Death certification of "suicide by cop"

Death certification of "suicide by cop" is controversial among some medical examiners and coroners. We present five such deaths that were certified as suicides and discuss the medico-legal issues involved with these certifications. To certify such a death as a suicide, certain criteria should be met. Suicide by cop is a circumstance that involves competing intentional acts that may result in dichotomous determinations of the manner of death. Despite the absence of direct self-infliction, there is overwhelming evidence that these five individuals intended to end their own lives. Their use of an unusual method to accomplish this goal may inappropriately result in a reflexive certification of homicide. All of the decedents possessed weapons or a facsimile of a weapon. We present five instances of suicide by cop and contend that these types of deaths are best certified as suicides.     

Police officers who commit suicide by cop: a clinical study with analysis

Suicide by cop has become a familiar topic among members of law enforcement, mental health professionals, and the general public. This paper presents two cases where police officers chose to commit suicide by getting other police officers to kill them. The two police officers studied, by examination of closed case files, were found to be similar to civilians who committed suicide by cop on several demographic (gender, age, history of mental illness, and suicide attempts), and situational (stress factors, trigger) variables. The cases help us to understand possible motives and management for individuals who choose to end their life in this manner.     

Attempted suicide by cop: a case study of traumatic brain injury and the insanity defense

Over the years, there have been a number of well-publicized incidents involving persons who seemingly maneuver police officers into shooting them. Such cases, while relatively rare compared with most forms of violence, nevertheless pose difficult challenges to law enforcement agencies. Relatively little is known about persons who engage in suicide by cop incidents. To our knowledge, there has been no published indepth research on instigators of suicide by cop who survived. In this paper, we present a case study of an individual who engaged in and lived through three separate "attempted suicide by cop" incidents. After describing relevant history as well as events of the most recent incident, we compare the case with the extant literature on suicide by cop and analyze commonalities and differences. Finally, we examine the legal considerations involved, with particular attention devoted to the role the individual's traumatic brain injury played in applying the insanity defense.     

Exit association-mediated suicide: toxicologic and forensic aspects

The Swiss German chapter of the Exit Association provides conditional assistance to individuals wishing to end their own lives. The Exit Association advocates death with dignity and fights for the right to freely choose the timing of one's own death. According to the Swiss criminal code (articles 114 and 115), altruistic assistance to suicide is not punishable. Active euthanasia is punished by imprisonment. An individual commits active euthanasia if he or she is driven by honorable motives (e.g., pity) and causes the death of another person wishing to die who seriously and insistently requests such action. Based on our information, the preparation for suicide and its completion relies on a well-defined protocol. First, the candidate's eligibility for Exit Association assistance is verified. The candidate then writes a farewell declaration that explicitly confirms the will to terminate his or her own life. A written report describes the events during the suicide procedure. Depending on the circumstances, the investigative judge requests a forensic autopsy and toxicologic analyses. The results of the forensic investigations conducted in the cases presented here are in agreement with the scenario described in the reports of the Exit Association, namely, suicide by massive ingestion of pentobarbital.     

The study and forensic significance of drill bit use indicators

Abstract:  A case study involving an improvised pipe bomb with a drilled fuse hole is presented. This case study and its accompanying research details drill bit use and/or nonuse indicators. These indicators are then further classified to develop relevant conclusion criteria. These criteria are: (1) trace deposits in the form of particulate and/or smears on the drill bit, especially inside the flute and the tip area, (2) physical damage including chipping, abrasion, and fissuring on the drill bit which mostly occurred on the flute edge bevels and lip edges, and (3) thermal damage. One or any combination of these indicators could be used as effective criteria for concluding drill bit usage. This study also determined that a drill bit produces well-defined toolmarks on swarf shavings that could be identified back to that particular tool, and there is no mechanical break-in period for obtaining reproducible toolmarks on newly manufactured or unused bits.     

Clinical forensic medicine

This article discusses the merits of participation by medical examiners in the area of clinical forensic medicine. The present connotation that we deal after the fact should be abandoned with enhanced involvement in assisting the living. The paper focuses on a broad range of categories where forensic scientists by virtue of their training and experience could be most helpful in the application of medical knowledge to the solution of questions of law.     

Clinical presentation of malingerers diagnosed by experienced forensic psychologists

Little is known about the incidence of malingering or the diagnostic criteria for malingering employed by forensic clinical psychologists conducting pretrial evaluations for the criminal justice system. The clinical presentations of 39 criminal defendants diagnosed as malingering psychotic symptoms were contrasted with 25 defendants diagnosed as genuinely psychotic. The incidence of diagnosed malingering was 8% in a series of 314 consecutive evaluations. Malingerers differed from psychotics on 14 of 24 clinical presentation variables, including measures of general presentation, affect, hallucinations, delusions, and formal thought disorder. Results indicate consistent clinical features associated with the diagnosis of malingered psychosis.A summary of this study was presented at the 1988 Annual Convention of the American Psychological Association in Atlanta, Georgia. We very much appreciate the contribution made by the six forensic clinical psychologists at the Michigan Center for Forensic Psychiatry who volunteered to participate in this study.     

Clinical effects and lethal and forensic aspects of propofol

Propofol is a potent intravenous anesthetic agent that rapidly induces sedation and unconsciousness. The potential for propofol dependency, recreational use, and abuse has only recently been recognized, and several cases of accidental overdose and suicide have emerged. In addition, the first documented case of murder using propofol was reported a few months ago, and a high profile case of suspected homicide with propofol is currently under investigation. A number of analytical methods have been employed to detect and quantify propofol concentrations in biological specimens. The reported propofol-related deaths and postmortem blood and tissue levels are reviewed. Importantly, limitations of propofol detection are discussed, and future considerations are presented. Because propofol has the potential for diversion with lethal consequences, the forensic scientist must have a basic understanding of its clinical indications and uses, pharmacologic properties, and detection methods. In addition, medical institutions should develop systems to prevent and detect diversion of this potential drug of abuse.     

Analysis of the suicide cases (by hanging) according to the data of forensic medical expertise in Iakutsk

The paper contains a detailed analysis of suicides through hanging for a period of 5 years (1996-2000) based on the data of the Yakutsk. Forensic Medical Bureau. The above data point at the most important concurrent factors, which can be helpful in the prevention of suicides.     

Psychopathic traits and change on indicators of dynamic risk factors during inpatient forensic psychiatric treatment

The main objective of the present study was to investigate the impact of treatment on forensic psychiatric inpatients, examining changes on 22 indicators of five dynamic risk factors for violence (i.e., egocentrism, hostility, impulsivity, lack of insight, and negative distrustful attitudes), and to relate these potential changes to level of psychopathy assessed with the Hare Psychopathy Checklist - Revised (PCL-R). Also, we studied the relationship between psychopathy and treatment compliance, as indicated by the attendance rate of therapeutic activities. Eighty-seven male patients (due to missing data on at least one measure, sample size varies from 58 to 87; 42 patients have complete datasets) were administered a standardized psychological assessment battery (self-report inventories, performance-based personality test, observer ratings) upon admission (T1) and after on average 20 months of treatment (T2). Upon admission, psychopathy (median split, PCL-R score≥22) was significantly related to a higher score on five of the 22 indicators of dynamic risk. The analyses showed no significant differences between psychopathic and non-psychopathic patients on the indicators of dynamic risk factors during 20 months of inpatient forensic psychiatric treatment. However, psychopaths showed the expected pattern of treatment noncompliance, compared to non-psychopaths. The clinical and research implications of these findings are discussed.     

Fictitious ambush following an attempted "extended" suicide

An unusual case of a 31-year-old-woman who was found near a forest road with self-inflicted injuries and burns is reported. The woman claimed to have been attacked by a man with a knife who then tried to burn her in her car. While she managed to escape, her cat died in the car. The examination of the wounds showed multiple superficial cuts in body regions easily accessible to her own hand. Gas chromatography of skin samples from the cat proved that it had been in in contact with a fire accelerant. On the basis of the examination findings, differential diagnostic aspects with regard to the motivation of the woman for simulating an offence are discussed. In all probability, the woman intended to commit suicide together with the cat through self-immolation, but did not complete the plan.     

Suicide by cop among female subjects in officer-involved shooting cases

An analysis of suicide by cop (SBC) among female subjects in a large sample (n = 707) of officer-involved shootings (OIS) is reported. Women represented 3% of the total sample (n = 21) and 5% (n = 12) of the 256 SBC cases. Therefore, 57% of the women (n = 12) were classified as SBC, and 81% of the women (n = 17) behaviorally evidenced some suicidal motivation. The results underscore that when a female subject becomes involved in a situation leading to an OIS, there is a very high likelihood that she is motivated to be intentionally killed. She is almost guaranteed to have a diagnosed mental disorder, has been prescribed psychiatric medications, and is abusing a substance at the time, most likely alcohol. Nevertheless, she also poses a serious risk of injury to both police officers and civilians during the encounter and will possess a firearm half the time. The wish for suicide is often precipitated by serious relationship issues. Comparisons are made to the male subjects in our previous study.     

Homicide and suicide by aircraft

A report of simultaneous homicide and suicide by aircraft is presented. This confirms the view of Phillips (Science, 201 (1978) 748–750), that despite the previous absence of similar reports in the history of civil aviation, such incidents may occur, and that therefore murder and suicide should be considered as a possible cause of aircraft accidents.     

"Legal highs"-Toxicity in the clinical and medico-legal aspect as exemplified by suicide with bk-MBDB administration

The easily available "legal highs", which are products containing psychoactive substances, such as cathinones, piperazines and synthetic cannabinoids, are abused by adolescents in Poland and in the world as alternatives to classic drugs, such as amphetamines or marijuana. The majority of these potentially dangerous substances are still legal and they are associated with a risk of severe poisoning or even death, and provide new challenges in clinical and forensic toxicological practice. Investigations in the field of "designer drugs" may be well illustrated by the case of a suicide of a 21-year old male who ingested a specified dose of a preparation called "Amphi-bi-a" that contains bk-MBDB, chemically 2-methylamino-1-(3,4-methylenedioxyphenyl) butan-1-one, which belongs to the cathinone group, as a synthetic euphoric empathogen and psychoactive stimulant that is chemically similar to MDMA. It is one of more common components of "legal highs" examined in Poland and other countries. The documentation of the case includes a clinical assessment of the patient's health status performed during his almost 4-h hospitalization before death, autopsy and histological examinations supported by toxicological findings revealing bk-MBDB at extremely high concentrations (at 20mg/l in the blood and 33mg/kg in the liver); hence, this body of evidence contributes to knowledge in the field of "designer drugs". Inventions of designers of new psychoactive xenobiotics, which are much in demand, especially in view of the dynamic Internet marketing, which drums up narcobusiness, must be balanced by a national strategy developed by medical, legal and educational circles in the modern civilized world in order to prevent the spreading of the phenomenon.     

The significance of the legal term "corpse" in forensic medicine

The definition of the term "corpse" is relevant for medicine in general and most particularly so for forensic medicine, as it has direct consequences on practical work: legally, postmortems and autopsies may only be performed on corpses. With this in mind, the legal term "corpse" was examined on the basis of German State Law regulations and provisions. Approximately half the burial acts include a definition of "corpse", but even here there are certain variations. The definitions for "corpse" can be divided into four categories: 1) according to the lack of vital signs or sure signs of death 2) according to the degree of decomposition and/or cohesion of body parts 3) on the basis of severed body parts, and 4) terminological differentiation of stillbirths and neonatal fatalities from miscarriages. Laws vary greatly in their definition of the term "corpse". Therefore, the decision whether or not human remains or parts thereof qualify as a "corpse" should be left to medical discretion.     

"Magical thinking," suicide, and malpractice litigation

Prospective clinical assessment of suicidality differs significantly from that used retrospectively in malpractice litigation. In the latter context, the judge or jury may be susceptible to hindsight reasoning and a disproportionate emphasis on the specific method of suicide, exaggerating its foreseeability and "magically" linking the means of death to the treating clinician, especially in the case of suicide by an overdose of prescribed medication. Such magical thinking, moreover, is rooted in the clinical context of suicide: The errors of reasoning observed in the courtroom exhibit striking parallels with the mind-set of the suicidal patient. An understanding of these dynamics suggests appropriate precautions for the clinician and thus contributes to the prevention both of suicide and of malpractice litigation.