Operational criteria for the determination of suicide

Suicide is an important public health problem for which we have an inadequate public health database. In the United States, decisions about whether deaths are listed as suicides on death certificates are usually made by a coroner or medical examiner. These certification decisions are frequently marked by a lack of consistency and clarity, and laws and procedures for guiding these decisions vary from state to state and even from county to county. Without explicit criteria to aid in this decision making, coroners or medical examiners may be more susceptible to pressures from families or communities not to certify specific deaths as suicide. In addition, coroners or medical examiners may certify similar deaths differently at different times. The degree to which suicides may be underreported or misclassified is unknown. This makes it impossible to estimate accurately the number of deaths by suicide, to identify risk factors, or to plan and evaluate preventive interventions. To remedy these problems, a working group representing coroners, medical examiners, statisticians, and public health agencies developed operational criteria to assist in the determination of suicide. These criteria are based on a definition of suicide as "death arising from an act inflicted upon oneself with the intent to kill oneself." The purpose of these criteria is to improve the validity and reliability of suicide statistics by: (1) promoting consistent and uniform classifications; (2) making the criteria for decision making in death certification explicit; (3) increasing the amount of information used in decision making; (4) aiding certifiers in exercising their professional judgment; and (5) establishing common standards of practice for the determination of suicide.     

The Constitutionalisation of Party Unity: The Origins of Anti-defection Laws in India and Israel

In spite of a pronounced increase in the number of states that have adopted anti-defection laws over the past several decades, the literature on party unity in democratic legislatures has paid scant attention to understanding the conditions that lead to the adoption of such restrictive measures on the mobility of elected deputies. This article seeks to fill this gap. The authors provide a simple game-theoretic model to explain the passage of anti-defection measures in India, in 1985, and Israel, in 1991. These two democratic states were among the first to experiment with the constitutionalisation of anti-defection measures. Moreover, their comparison is important because although these laws were adopted under seemingly very different circumstances, they were supported with a strong consensus by both the government party, or coalition, and the opposition. It is argued that the reasons for the passage of the anti-defection laws in these two states were rooted in the strategic consequences of the changes that took place in the format of their party systems. The Indian and the Israeli cases show, respectively, that a dominant party system (India) and a tightly balanced bipolar party system (Israel) provided equally compelling incentives for rampant party switching between government and opposition, which therefore created an incentive for both sides to agree to, and adopt, a strict legislative measure to curb defections.     

Homicide–Suicide in China: an Exploratory Study of Characteristics and Types

This study explores 63 homicide–suicide cases that include two or more homicide victims, in the People’s Republic of China. This is the first study to examine homicide–suicide in the Chinese context, following calls to develop a research strategy outside of the USA and Europe. Data are derived from a content analysis of Chinese news sources from 2000 to 2014. Findings show homicide–suicide offenders are likely to be married males living in rural cities who kill their intimate partners and/or children inside a residence using knives. Intimate partner conflict and extramarital affairs are precipitating factors in almost half of the incidents. Patterns of homicide–suicide in China are comparable to those in high-income countries, except that firearms are not the primary means in China and there is no evidence of “mercy killing” among older persons, as described in western homicide–suicide studies. Findings are related to the social and economic structure of Chinese society. Clinical and policy implications include the need for greater transparency and a nationwide homicide and suicide tracking system in China, stricter domestic violence laws, postmortem studies of the brains of homicide–suicide offenders, and psychological autopsies on homicide–suicide perpetrators.     

The body and the body politic: assisted suicide under the Canadian Charter of Rights and Freedoms

The author critically examines the majority judgment of the Supreme Court of Canada in Rodriguez v. Canada (A.G.) and concludes that the judges in the majority have adopted a legislative public policy mandate rather than carrying out a judicial function that accords with established canons of Charter interpretation and analysis. The author contends that the majority read section 7 of the Charter as enshrining the sanctity of life as an intrinsic, abstract societal value necessary to protect the ill and the vulnerable and not as an expression of the individual's entitlement to autonomy against the State. She also contends that the majority's section 1 analysis was unduly deferential not only to the Canadian Parliament but also to the legislatures of the majority of Western democracies. This came at the expense of considering the legislative pattern of abandoning laws against suicide, the common law respect for individual autonomy and quality of life regarding refusal of and withdrawal from medical treatment, and the widespread lax enforcement of laws critical of the majority's reliance on "slippery slope" reasoning, which subordinated Ms Rodriguez's Charter rights to apprehend wrongdoing by the medical profession and the presumed best interests of society as a whole. The author recommends that legislators who address the question of assisted suicide look to methods of regulating access to assisted suicide that reflect respect for individual dignity under the Charter at the end of life, and reject any reading of the majority judgment that suggests that legislators are free to regulate or to proscribe assisted suicide according to abstract notions of the sanctity of life, pragmatic views of the public good, or the false consciousness or perceived vulnerability of the terminally ill or disabled.     

In the laboratory of the states: the progress of Glucksberg's invitation to states to address end-of-life choice

It has now been ten years since the Supreme Court handed down Glucksberg and Quill, rulings on laws that forbid "assisted suicide." In that time, normative and legal developments in the fields of law, medicine, and psychology have changed the landscape of the discourse on the choice of a mentally competent, terminally ill individual to choose to self-administer medications to bring about a peaceful death. Although the Court rejected petitioners' claims that state laws denying them the ability to end their terminal illnesses through self-administered medication violated the Constitution, it left states with the opportunity to experiment with legislation that would allow terminally ill individuals the choices they had previously sought through litigation. Oregon's experience with its Death with Dignity Act, which grants terminally ill, mentally competent individuals the choice to end their lives through self-administered medication, has proven that such laws provide comfort not only to those who, faced with the prospect of a horrible death from a terminal illness, choose to end their lives in a peaceful and dignified manner, but also to those to ultimately choose not to. Additionally, Oregon's experience shows that the fears that originally attended the "assisted suicide" debate are unfounded so long as proper procedures are in place. Because Oregon's Death with Dignity Act has proven both useful and harmless, this Article concludes that it is time for other states to follow Oregon's lead and enact their own legislation to allow their citizens an alternative to what otherwise could be a prolonged and painful death from terminal illness.     

Deprivation, importation, and prison suicide: Combined effects of institutional conditions and inmate composition

Previous research on suicide in United States prisons focused on the characteristics of inmates who commit suicide while largely ignoring the prison context surrounding these suicides. The following analyses used national data on 1,082 state prisons in the United States to examine how prison conditions (deprivation) and inmate composition (importation) predict prison suicide. Results of a negative binomial regression model showed that the number of suicides was significantly increased in supermaximum and maximum security prisons (relative to minimum), under conditions of overcrowding and violence, and in prisons where a greater proportion of inmates received mental health services. Although deprivation variables were overwhelmingly predictive of suicide, the results pointed to the combined effects of institutional conditions and inmate composition on prison suicide.     

法治·德治·公安

道德与人类俱来。道德与法律从来密切。法律的独立与疏远道德。"道德赤字"时代,新世纪呼唤道德。亟需道德价值观补课,达到五项共识。德与法均衡发展,使法律的权威建立在人民自觉的基础上。中国走向法治与德治相结合,德治工程时不我待。公安法制应与公安道德相结合,公安工作具有道德性,道德预防是公安预防的主要防线,公安道德是公安软实力。公安立法、执法、守法都要坚持伦理原则,应以德建警。     

Trouble in Mayberry: A national analysis of suicides and attempts in small jails

Despite the fact that there are approximately 1,775 American jails of 99 beds or less, little is known about how these jails function, or the challenges that they confront. This study examined the problem of suicides and attempted suicides in small jails, finding that the prevalence of these incidents is two to five times greater than in their larger counterparts. Net of other factors, jails that had higher rates of admissions, as well as overcrowded facilities had a positive relationship with suicide attempts. We also found that jails that reported higher concentrations of special needs inmates were significantly associated with attempts. Specifically, facilities that had higher levels of long-term inmates were positively associated with suicide attempts. While almost one-fifth of small jails did not use formal suicide assessments at admission, and only slightly more than one-half of these facilities provided annual suicide training to jail officers, these factors were not significantly associated with suicide attempts in 2004. Implications for future research and practice are outlined.     

Childhood Abuse,Intrapersonal Strength,and Suicide Resilience in African American Females who Attempted Suicide

There is a significant association between childhood abuse and suicidal behavior in low-income African American women with a recent suicide attempt. Increasingly, empirical focus is shifting toward including suicide resilience, which mitigates against suicidal behavior. This cross-sectional study examines childhood abuse, intrapersonal strengths, and suicide resilience in 121 African American women, average age of 36.07 years (SD?=?11.03) with recent exposure to intimate partner violence and a suicide attempt. To address the hypothesis that childhood abuse will be negatively related to suicide resilience and that this effect will be mediated by intrapersonal strengths that serve as protective factors, structural equation modeling examined the relations among three latent variables: childhood abuse (measured via physical, sexual, and emotional abuse), intrapersonal strengths (assessed by self-efficacy and spiritual well-being), and suicide resilience (operationalized via the three components of suicide resilience—internal protective, external protective, and emotional stability). The initial measurement model and the structural model both indicated excellent fit. Results indicated that childhood abuse was negatively associated with intrapersonal strengths and suicide resilience, intrapersonal strengths were positively associated with suicide resilience, and intrapersonal strengths fully mediated the association between childhood abuse and suicide resilience. Thus, the results suggest a positive and protective influence of intrapersonal strengths on suicide resilience in the face of childhood abuse in suicidal African American women. The clinical implications and directions for future research that emerge from these findings are discussed.     

Sexually violent predators and civil commitment: is selection evidence based?

Sexual offenses represent an alarming proportion of crimes committed yearly. To address these concerns, several states, including South Carolina (SC), have enacted laws requiring sexually violent predators (SVPs) to be civilly committed to treatment. To date, no published study has examined sexual offenders recommended for treatment in SC. This study used a specially designed statewide database (SC-SVP research database) to determine which offender and offense characteristics were associated with increased likelihood of being recommended for civil commitment. Factors correlated with being more likely to be recommended included: being of a younger age at time of evaluation, prior sex convictions, having related and unrelated victims, a higher number of victims, frequent substance use, and a history of suicide attempts. Prior sex convictions, having both related and non-related victims, and a higher total number of victims align with characteristics associated with sexual recidivism. Frequent substance abuse and a history of suicide attempts do not mirror previous findings regarding sexual recidivism. These findings present new information regarding the civil commitment process of offenders being committed to the SC-SVP treatment program, characterize types of offenders committed to SC-SVP treatment program, and provide a foundation for using a computerized database in conducting sex offender research.     

Mental health performance measurement in corrections

Correctional facilities have become, by default, one of the largest providers of mental health care for patients with serious mental illness. In its 2002 Report to Congress, the National Commission on Correctional Health Care has reported that most facilities do not provide quality mental health care, nor do they conform to nationally accepted guidelines for mental health screening and treatment. This article describes the product of a consensus panel of correctional health care experts, charged to develop performance measures, based on nationally accepted standards, for selected elements of psychiatric treatment behind bars, aimed to improve the quality of care. Performance measures were developed for medication adherence, suicide prevention, mental health treatment planning, and sleep medication usage.     

The way assisted suicide is legalised: balancing a medical framework against a demedicalised model

To date, in three European countries and three American states--i.e., The Netherlands, Luxemburg, Switzerland, and the states of Oregon, Washington and Montana--it is permitted by law for one person to assist in the suicide of another person. When comparing the legislations of these countries/states, it becomes apparent that The Netherlands, Luxemburg, Oregon, Washington and Montana have chosen a medical approach (the so-called medical model), whereas the Swiss legal framework for assisted suicide is clearly a non-medical one (the demedicalised model). The differences between these two models mainly concern two aspects: the requirement as to the capacity of the person providing assistance in suicide and the condition regarding the state of health of the person committing suicide. A closer view on the practice of assisted suicide in the depenalising countries shows that the differences are smaller than initially thought. Nevertheless, important distinctions still remain. When analysing which model is most preferable, it is concluded that an involvement of a physician is inevitable and necessary and that the requirement of a certain medical condition is needed to set a clear and objective limit.     

It's War, Jim, But Not As We Know It: A ``Reality-Check' for International Laws of War?

International Humanitarian Laws of Armed Conflict effectively prohibit the use of terror-violence as a means or method of warfare in all circumstances of armed conflict. However, as new ``terrorist' enemies do not appear to share this humanitarian consensus, it becomes crucial to contextualise accurately any characterisation of the recent ``war' on ``global terror' as a ``war' to which International Humanitarian Law can attach. What needs to be remembered, first, is that technological innovation can destabilise accepted frameworks for waging war. Thus, any laws intended to curtail the use of particular means and methods of warfare will reflect the contemporaneous environment within which such laws were formulated. Secondly, modern laws of war evolved from nineteenth century reciprocal pacts designed to ensure minimal levels of restraint between ``civilised' peoples. While any strict contractual approach to mutuality-in-restraint has been superceded in the post-1945 era by more universalised obligations, the interests reflected in this original mutuality of interest warrant examination when distinguishing today between ``justifiable' and ``unjustifiable', or ``licit' and ``illicit', uses of violence.     

Will Listing Rule Reform Deliver Strong Public Markets for the UK?

There is a general consensus that the UK needs strong public equity markets. To help to ensure Britain is well-positioned on this front, the Financial Conduct Authority reformed the London Stock Exchange's listing regime in 2021 to foster initial public offerings (IPOs). This article outlines and evaluates these IPO-related reforms, assessing their potential to resuscitate the UK's public equity markets. The article puts the IPO-related reforms into context by considering whether the fostering of strong equity markets is a sensible policy goal and by assessing what laws governing publicly traded companies can contribute to this endeavour. The article acknowledges that the specific IPO reforms may increase IPO activity but concludes that concerns about strong public markets will continue to exist. This is because the reforms do not address stock market exits or the ‘over’-regulation of public companies which discourages reliance on equity markets.     

Preliminary test with chlorindazone DS for zinc in Sintox residue

So-called exit bags are voluminous, transparent plastic bags, each with a collar to go round the neck, and a Velcro fastening. In conjunction with the consumption of sleeping pills, the bags are recommended as an aid to commit suicide by organizations in favour of "humane death". It is reported on four such suicides by elderly people between 79 and 87 years of age. In two of these cases, there was assistance in committing suicide, one corresponding to a suicide protocol from the Swiss organization for euthanasia, EXIT. In two cases, detailed instructions for committing suicide were found. The morphological findings were not very specific in any of the cases. If the plastic bags are removed by a third party, this type of suicide may remain undetected even after performance of an autopsy. Exit bags tend to be used by older people with either real or feared life-threatening illnesses, in suicides which have usually been planned for some time. From the criminological point of view, the possible active participation of other persons in pulling the covering over the head can often not be proved. Assisting a suicide, in the sense of giving instructions on how to accomplish it, is not punishable in German law.     

Changing patterns of male suicide in Scotland.

Mortality statistics published annually by the Registrar General Scotland for 1970-1989 are analysed. There has been a recent increase in the suicide rate amongst younger males in Scotland which cannot be explained by changes in the misattribution between suicides (ICD E950-E959) and undetermined deaths (ICD E980-E989). The increase is almost entirely attributable to hanging and the use of motor vehicle exhaust fumes. Analysis of the sex/age/method-specific suicide rates demonstrates that age-specific increases in the male suicide rate are linked to age-specific increases in the use of these two methods. The increased suicide rate involving motor vehicle exhaust fumes can be explained by changes in method availability and acceptability. The increased suicide rate involving hanging may be explained by increased acceptability, possibly flowing from the abolition of judicial hanging in 1965. The increased suicide rate in younger males may reflect a change in the proportion of suicidal attempts resulting in a completed suicide consequent on an age-specific shift to the use of more lethal methods, namely hanging and motor vehicle exhaust fumes. This possibility needs to be evaluated before assessing the influence of other social factors on the suicide rate.     

Elderly suicide: a 10-year retrospective study

The suicide rate in the 65-year and older age group has been increasing since 1980. The elderly attempt suicide less often than younger people but are successful more often. The authors retrospectively reviewed all cases referred to the Forensic Pathology Section of the Medical Examiners' Office at the Medical University of South Carolina (Charleston, SC) from January 1988 through December 1997. The cases of suicide in victims 65 years and older totaled 78, accounting for 11.5% of all suicides reviewed. Of these 78 cases, 41% were autopsied and 59% were externally examined. All of the cases were initially analyzed as to age, race, sex, and method of suicide. Files also were reviewed to determine time of year of the suicide, toxicology results, psychiatric history, social history, medical history, and whether a suicide note was left. The ages of these suicide victims ranged from 65 to 94 years; men comprised 85% of the victims, and whites, 94%. The male-to-female and white-to-black ratios were 6:1 and 15: 1, respectively. The average age of the victim was 73 years. Gunshot wound was the most common method of suicide, accounting for 80.7% of the cases. Other methods included overdose (6.4%), hanging (3.8%), fall from height (2.6%), incised wounds (2.6%), drowning (2.6%), and carbon monoxide poisoning (1.3%).     

Filicide-suicide in Chicago, 1870-1930

Filicide (the killing of a child by a parent) followed by the offender's suicide is a tragic but, fortunately, rare event. The contexts and circumstances surrounding filicide-suicide may provide insight into parental psychology. The authors test several hypotheses about filicide-suicide using a database including incident-level information on 11,018 Chicago homicides during 1870-1930. The results provide some support for the hypothesis of differential risk of suicide following filicide by genetic parents and stepparents and replicate previous research indicating that filicides with multiple victims are more likely to end in the offender's suicide than are filicides with a single victim; parents are more likely to commit suicide following the filicide of an older child than of a younger child; and older parents, relative to younger parents, are more likely to commit suicide following filicide. The discussion situates these results within the existing literature and highlights important directions for future research.     

Are the similarities between a woman's right to choose an abortion and the alleged right to assisted suicide really compelling?

In this Article, Marc Spindelman examines the relationship between abortion and assisted suicide. He begins his discussion with the constitutional framework within which courts should consider the assertion that the Due Process Clause of the Fourteenth Amendment protects the individual's decision to commit assisted suicide. The Author then considers and, based on relevant Supreme Court doctrine, rejects the conception of personal autonomy that undergirds the claimed constitutional right to assisted suicide. Finally, the Author points out some legal and cultural distinctions between abortion and assisted suicide, arguing that these distinctions offer courts good reasons for holding that the Fourteenth Amendment's promise of liberty does not include the liberty to commit assisted suicide. In addition, the Author makes a few observations about recent assisted-suicide cases decided by the Ninth and Second Circuits.