nature of the mandated services and assessments to the legal guardians, (b) highlighting the potential risks involved if the consent is not provided, and (c) emphasis on the type of information that would be disclosed. Now, concerning disclosing the court-mandated information, the counsellor faces a conflict between fidelity (honouring trust) and veracity (dealing truthfully), with potentially life-or-death legal mandates. However, Section B.2.d does allow for limiting the scope of the disclosure to only what is asked for.

There is a co-occurring multicultural issue where the counsellor must ensure that they are maintaining cultural sensitivity when obtaining informed consent from the parents and guardians (Section A.2.c)

Role conflict and beneficence.

The counsellor's role is ambiguous. Are they a supportive counsellor or a forensic evaluator whose assessment could determine Nagaenthran's competency for execution? It has been mentioned in Section E.13.b that the counsellor (for evaluation) must obtain written consent, stating that the nature is non-therapeutic and that the counsellor must remain completely objective, as required. Hence, role clarification of the counsellor becomes increasingly important.

The highlight is the ethical debate of the treatment to competency; restoration of Nagaenthran's competency violates the age-old Hippocratic Oath; as per ACA (2014), the counsellor faces the challenge against the core principles of beneficence (working for the good of the individual and society), nonmaleficence (avoiding actions that cause harm). The SPS assigned counsellor is 'wearing two hats,' presenting a deontological dilemma.

Considering that the role is therapeutic, to reduce immediate distress, contributing to his competency to be executed, the counsellor will face a greater ethical dilemma, forcing the counsellor to consider the true purpose of counselling and avoid imposing personal values or agendas. Even in dire circumstances, the focus must remain on alleviating immediate distress and enhancing comfort (Section A.1.a and A.4.a).

As per Section A.6.d, the counsellor, if it is a dual therapeutic and evaluative, must keep the consent-providing-representatives (in this case, the parents and guardians) informed of the changes in their roles as and when required. Consent must be obtained before any role transition. When the counsellor's role is to be an evaluator, as listed under Section E.13. a, the counsellor must remain objective in all forensic roles, from their expert testimonies to reporting their findings. As an evaluator, the counsellor must uphold Section E.8, which requires considering Nagaenthran's diverse cultural background. Though Nagaenthran is a Malay man, he has a family origin in India, and some news articles mention that he celebrated Deepavali (Regan, 2021).

Advocacy vs. neutrality.

ACA (2014) encourages the counsellors to promote social justice under Section A.7.a to "advocate at individual, group, institutional, and societal levels to address potential barriers and obstacles that inhibit access and/or the growth and development of clients" (p. 5). This is a particular challenge and ethical dilemma towards the counsellor due to the extensive international criticism of Singapore's decision to execute an intellectually disabled individual for a 'non-serious crime.'

There is a cross-cultural discrepancy in advocacy. While countries like Singapore have a zero-tolerance policy to drug possession, in India, if one is found with drugs, the individual is subjected to a punishment, which includes imprisonment for a term of three to five years and a fine of around one lakh rupees to three times the value of the drugs confiscated, whichever is more. In the USA, possession leads to a year or less prison term for a first offence, followed by felony charges and steep fines (Patterson, 2022).

Given the international criticism, the counsellor may feel a conflict between maintaining professional neutrality and objectivity within the prison system (as they are SPS appointed) and a personal or professional ethical obligation to advocate for Nagaenthran's human rights. The counsellor could advocate discreetly by documenting Nagaenthran's incompetence per ACA A.7.a, while adhering to Singaporean legal limits set up by the SPS. Section A.7.b mentions the need to obtain consent for advocacy from the client, which again is a loophole.

Solutions to the highlighted challenges.

Given the complicated nature of the case with such intricate ethical and multicultural issues, these are the hypothetical actions that the counsellor could take.

The counsellor must seek immediate clarification from the SPS regarding their precise role, either for palliative emotional support or forensic assessment.

The counsellor must then communicate their defined role and the limitations of confidentiality to Nagaenthran, his family, and legal counsel to the best of their ability. Adequate explanations of reporting and purpose must be provided. This act aligns well with Section A.2.a, requiring the counsellor to provide sufficient information about the counselling processes, purpose, and limitations. This also addresses Section B.1.d regarding confidentiality.

Suppose her role requires conflicting functions as both therapeutic and forensic. In that case, they should clarify, adjust, or withdraw from roles appropriately, as per Section A.8 (Multiple Clients) and implied in role changes like those under Section A.6.d (Role Changes in the Professional Relationship).

The counsellor must be mindful of Section E.13.a in all forensic evaluations, where they must "produce objective findings that can be substantiated" (p. 12). Conducting evaluations alongside treatments would compromise objectivity, and it is advised against this.

Beneficence and nonmaleficence must be prioritised. In a therapeutic relationship, the counsellor's responsibility should be to alleviate Nagaenthran's suffering and promote his well-being as much as possible. This means addressing the symptoms of distress, anxiety, or disorientation is A.4.a, which states, "Counsellors act to avoid harming their clients... and to minimise or to remedy unavoidable or unanticipated harm" (p. 4).

If the role is "supportive counselling," the goal should be to help Nagaenthran cope with his reality, rather than attempting to restore competency for execution. This, as discussed earlier, is a grave ethical conflict. Alleviating current distress and enhancing comfort in his final days should be the goals of the counselling relationship, aligning with SECTION A.1.a. (Primary Responsibility) to promote client welfare.

If her findings are court-mandated, the counsellor should disclose only the directly relevant and legally required information, ensuring minimal intrusion into privacy, adhering to Section B.2.e. The counsellor should also carefully document the ethical decision-making process, tracking attempts to protect Nagaenthran's privacy within legal constraints.

High cultural sensitivity should be demonstrated towards Nagaenthran's Malaysian background, Hindu religious practices, and his family's involvement. This is mandated by Section A.2.c, which requires communicating information "in ways that are both developmentally and culturally appropriate" (p. 4) and adjusting treatments and practices accordingly. It also aligns with Section B.1.Regarding multicultural confidentiality and privacy.

Advocacy for Nagaenthran's right to appropriate and humane care within the prison system must also be ensured by the counsellor under Section A.7.a, which asks the counsellor to "address potential barriers and obstacles that inhibit access and/or the growth and development of clients" (p. 5). The advocacy for his human rights, especially given his intellectual disability, also reflects the ACA's core professional value of promoting social justice.

References

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