Patient termination of a life-sustaining medical device: Suicide or natural death?

Medical technology has made tremendous strides in extending the lives of patients who have suffered organ failure. Machines can now replace the function of the kidneys, the heart, and other vital organs. Much has been written about a patient's right to refuse or direct the withdrawal of medical treatment, especially at the end of life, under the guise of “death with dignity.” However, little attention has been paid to the situation where a patient elects to deactivate their life-sustaining medical device without a physician's involvement. This raises the challenging question of whether the patient's manner of death should be classified as suicide or natural. Surprisingly, common law, statutes, medical ethics, and public health practice are not in alignment on the answer. This article will explore the ramifications and far-reaching impact that such divergence has on the survivors and the medical community, as well as recommend corrective actions and practical approaches for the medical and legal practitioner.     

中国语境下帮助自杀的重构

帮助自杀的定性是一个争议已久的问题，一直困扰着理论界和司法界。长期以来，帮助自杀与公民生命权的保障存在着冲突与矛盾，但帮助自杀的合法化是一种价值选择的趋势。我国应该使帮助自杀行为非罪化，并对帮助自杀行为在中国语境下予以重构。     

Biting Through an Arteriovenous Hemodialysis Graft: An Unusual Method of Suicide

Abstract:  Patients on long-term hemodialysis often have multiple medical and social problems with associated psychological stress and depression. The suicide rate in this population is higher than the general population, and suicides have been reported following severing or disconnection of hemodialysis vascular access sites. We report a patient on chronic hemodialysis with a history of depression and suicidal ideation who bit into his forearm arteriovenous graft and exsanguinated.     

科学分类之下罪犯自杀的紧急处置

罪犯的自杀问题是现代监狱关注的热点问题。对罪犯的自杀可以分为手段型自杀、报复型自杀、绝望型自杀和精神病型自杀四种类型。在现场，监狱民警应按照规范的程序、适当的方法对罪犯自杀事件进行合理处置，以降低罪犯自杀的成功率。     

Evolution of the Psychological Autopsy: Fifty Years of Experience at the Los Angeles County Chief Medical Examiner‐Coroner's Office

The origin of the psychological autopsy was in the late 1950s and the result of a collaboration between the Los Angeles County Chief Medical Examiner‐Coroner's Office and the Los Angeles Suicide Prevention Center. It was conceptualized as a thorough retrospective analysis of the decedent's state of mind and intention at the time of death. It was used initially in “equivocal” deaths where the manner of death was possibly either suicide or accident. Later, it was used in cases where a party (primarily family members) protested the Medical Examiner‐Coroner's suicide determination. Over the past 25 years, the University of Southern California Institute of Psychiatry, Law, and Behavioral Science has served as the psychiatric/psychological consultants to the Coroner's Department. Research findings, the use of this approach in high‐profile cases, and the most recent manner in which the psychological autopsy is conducted are discussed.     

Cluster hanging suicides in the young in South Australia

Retrospective review of hanging suicides in individuals aged ≤ 17 years was undertaken at Forensic Science South Australia, Australia, over two 5-year periods: 1995-1999 and 2005-2009. Seven cases of hanging suicides were identified from 1995 to 1999, with a further 14 cases from 2005 to 2009, an increase of 100% (p < 0.001). Hanging accounted for 33.3% of all suicides in this age group (7/21) from 1995 to 1999, compared with 93.3% of the total number of suicides (14/15) in the second 5-year period. In contrast, Australian national data from 1998 and 2008 showed a 30% decrease in hanging suicides in the young, from one case/100,000 population in 1998 to 0.7 in 2008. Cluster suicides occur in the young and are often initiated by direct communication. As it is possible that Internet-based social sites may facilitate this phenomenon, investigations should include an evaluation of the victim's Internet access given the potential risk of similar actions by peers.     

自杀的认定及其相关行为的刑法评价

刑法中认定自杀有主客观两方面要求。在主观方面,被害人不仅应当认识到并且意欲死亡结果发生,而且必须自愿地、也即自主决定地选择了死亡。对于自愿性的判断应当以有效承诺的主观要件为标准。重大的动机错误同样导致不能成立自杀。此外,被害人还必须客观上事实性地支配着直接导致死亡的行为,在将不可逆转地造成死亡结果的最后关键时刻自己控制着事态的发展。自杀本身并非刑事不法行为,教唆或帮助自杀、对自杀者不予救助或者过失导致他人自杀等自杀相关行为也不应受到刑事处罚。     

Study of an economic issue as a possible indicator of suicide risk: a discussion of stock prices and suicide

There were more than 30,000 suicides in 1998 in Japan, and since then, the numbers have remained high. In 2009, the number of suicides per a day was c. 90. This phenomenon constitutes a major social problem. One of the major reasons for the rapid increase in the number of suicides appears to be the worsening economic problems. It is therefore necessary to research the relationship between economic issues and suicide. In this study, we examined the relationship between the value of the Nikkei Stock Average and suicide rates in Japan. The value of the Nikkei Stock Average may be related to suicide among men. On the basis of the results, relevant researchers and organizations should understand the factors that relate to suicide to better carry out specific suicide prevention measures.     

The economics of environmental law enforcement: end-of-life vehicles

Abandoned End-of-Life Vehicles (ELVs) have been an environmental concern for a long time in a number of countries. This article examines different ways to address the issue by changing the incentive structure for agents. Following (Polinsky A. M., & Shavell, S. (2000). The Economic theory of public enforcement of law. Journal of Economic Literature, 38, 45–76.) a model is used to compare a fine-based system with a deposit-refund system; a combination of the two is then considered. It is shown that when the environmental harm is relatively low and constant, a deposit-refund system is preferred. When cases of high environmental harm are included, the optimal choice would be a combined system.      

Suicide with associated acts of arson: two cases from Colorado

We report on two cases of suicide in which the victims started fires before their deaths. In one case the victim died of a single self-inflicted gunshot wound to the head after setting several fires in his residence. In the second case the victim hung himself after setting several fires in his residence and an adjoining building. In both cases, the victim's position was not near the origin of the fires suggesting that the arson was not a failsafe device to the primary mechanism of suicide. Neither victim showed a significant percentage of carboxyhemoglobin, or thermal damage from the fires. Both cases are remarkable in that, had the fire caused more damage to the remains and dwellings, a finding of suicide may not have been reached. We discuss similar aspects between the two reported cases and discuss differences observed with similar events such as complex suicide, suicide by self-immolation, and concealed homicide by burning. Similar cases should be reported to broaden our understanding of these complex events.