Fatal chest injury from a shotgun slug: homicide, accident or suicide?

A 78-year-old hunter was found dead beside his raised hide with a gunshot wound to his chest. In the present case, the reconstruction of the shooting event revealed an accident. Disregarding all safety rules, the hunter had placed his superposed rifle-shotgun on the chair and pulled the barrels of the cocked gun towards his body. One of the triggers interlocked with the button of a camping chair's cushion and a shot was fired. Furthermore the morphology of wounds from shotgun slugs is discussed on the basis of the autopsy findngs.     

Domestic accident or child abuse?

While playing, a 33/4-year-old girl was hiding in a tumble dryer, which had been running before and started the drying process with rotation of the drum again after the girl had climbed into the machine and shut the door. The child suffered multiple haematomas, especially on the back and the lower arms, as well as second-degree burns on body regions not covered by the clothing. The injury pattern was consistent with the properties of the appliance, and the initial suspicion that the child had been physically abused could not be maintained.     

An unusual death by transcranial stab wound: homicide or suicide?

Penetrating stab wounds of the brain are uncommonly seen in modern times and occur almost exclusively in homicides. We report an unusual death by self-stabbing. A 24-year-old man was found dead at home, the handle of a kitchen knife protruding from his forehead. Data such as the psychiatric history of the victim, the multiplicity and site of wounds, the implement used, the presence of hesitation, and defense wounds were studied to elucidate the manner of death, and the suicidal nature of the event was established after police investigation. Atypical injuries require a careful forensic investigation, and medico-legal aspects of the differentiation between homicide and suicide are discussed in this particular case. A review of the literature revealed few cases of suicidal transcranial stab wounds.     

Accidental autoerotic death by volatile substance abuse or nonsexually motivated accidents?

In contrast to typical autoerotic fatalities, when death is due to asphyxia mostly by mechanical compression of the neck, atypical autoerotic accidental deaths (AADs) involve sexual self-stimulation by other means such as electrocution or inhalation of chemical agents. Especially in lethal cases of volatile substance abuse (VSA), a differentiation between suicide or sexually or nonsexually motivated accident is often complicated in practical casework. Considering the small number of AADs involving chemical substance abuse reported in the literature, the number of unreported cases seems to be very high. We report about 5 lethal cases of VSA; analysis was performed using headspace solid-phase microextraction (HS-SPME) and gas chromatography-mass spectrometry (GC/MS). When headspace sampling is not performed at autopsy, the analysis of volatile substances can be very complicated. In 2 cases, an AAD was diagnosed considering findings at the scene, reconstruction of the event, and discussion of the circumstances of the death. These findings demonstrate the importance of VSA in atypical autoerotic asphyxia. Therefore, in cases of suspected lethal inhalational intoxications, as a matter of principle, headspace asservation should be performed at autopsy and an autoerotic motivational background should be taken into consideration for differential diagnosis.     

Oregon: does physician-assisted suicide work?

Since November 1997, Oregon, a State in the United States of approximately 3.3 million people, has allowed physician-assisted suicide, although not euthanasia, by virtue of the Death with Dignity Act. Before the Act, physician-assisted suicide, as in Australia and other common law jurisdictions, was illegal. Under the Act, the Oregon Department of Human Services is required to collect information and provide an annual report. The Sixth Annual Report on Oregon's Death with Dignity Act was released on 10 March 2004.     

Bumping into a knife--exculpatory statement or (tragic) accident?

Assessing stab wounds is a common task in forensic medicine. Quite often an accused claims that the victim bumped into the knife. Taking into account all the facts ascertained in the investigations conducted, such a statement can be rapidly disproved in most cases. The present case of a 14-year-old boy fatally wounded by his mother with a kitchen knife examines the aspect of walking into a knife. It is an example that this statement cannot always be regarded as implausible and that every single case has to be reconstructed in detail on the basis of all the investigation results.     

Death caused by a chain saw--homicide, suicide or accident? A case report with a literature review (with 11 illustrations)

A 31-year-old farm worker was found dead beside a chain saw. Based on the testimony of a colleague and because of the situation at the site, the police very soon presupposed an accident. It was assumed that the victim had slipped on the sudden ground and had been killed by the subsequent swerving of the saw when starting the engine. The body presented with a deep lacerated wound at the right side of the nape of the neck, including the first cervical vertebra, the medullary canal and the right mandible as well as multiple fissures of the occipital bone, which were attributed to repeated forceful use of the chain by another person. A second wound with relatively sharp edges and a tangential fissure in the corresponding area of the skull raised the suspicion that an axe or some similar device had been used. Although the forensic medical findings seemed to give clear evidence of external violence, no further investigations have been carried out so far by the authorities.     

Overlooking the criminally compassionate: what are the implications of prosecutorial policy on encouraging or assisting suicide?

The decision of the House of Lords in the case of Purdy compelled the Director of Public Prosecutions (DPP) to promulgate guidance as to the exercise of prosecutorial discretion with respect to those suspected of an offence under the Suicide Act 1961. Consequently, the Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide now sets out determining factors for potential culpability in encouraging or assisting suicide. This paper discusses the implications of the Policy, particularly with respect to the role of compassion as a key determining factor which effectively decriminalises acts of assisting or encouraging suicide in the majority of cases, despite such acts remaining technically criminal. Following the DPP's assertion that the location of the actual suicide is irrelevant to the prosecutorial decision, this article considers whether some elements of the Policy might belie this assertion. The apparently heightened risk of prosecution now faced by doctors and other healthcare professionals and workers is also considered. Finally, in light of the apparent prosecutorial endorsement of compassionate assisted suicide, this article questions whether we might now expect the imminent legalisation of assisted suicide.     

Vaginorectal impalement injury in a 2-year-old child--caused by sexual abuse or an accident?

Anogenital impalement injuries are rarely encountered in clinical or forensic practice. If seen in children and if incurred under suspect circumstances, sexual abuse must be considered in the differential diagnosis. Here we describe the case of a 2-year-old girl admitted to hospital with a vaginorectal impalement injury. According to the girl's parents, she had slipped in the bathroom and fallen onto the handle of an upright toilet bowl brush. Since a second slight anal injury was present, the parents' account appeared inconsistent. Therefore, physicians from the Institute of Legal Medicine were consulted to investigate the possibility of underlying sexual abuse. Because they could not rule out that the injuries could have been caused by sexual abuse, they recommended having the police immediately examine the site of the purported accident for evidence. The police and forensic investigations, however, verified the parents' account of an accidental injury. Thus, in this case, the initiation of a police inquiry, which is not compulsory in Germany even when sexual abuse is strongly suspected, led to the exoneration of the father.     

Arsenic poisoning: acute or chronic? Suicide or murder?

The case of the death by arsenic poisoning of a 62-year-old white man is presented. One year prior to death, he developed intermittent bouts of severe gastroenteritis with vomiting and diarrhea, hyperpigmentation and keratosis of the skin, neutropenia, and Guillain-Barré-like neuropathy for which he was hospitalized several times. Urine test results 6 months prior to death indicating 36 mg/L arsenic were believed to be in error. At the patient's last admission, he appeared in the emergency room with severe gastroenteritis, hypotension, and dehydration. He died 3 days later. Antemortem as well as autopsy specimens revealed elevated arsenic concentrations. Arsenic micrograms/g analysis by neutron activation of hair pulled from the man's head revealed by centimeter segmental analysis proximal to distal: 226, 104, 28, 56, 41, 40, and 74. The wife of the decedent was charged with murder by arsenic poisoning of this, her fifth, husband. The defense alleged that the decedent had committed suicide. The judge awarded a directed verdict of "not guilty." Particulars of the medical, toxicological, and investigative findings are presented.