In January 2014, Muhammad Asghar, a 70-year-old British man from Edinburgh, was convicted of blasphemy and sentenced to death by a court in Rawalpindi. Mr Asghar had initially been arrested in 2010 after sending letters in which he declared himself a prophet. His UK medical records report that he was first referred to psychiatric services and treated for depression in 1993. In 2000, he suffered a stroke, which resulted in left-sided weakness of limbs and facial palsy. He suffered from epilepsy, depression, hallucinations and persecutory and grandiose delusions. On February 17, 2010, before travelling to Pakistan, Mr Asghar was sectioned in Scotland under the Mental Health (Care and Treatment) (Scotland) Act 2003, and taken to Royal Victoria Hospital in Edinburgh. Shortly afterwards, he was diagnosed with late onset paranoid schizophrenia. Given the nature of his illness, it is very likely, on the balance of probabilities, that he is still and was exhibiting the symptoms and signs of his illness at the time of the alleged offence, even if he continued to be fully medicated. A government prosecutor in this case is on record as saying that convicted Mr Asghar claimed and confessed to be a prophet inside the court and even in front of the judge. Mr Asghar’ s lawyers had argued during the trial that he should be granted leniency on account of a history of mental illness but a medical panel appointed by the state later rejected this argument after reviewing his case. In this case, the nature and degree of the mental disorder, namely paranoid schizophrenia, is such that the person’s reason was alienated. It is difficult to translate the terminology of legal judgments into clinical corollaries but the mental disorder had been such that it played an overwhelming role in determining the occurrence of the offence. In this case, the person is suffering from a psychotic illness and there is a direct link between positive psychotic symptoms (delusions and hallucinations) and the act committed. If evidence had been presented in this trial, it would provide information contributing to the area of forensic psychiatric assessment and would address the aspects of mental disorder and circumstances leading up to the event. An appeal challenges both his conviction and his sentence. The grounds for appeal include the court’s failure to consider any evidence of his mental health problems. This case is highly sensitive because of the strong reaction by the religious right to blasphemy cases. It is not my intention to oppose the blasphemy law — I believe that Allah is one and incomparable, and that Prophet Mohammad (PBUH) is the last prophet of Allah. However, my professional oath demands and ethically binds me to help in saving the life of a patient and that the case gets thoroughly investigated so that an innocent person does not become the victim of a misplaced judicial process. The findings of the mental evaluation will become evidence in Mohammad Asghar’s trial and whether he was legally insane at the time of writing letters in which he had claimed to be a prophet. The High Court is expected to re-examine the medical evidence and decide if the verdict is not guilty by reason of insanity. Mr Arshad suffers from paranoid schizophrenia and his medical history and psychiatric report from his consultant psychiatrist, Dr McLennan, confirms the diagnosis in this case. If defence applied the ‘McNaughton rule’ and proved that Mr Arshad, at the time of committing the act, was labouring under such a defect of reason — from disease of the mind — as not to know the nature and quality of the act he was committing or, if he did know it, that he did not know what he was doing was wrong, then rules state that a person cannot be held responsible for a crime, creating grounds for insanity. Considering that Mr Asghar is still suffering from mental disorder and is presenting with acute psychotic symptoms, i.e. paranoid delusions of prophethood at the time of examination, he could be committed to the psychiatric hospital and detained under the Mental Health Act. If Mr Arshad is found to be insane, he can be released to go back to Scotland. His consultant psychiatrist, Dr Jane Mclennan, has confirmed that in the affidavit dated June 10, 2011, which was submitted to the court during the trial, that she would be happy to have him admitted in her care in the Royal Victoria Hospital. He could theoretically be released one day if doctors determine his sanity has been restored. However, if the verdict is guilty, Mr Arshad may be sentenced to death or spend the rest of his life in prison without the possibility of parole. The stance finally taken by the American Law Institute on the insanity defence in 1965, which states that a person is not responsible for criminal conduct if it is the result of mental defect or illness, is essentially the same as Islamic law. Islamic law states that a crime is not a crime unless there is the intention of doing it. Thus, an insane person is considered to be lacking intention because of a disturbed thought process, and so is not liable for the crime committed. Prophet Mohammad (PBUH) said, “Allah’s commands exclude those who are asleep till he wakes up, and the young until reaching puberty, and the insane till they become mentally competent.” The law has important implications for the lives of all citizens, including those who are mentally ill. The laws governing the treatment of mentally ill people give a clear indication of a country’s attitude towards such people. The relationship between a society’s attitude and the law is a dynamic one, and a two-way affair. On February 20, 2001, the Pakistan Mental Health Ordinance came into effect and the Lunacy Act of 1912 consequently stood repealed. The 2001 ordinance promised to bring about significant changes in the law relating to mentally disordered persons with respect to their care and treatment, management of their property and other related matters but it did not include any clause relating to insanity and diminished responsibility. The Mental Health Ordinance 2001 does not answer the crucial question of the extent of the criminal and civil liability of people who are mentally ill, which means that the law on this matter has to be sourced from other sources of criminal and civil law. The new ordinance, therefore, has had no mileage on one of the most crucial questions of law related to individuals who are mentally disordered and how it will be determined whether someone is or is not mentally disordered. Nonetheless, in today’s insanity cases, mental health experts, doctors and lawyers have important roles to play. Furthermore, the argument for eliminating the insanity defence but not the impact of mental illness in criminal trials is based on culpability and retributivism, because the law wants to ensure that people are convicted of a crime if and only if they are truly responsible for it. Rather than consideration of the death sentence in this case, the High Court should examine the whole spectre of the insanity defence and consider that its purported unfairness no longer loom over the criminal justice system and obscure its true purpose. Therefore, in making these adjustments, courts and the great scholars of Islamic law are not seeking to subvert the law, but rather to work, through the most meticulous attention to its letter, in harmony with its spirit and purpose. The writer is a member of the Diplomate American Board of Medical Psychotherapists Dip.Soc Studies, member Int’l Association of Forensic Criminologists, associate professor Psychiatry and consultant Forensic Psychiatrist at the Huntercombe Group United Kingdom. He can be reached at fawad_shifa@yahoo.com