Suicide methods

For more information on the historical use of poison for suicide, see History of poison.

A suicide method is any means by which a person purposely kills himself or herself. Examples of methods that have been used to commit suicide are listed below. Though individuals with suicidal feelings may consider these methods, most eventually do not act on them.

Suicide methods can be classified according to two modes of interrupting life processes: physical or chemical. Physical modes of interruption typically act by incapacitating the respiratory system or the central nervous system, usually by destruction of one or more key components. Chemical modes focus on interrupting biologically significant processes such as inhibition of cellular respiration or reduction of diffusion capacity. Chemical methods of suicide produce latent evidence of action, while physical methods provide direct evidence.

Bleeding

Main article: Bleeding

See also: Self mutilation

Exsanguination is a method of death which is caused by blood loss. It is usually the result of damage inflicted on arteries. The carotid, radial, ulnar or femoral arteries may be targeted. Death may occur directly as a result of the desanguination of the body or via hypovolemia, wherein the blood volume in the circulatory system becomes too low and results in the body shutting down.

Cutting wrists

This method attempts to self-inflict a class IV haemorrhage by traumatic bleeding. The technique may be performed with a single or multiple incisions and/or lacerations at the wrist(s) with the aim of tearing open arteries and/or veins; i.a. the radial artery, ulnar artery, the cephalic vein and basilic vein are obvious candidates. The body will attempt to remedy and compensate for the problem by i.a. increased cardiac performance and vasoconstriction. The victim will experience a drop in blood pressure, increased heart rate, somatic pain and peripheral perfusion. In the case of a failed suicide attempt, the patient may experience injury of the tendons for the extrinsic flexor muscles, the ulnar and median nerves which control the muscles of the hand -- which can result in temporary or permanent reduction in sensory and/or motor ability. As in any class IV haemorrhage it is required aggressive resuscitation to prevent death of the patient. Standard emergency bleeding control applies for pre-hospital treatment -- i.e. elevation and direct pressure; application of tourniquets should be reserved for professionals if used at all.

Drowning

A homeless girl contemplates drowning herself.

Main article: Drowning

Suicide by drowning is the act of deliberately submerging oneself in water or other liquid and staying there long enough to prevent breathing and deprive the brain of oxygen. Due to the body's natural tendency to come up for air, drowning attempts often involve a heavy object, to circumvent this reflex. If the drowning is stopped before death, oxygen deprivation can cause brain damage. Drowning is among the least common methods (typically less than 2% of all reported suicides in the United States for 2005)

Suffocation

Suicide by suffocation is the act of inhibiting one's ability to breathe or to limit the oxygen uptake while breathing, which causes asphyxia (by all methods excluding drowning). This may involve an exit bag, a plastic bag tightly sealed over the head, or confinement in an enclosed space without oxygen. These attempts usually involve using depressants to make the user pass out before oxygen deprivation which prevents any escape instinct or panic. Inert gasses, such as helium, argon and nitrogen, are sometimes used, because breathing inert gas causes loss of consciousness and death without ever experiencing air hunger. The latter method has been considered by some countries for adoption as a form of capital punishment.

Electrocution

Suicide by electrocution involves using a lethal electric shock to kill oneself. A high enough voltage can overcome the high resistance of the skin and pass a sizeable current through the body. A large alternating current through the body can seriously disrupt nerve signals and can cause the heart to go into fibrillation.

Jumping

Many people have committed suicide by jumping from high altitudes (eg from a cliff, dam, bridge, ...) Also, many people have committed suicide by defenestration whereby they throw themselves out of a high window.

Firearms

A common suicide method is to use a firearm. Generally the bullet will be aimed at point-blank range often at the head.

Some research shows an association between household firearm ownership and gun suicide rates, while other research indicates no such association between firearm ownership and gun suicide rates. During the 1980s and early 1990s, there was a strong upward trend in adolescent suicides with a gun, as well as a sharp overall increase in a suicides among those age 75 and over. In the United States, firearms remain the most common method of suicide, accounting for 53.7% of all suicides committed during 2003.

Hanging

Suicide by hanging.

Main article: Hanging

Hanging is the prevalent means of suicide in pre-industrial societies and is still more common in rural rather than urban areas.

The traditional death penalty of hanging by gallows consists of a rope tied to a fixed object (i.e. the gallows), with one end tied into a hangman's noose and placed around the neck. The person falls through the release of a trap door (or leaps from a height, in the case of suicide), and death is relatively quick due to breaking of the neck. However a person may not have an adequate drop height which instead of breaking one's neck would lead to a much slower death by suffocation.

Vehicular impact

Jumping, lying or standing in front of a fast-moving vehicle, especially a large one, such as a truck, train or subway car, can prove fatal.

Rail

Some people jump or lie on the rails or sit in their car in front of an oncoming train . This may be traumatizing to the driver of the train. Suicide by being hit by a train has a 10% survival rate. Not dying following impact of the vehicle could result in massive body damage including amputations, fractures, brain damage, organ bruising, and disability.

In some European countries with highly developed rail networks and very strict gun-control laws, such as Germany and Sweden, railway-related suicide is considered a social problem, and extensive research has been carried out into this type of suicide. According to these studies, most suicides occur in densely populated areas, but away from train stations and terminal points. Wooded areas, curves and tunnels are especially plagued. Most suicides occur at evening or night time, with reduced visibility for the driver.

People that commit suicide in this manner usually stay at or around the place for the suicide for an extended period of time before the actual suicide. Unlike suicides in the underground, they rarely or never jump in front of the train, but rather stand or lie on the tracks, waiting for the arrival of the train. As the trains usually keep high speeds, at around 80 km/h for regular trains and around 200 km/h or more for high speed trains, the driver is usually unable to bring the train to a halt before hitting the suicide candidate. Drivers are often traumatized and suffer from post-traumatic stress disorder.

In Germany 10% of all suicides occur in this manner. Germany is the country where railway related suicides account for the largest share of overall suicides. Railway related suicides are also common in Britain and Japan.

Methods to reduce the number of rail-related suicides include video surveillance of stretches where suicides frequently occur, often with direct links to the local police or surveillance companies. This enables the police or guards to be on the scene within minutes after the trespassing was noted. Public access to the tracks is also made more difficult by erecting fences. Trees and bushes are cut down around the tracks in order to increase driver visibility.

Subway

Jumping in front of an oncoming subway train has a 67% survival rate, much higher than the 10% survival rate for rail-related suicides. Jumping in front of an underground train is a common form of suicide in many larger cities, such as London.

Different methods have been used in order to decrease the number of suicide attempts in the underground: a deep drainage pit halves the likelihood of fatality. Separation of the passengers from the track by means of a partition with sliding-doors is being introduced in some stations but this is expensive.

Traffic collisions

Some car accidents are in fact suicides. This especially applies to single-occupant, single-vehicle accidents. "The automobile lends itself admirably to attempts at self-destruction because of the frequency of its use, the generally accepted inherent hazards of driving, and the fact that it offers the individual an opportunity to imperil or end his life without consciously confronting himself with his suicidal intent".

The real percentage of suicides among car accidents is not reliably known; studies by suicide researchers tell that "vehicular fatalities that are suicides vary from 1.6% to 5%". Some suicides are misclassified as accidents because suicide must be proven; "It is noteworthy that even when suicide is strongly suspected but a suicide note is not found, the case will be classified 'accident.'"

Some researchers believe that suicides disguised as traffic accidents are far more prevalent than previously thought. One large-scale community survey among suicidal persons provided the following numbers: "Of those who reported planning a suicide, 14.8% (19.1% of male planners and 11.8% of female planners) had conceived to have a motor vehicle “accident”... Of all attempters, 8.3% (13.3% of male attempters) had previously attempted via motor vehicle collision."

Poisoning

Suicide can be committed by using fast-acting poisons (eg HCN), or substances which are known for their high levels of toxicity to humans. For example, most of the people of Jonestown, in northwestern Guyana, died when the leader of a religious sect organized a mass suicide by drinking a cocktail of diazepam and cyanide in 1978. Sufficient doses of some plants like the Belladonna family, castor beans, jatropha curcas and others, are also toxic. Poisoning trough the means of toxic plants however is usually less quick and relatively painful. Poisioning by farm chemicals is very common among females in the Chinese countryside, and is regarded as a major social problem in the country.

Drug overdosing

Suicide by pharmaceuticals ("overdosing") is a method which involves taking medication in doses greater than the indicated levels, or in a combination which will enhance each drug's effect.

A peaceful overdose is the preferred method of dignified dying among members of right to die societies. A poll among members of right to die society Exit International has shown that 89% would prefer to take a pill, rather than use a plastic exit bag, a CO generator or use 'slow euthanasia'.

Reliability of this method highly depends on chosen drugs and additional measures like use of antiemetics to preventing vomiting. Average fatality rate for overdoses in the US is estimated to be 1.8% only. At the same time, assisted suicide group Dignitas reported no single failure among 840 cases (fatality rate 100%), where an overdose of a former sleeping pill active agent Nembutal was used in combination with antiemetic drug.

While barbiturate (like Seconal or Nembutal) are considered a safe option for suicide, it is becoming increasingly difficult to acquire these drugs. Today they are only available as a dilution and are used by veterinarians to euthanize animals. Dutch right to die society WOZZ proposed several safe alternatives to barbiturates for use in euthanasia.

However, a typical drug overdose uses random prescription and over-the-counter substances. In this case death is uncertain, and an attempt may leave a person alive but with severe organ damage, which may prove eventually fatal itself. Drugs taken orally may also be vomited back out before being absorbed. Considering the very high doses needed, vomiting or falling asleep before taking enough of the active agent might be a serious hurdle.

Analgesic overdose attempts are among the most common due to easy availability of over-the-counter substances. Overdosing may also be performed by mixing medications in a cocktail with one another, or with alcohol or illegal drugs. This method may leave confusion over whether the death was a suicide or accidental, especially when alcohol or other judgment-impairing substances are also involved and no suicide note was left behind.

Carbon monoxide poisoning

Main article: Carbon monoxide poisoning

A particular type of poisoning involves inhalation of high levels of carbon monoxide. Death usually occurs through hypoxia. In most cases carbon monoxide (CO) is used because it is easily available as a product of incomplete combustion; for example it may be released by cars and some types of heaters.

Carbon monoxide is a colorless and odorless gas, so its presence cannot be detected by sight or smell. It is harmful to humans since the CO molecules attach themselves to hemoglobin in the blood, displacing oxygen molecules and progressively lowering the body's oxygenation, eventually resulting in death.

In the past, before air-quality regulations and catalytic converters, suicide by carbon monoxide poisoning would often be achieved by running a car's engine in a closed space such as a garage, or by redirecting a running car's exhaust back inside the cabin with a hose. Motor car exhaust may have contained up to 25% carbon monoxide. However, catalytic converters can eliminate over 99% of carbon monoxide produced. As a further complication, the amount of unburned gasoline in emissions can make exhaust unbearable to breathe well before losing consciousness.

The incidence of suicide by carbon monoxide poisoning through burning charcoal, such as a barbecue in a sealed room, appears to have risen. This has been referred to by some as "death by hibachi".

Carbon monoxide is extremely dangerous to bystanders and people who may discover the body, so "Right to Die" advocates like Philip Nitschke recommend the use of safer alternatives like nitrogen, for example in his EXIT euthanasia device.

Detergent-related suicide

Detergent-related suicide involves mixing household chemicals to produce hydrogen sulfide or other poisonous gasses.

Immolation

Immolation usually refers to suicide by fire. It has been used as a protest tactic, most famously by Thich Quang Duc in 1963 to protest the South Vietnamese government; and by Malachi Ritscher in 2006 to protest the United States' involvement in the Iraq war. The Latin root of 'immolate' means 'sacrifice', and is not restricted to the use of fire, though common media usage uses the term immolation to refer to suicide by fire.

Seppuku

Main article: Seppuku

Seppuku (colloquially harakiri "belly slitting") is a Japanese ritual method of suicide, practiced mostly in the medieval era, though some isolated cases appear in modern times. For example, Yukio Mishima committed seppuku in 1970 after a failed coup d'etat intended to restore full power to the Japanese Emperor.

Unlike other methods of suicide, this was regarded as a way of preserving one's honor. The ritual is part of bushido, the code of the Samurai.

As originally performed solely by an individual it was an extremely painful method by which to die. Dressed ceremonially, with his sword placed in front of him and sometimes seated on special cloth, the warrior would prepare for death by writing a death poem. The samurai would open his kimono, take up his wakizashi (short sword), fan, or a tanto (knife) and plunge it into his abdomen, making first a left-to-right cut and then a second slightly upward stroke. As the custom evolved a selected attendant (kaishakunin, his second) standing by who, on the second stroke, would perform daki-kubi, when the warrior is all but decapitated, leaving a slight band of flesh attaching the head to the body, so as to not let the head fall off the body and roll on the floor/ground; which was considered dishonorable in feudal Japan. The act eventually became so highly ritualistic that the samurai would only have to reach for his sword and his kaishakunin would execute the killing stroke. Still later, there would be no sword but something like a fan for which the samurai would reach.

Apocarteresis (suicide by starvation)

Main article: Starvation

Starvation has been used by Hindu, Jain and Buddhist monks as a ritual method of suicide. Albigensians or Cathars also fasted after receiving the 'consolamentum' sacrament, in order to die while in a morally perfect state.

The explorer Thor Heyerdahl refused to eat or take medication for the last month of his life, after having been diagnosed with cancer.

A hunger strike may ultimately lead to death.

Suicide attack

Main article: Suicide attack

A suicide attack is an attack in which the attacker (attacker being either an individual or a group) intends to kill others and intends to die in the process of doing so (e.g. Columbine, Virginia Tech.) In a suicide attack, in the strictest sense, the attacker dies by the attack itself, for example in an explosion or crash caused by the attacker (e.g. 9/11). The term is sometimes loosely applied to an incident in which the intention of the attacker is not clear though he is almost sure to die by the defense or retaliation of the attacked party. This can also be referred to as murder/suicide.

Such attacks are typically motivated by religious or political ideologies and have been carried out using numerous methods. For example, attackers might attach explosives directly to their bodies before detonating themselves close to their target also known as suicide attack. They may use a car bomb or other machinery to cause maximum damage (e.g. Japanese kamikaze pilots during World War II).

Islamic extremist terrorists have engaged in suicide attacks numerous times in the Arab-Israeli conflict, and also against the West at other times. Perpetrators believe the gains to others, or to a religious, political or moral cause, outweigh their personal loss and/or that they will be rewarded in the afterlife.

Additionally, teenage students (most often in the United States of America and recently in Finland and Germany) have committed several notable suicide attacks in recent years, in the form of school shooting massacres. Often, these suicide attacks involve guns or homemade bombs brought into high schools or college campuses. After the attack, the perpetrator will commit suicide before being apprehended.

Indirect suicide

Indirect suicide is the act of setting out on an obviously fatal course without directly committing the act upon oneself. Indirect suicide is differentiated from legally defined suicide by the fact that the actor does not pull the figurative (or literal) trigger. Examples of indirect suicide include a soldier enlisting in the army with the express intention and expectation of getting killed in combat. Another example would be provoking an armed officer into using lethal force against them. This is generally called "suicide by cop". In some instances the subject commits a capital crime in hope of being sentenced to death. This state-assisted suicide was extremely popular in Enlightenment Era Scandinavia, where law and religion forbade suicide.Also this type of suicide is rare.

Further reading

• Humphry, Derek. Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying. Dell. 1997.
• Philip Nitschke. The Peaceful Pill Handbook. Exit International US, 2007. ISBN 0-9788-7882-5
• Stone, Geo. Suicide and Attempted Suicide: Methods and Consequences. New York: Carroll & Graf, 2001. ISBN 0-7867-0940-5
• Guide to a Humane Self-Chosen Death by Dr. Pieter Admiraal et al. WOZZ Foundation, Delft, The Netherlands. ISBN 9-0785-8101-8. 112 pages
• Departing Drugs by Chris Docker , Cheryl Smith, and the International Drugs Consensus Working Party

1993, 68 pages

• Five Last Acts by Chris Docker 186pp 2008
• alt.suicide.holiday
• The Complete Manual of Suicide