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| {{Suicide}} | |||
| A '''suicide method''' is any means by which one or more persons purposely kills themselves. Examples of methods that have been used to commit ] are listed below. Though individuals with ] may consider these methods, most do not ultimately act upon them.<ref>{{cite journal | |||
| | last = Gliatto | |||
| | first = Michael F. | |||
| | authorlink = | |||
| | coauthors = Ander dahl S'rensen | |||
| | year = 1999 | |||
| | month = March | |||
| | title = Evaluation and Treatment of Patients with Suicidal Ideation | |||
| | journal = ] | |||
| | volume = 59 | |||
| | issue = 6 | |||
| | pages = | |||
| | id = | |||
| | url = http://www.aafp.org/afp/990315ap/1500.html | |||
| | accessdate = 2008-03-14 | |||
| }}</ref> | |||
| 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 ] or the ], usually by destruction of one or more key components. Chemical modes focus on interrupting biologically significant processes such as ] or ]. Chemical methods of suicide produce latent evidence of action, whereas physical methods provide direct evidence. | |||
| Whether or not exposure to suicide is a risk factor for suicide is controversial.<ref>{{cite web |url=http://www.uptodate.com/online/content/topic.do?topicKey=adol_med/7847&selectedTitle=3~150&source=search_result#H17 |title=UpToDate Inc. |format= |work= |accessdate=}}</ref> A 1996 study was unable to find a relationship between suicides among friends,<ref>{{cite journal |author=Brent DA, Moritz G, Bridge J, Perper J, Canobbio R |title=Long-term impact of exposure to suicide: a three-year controlled follow-up |journal=J Am Acad Child Adolesc Psychiatry |volume=35 |issue=5 |pages=646–53 |year=1996 |month=May |pmid=8935212 |doi= 10.1097/00004583-199605000-00020|url=}}</ref> while a 1986 study found clusters of suicide among teenagers following the televisation of news stories regarding suicide.<ref>{{cite journal |author=Phillips DP, Carstensen LL |title=Clustering of teenage suicides after television news stories about suicide |journal=N. Engl. J. Med. |volume=315 |issue=11 |pages=685–9 |year=1986 |month=September |pmid=3748072 |doi= |url=}}</ref> These clusters account for 5% of teenage suicides.<ref>{{cite journal |author=Hazell P |title=Adolescent suicide clusters: evidence, mechanisms and prevention |journal=Aust N Z J Psychiatry |volume=27 |issue=4 |pages=653–65 |year=1993 |month=December |pmid=8135690 |doi= 10.3109/00048679309075828|url=}}</ref> | |||
| ==Bleeding== | |||
| {{See also|Self-injury}} | |||
| Suicide by ] involves reducing the volume and pressure of the blood to below critical levels by inducing massive ]. It is usually the result of damage inflicted on ]. The ], ], ] or ] arteries may be targeted. Death may occur directly as a result of the ] of the body or via ], wherein the ] in the circulatory system becomes too low and results in the body shutting down. Death may be much harder to bear than the suicidal person intended or expected. <ref>http://www.samaritans.org/about_samaritans/case_studies/tonys_story.aspx</ref> | |||
| ===Wrist cutting=== | |||
| Wrist cutting is usually due to deliberate ] rather than attempted suicide. People who engage in self harm however are at a 30 times greater risk of future suicide.<ref>{{cite journal |author=Izutsu T, Shimotsu S, Matsumoto T, ''et al.'' |title=Deliberate self-harm and childhood hyperactivity in junior high school students |journal=Eur Child Adolesc Psychiatry |volume=15 |issue=3 |pages=172–6 |year=2006 |month=March |pmid=16447027 |doi=10.1007/s00787-005-0520-5 |url=}} </ref> | |||
| The subject may or may not experience a noticeable release of adrenaline and endorphins. As the bleeding continues cardiac arrhythmia is likely to ensue as the body is eventually unable to compensate. If the exsanguination is allowed to continue, the resulting severe hypovolemia will cause shock, followed by cardiovascular collapse, cardiac arrest and death. | |||
| In the case of a failed suicide attempt, the person may experience injury of the ] of the extrinsic flexor muscles, or the ] and ] nerves which control the muscles of the hand, both of which can result in temporary or permanent reduction in the victim's sensory and/or motor ability and/or also cause chronic somatic or autonomic pain.<ref>{{cite journal | last = Bukhari | first =AJ | coauthors =Saleem M, Bhutta AR, Khan AZ, Abid KJ. | title = Spaghetti wrist: management and outcome | journal = J Coll Physicians Surg Pak. | volume = 14 | issue =(10) | pages = 608–11 |year=2004 | month=October | pmid = 15456551 | doi = 10.2004/JCPSP.608611}}</ref> As in any class IV hemorrhage, aggressive resuscitation is required to prevent death of the patient; standard emergency bleeding control applies for pre-hospital treatment. | |||
| Arterial bleeding is identified by the rhythmic ] (in unison with the heartbeat) that is bright red in color. Venous bleeding, on the other hand, produces a continuous stream of blood of a darker red color. Arterial bleeding is more difficult to control and usually more life-threatening. The bleeding may be further controlled by indirect arterial pressure—for example, pressure on the brachial artery can reduce bleeding from the arm; however, pressure points should be used with caution as inadequate blood flow may cause severe damage to a limb. Tourniquets, if used at all, should be reserved for professionals. | |||
| ==Drowning== | |||
| ] | |||
| {{Main|Drowning}} | |||
| Suicide by ] is the act of deliberately submerging oneself in ] or other liquid to prevent ]ing and ]. Due to the body's natural tendency to come up for air, drowning attempts often involve the use of a heavy object to overcome this reflex. Drowning involves physical and mental anguish.<ref>{{ cite web | |||
| | url=http://www.ycaol.com/Drowning.htm | |||
| | title=The Agony of Drowning | |||
| }}</ref> | |||
| Drowning is among the least common methods of suicide, typically accounting for less than 2% of all reported suicides in the United States.<ref name='WISQARS'>{{ cite web | |||
| | url = http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html | |||
| | title = WISQARS Leading Causes of Death Reports | |||
| | accessdate = 2009-07-06 | |||
| }}</ref> | |||
| ==Suffocation== | |||
| {{Main|Suicide bag}} | |||
| Suicide by ] is the act of inhibiting one's ability to breathe or limiting oxygen uptake while breathing, causing ] and eventually ]. This may involve an ] (a plastic bag fixed over the head) or confinement in an enclosed space without oxygen. These attempts involve using depressants to make the user pass out before oxygen deprivation triggers instinctive panic and the urge to escape due to the ]. | |||
| ], ] and ] are commonly used in suicides by suffocation. Breathing ] quickly renders a person unconscious and may cause death within minutes.<ref>{{ cite web | url=http://www.osha.gov/dts/shib/shib042704.html | title=Deaths Involving the Inadvertent Connection of Air-line Respirators to Inert Gas Supplies }}</ref> | |||
| ==Electrocution== | |||
| {{Main|Electrocution}} | |||
| Suicide by electrocution involves using a lethal ] to kill oneself. This would cause arrythmias of the heart, meaning that the heart would not contract in synchrony between the different chambers causing essentially elimination of blood flow. Furthermore, depending on the amount of electrical current, burns may also occur. | |||
| <blockquote> “The evidence here shows that electrocution inflicts intense pain and agonizing suffering,” (Justice William M. Connolly) <ref>http://www.nytimes.com/2008/02/09/us/09penalty.html</ref></blockquote> | |||
| ==Jumping from height== | |||
| {{Main|Jumper (suicide)|Self-defenestration}} | |||
| Jumping from height is the act of ] from high altitudes, for example, from a window (self-defenestration or autodefenestration), balcony or roof of a ], ], ] or ]. | |||
| In the United States, jumping is among the least common methods of committing suicide (less than 2% of all reported suicides in the United States for 2005).<ref name='WISQARS'>{{ cite web | |||
| | url = http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html | |||
| | title = WISQARS Leading Causes of Death Reports | |||
| | accessdate = 2009-07-06 | |||
| }}</ref> | |||
| In ], jumping is the most common method of committing suicide, accounting for 52.1% of all reported suicide cases in 2006 and similar rates for the years prior to that.<ref>{{cite web | last = | first = | authorlink = http://csrp.hku.hk | coauthors = | title = Method Used in Completed Suicide | work = | publisher = HKJC Centre for Suicide Research and Prevention, University of Hong Kong | year = 2006 | url = http://csrp.hku.hk/WEB/eng/statistics.asp#3 | format = | doi = | accessdate = 2009-09-10}}</ref> The Centre for Suicide Research and Prevention of the ] believes that it may be due to the abundance of easily accessible ] buildings in Hong Kong.<ref>{{Cite news | |||
| | last = | |||
| | first = 周志鴻 | |||
| | author-link = | |||
| | last2 = | |||
| | first2 = 譚健文 | |||
| | author2-link = | |||
| | title = 遭家人責罵：掛住上網媾女唔讀書 成績跌出三甲 中四生跳樓亡 | |||
| | newspaper = ] | |||
| | pages = | |||
| | year = 2009 | |||
| | date = 9th August | |||
| | url = http://hk.apple.nextmedia.com/template/apple/art_main.php?iss_id=20090809&sec_id=4104&subsec=12731&art_id=13078710 | |||
| | accessdate = 2009-09-10 | |||
| }}</ref> | |||
| ==Firearms== | |||
| A common suicide method is to use a ]. Generally, the ] will be aimed at ], often at the head or less commonly into the mouth or pointed at the chest. In the United States, firearms remain the most common method of suicide, accounting for 53.7% of all suicides committed during 2003.<ref>{{cite web |url=http://www.suicidology.org/associations/1045/files/2003data.pdf |title=U.S.A. Suicide: 2000 Official Final Data |publisher=American Association of Suicidology}}</ref> | |||
| Interaction and performance between a rapid missile and a biological target will be a function of at least the missile velocity, the available energy in the projectile and the ''tissue interaction''. A high caliber weapon and a proper barrel orientation to the head is likely to create devastating damage; high class haemorrhage, severe rearrangement of the brain structure with permanent partial or complete tissue destruction of multiple lobes, nerve destruction and obvious skull fracture with potential bone fragments embedded in the brain; structures likely to be affected are intracranial, vascular, middle or inner ear, cranial nerve and external canal structures. With low caliber and low powered weapons, despite optimal orientation of the barrel the firearm may not be effective in killing the victim.{{Citation needed|date=April 2010}} | |||
| A failed suicide attempt by firearm may result in severe chronic pain for the patient as well as reduced cognitive abilities and motor function, subdural hematoma, foreign bodies in the head, pneumocephalus and cerebrospinal fluid leaks. For temporal bone directed bullets, temporal lobe abscess, meningitis, aphasia, hemianopsia, and hemiplegia are common late intracranial complications. As many as 50% of people who survive gunshots wounds directed at the temporal bone suffer facial nerve damage, usually due to a severed nerve.<ref name = "TEMPORAL_SHOT"></ref><ref name = "LIMBS_SHOT"></ref> | |||
| As for treatment, the patient should first be treated for critical life-threatening injuries. If dural injury is suspected, antibiotic prophylaxis is often employed, intracranial injuries are treated by intravenous steroids and osmotic diuretics. Craniotomy and lumbar drainage are utilized as needed. An important notion is that the surgeon should treat the wound, not the weapon—i.e. that wound management is difficult to be based on the characteristics of the weapon.<ref name = "TEMPORAL_SHOT"/><ref name = "LIMBS_SHOT"/> | |||
| Research published in the New England Journal of Medicine and the National Academy of Science found an association between household firearm ownership and gun ] rates,<ref name="NAS-exec">{{cite book |title=Firearms and Violence: A Critical Review |year=2004 |publisher=National Academy of Science |author=Committee on Law and Justice |chapter=Executive Summary |url=http://www.nap.edu/books/0309091241/html/1.html}}</ref><ref>{{cite journal |author=Kellermann, A.L., F.P. Rivara, G. Somes, ''et al.'' |title=Suicide in the home in relation to gun ownership |journal=New England Journal of Medicine |year=1992 |volume=327 |pages=467–472 |pmid=1308093 |issue=7}}</ref> though a study by one researcher did not find a ] association between household firearms and gun suicide rates,<ref name="Miller_Hemenway"/> except in the suicides of children aged 5–14.<ref name="Miller_Hemenway">{{cite book |author=Miller, Matthew and Hemenway, David|title=Firearm Prevalence and the Risk of Suicide: A Review|url= http://www.hcs.harvard.edu/~epihc/currentissue/Fall2001/miller.htm |publisher=Harvard Health Policy Review |year=2001 | page=2 | quote=One study found a statistically significant relationship between gun ownership levels and suicide rate across 14 developed nations (e.g. where survey data on gun ownership levels were available), but the association lost its statistical significance when additional countries were included.}}</ref> During the 1980s and early 1990s, there was a strong upward trend in adolescent suicides with a gun,<ref name="cook2000-ch2">{{cite book |author=Cook, Philip J., Jens Ludwig |title=Gun Violence: The Real Costs |publisher=Oxford University Press |year=2000 |chapter=Chapter 2 |isbn=0-19-513793-0}}</ref> as well as a sharp overall increase in suicides among those age 75 and over.<ref>{{cite book |author=Ikeda, Robin M., Rachel Gorwitz, Stephen P. James, Kenneth E. Powell, James A. Mercy |title=Fatal Firearm Injuries in the United States, 1962-1994: Violence Surveillance Summary Series, No. 3 |year=1997 |publisher=National Center for Injury and Prevention Control}}</ref> | |||
| Two separate studies, in Canada and Australia, conducted in conjunction with more restrictive firearms legislation, demonstrated that while said legislation showed a decrease in firearms suicide, other methods such as hanging increased. In Australia, the overall rate of suicide actually increased (following a trend that had been moving upwards for some time), and did not decrease until measures specifically aimed at providing support to would-be suicide victims was enacted.<ref>http://bases.bireme.br/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&src=google&base=ADOLEC&lang=p&nextAction=lnk&exprSearch=12882416&indexSearch=ID</ref><ref>http://www.atypon-link.com/GPI/doi/abs/10.1521/suli.33.2.151.22775</ref><ref>http://www.questia.com/googleScholar.qst?docId=5000258711</ref> | |||
| Research also indicates no association ''vis-à-vis'' safe-storage laws of guns that ''are'' owned, and gun suicide rates, and studies that attempt to link gun ownership to likely victimology often fail to account for the presence of guns owned by other people.<ref name="kleck-2004">{{cite journal |author=Kleck, Gary |title=Measures of Gun Ownership Levels of Macro-Level Crime and Violence Research |url=http://www.hawaii.edu/hivandaids/Measures_of_Gun_Ownership_Levels_for_Macro-Level_Crime_and_Violence_Research.pdf |journal=Journal of Research in Crime and Delinquency |year=2004 |volume=41 |pages=3–36 |id={{NCJ|203876}} |doi=10.1177/0022427803256229 | quote= Studies that attempt to link the gun ownership of individuals to their experiences as victims (e.g., Kellermann, et al. 1993) do not effectively determine how an individual's risk of victimization is affected by gun ownership by other people, especially those not living in the gun owner's own household.}}</ref><ref name=autogenerated2>{{cite journal |author=Lott, John, John E. Whitley |title=Safe-Storage Gun Laws: Accidental Deaths, Suicides, and Crime | url=http://johnrlott.tripod.com/whitney.pdf |journal=Journal of Law and Economics |volume=44(2) |year=2001 |pages=659–689 |quote= It is frequently assumed that safe-storage laws reduce accidental gun deaths and total suicides. We find no support that safe-storage laws reduce either juvenile accidental gun deaths or suicides. |doi=10.1086/338346}}</ref> Researchers have shown that ''safe-storage laws'' do not appear to affect gun suicide rates or juvenile accidental gun death.<ref name="kleck-2004"/><ref name=autogenerated2/> | |||
| ] suicides tend to be extremely messy, and can cause body matter to go under closed doors, around double turns, etc. Suicides committed with some ] bullets can essentially cause the head to explode.<ref>{{citation|title=Aftermath, Inc.: Cleaning Up After CSI Goes Home|isbn=1592402968|publisher=Gotham|date=May 17, 2007|author=Reavill, Gil}}</ref> | |||
| ==Hanging== | |||
| ].]] | |||
| {{Main|Hanging}} | |||
| With this technique, the patient attempts to use some form of device around the throat to strangle and/or break the neck. In the event of death, the actual cause of death depends upon the type of hanging used, where type usually refers to the length of the drop. | |||
| In a short drop the victim may die from strangulation—in which the death may result from a lack of air asphyxiating the brain; if the former is true the patient is likely to experience hypoxia, skin tingling, dizziness, vision narrowing, convulsions, shock and acute respiratory acidosis; if the latter is true one or both carotid arteries and/or the jugular vein may be compressed sufficiently to cause cerebral ischemia and a hypoxic condition in the brain which will eventually result in or contribute to the death. | |||
| In the case of a sufficiently long drop, the patient is likely to suffer a fractured 2nd and 3rd and/or 4th and 5th cervical vertebrae which may cause paralysis or death. | |||
| The patient should be supported and removed from the entrapment with standard emergency procedures applied for resuscitation when necessary, in the event of suspected neck injury complete immobilization of the head and neck should be done as early as possible and before moving the patient to minimize or prevent further spinal cord injury—obviously in the event of neck injuries only medical professionals should handle the patient post release from the choking device and obviously only critical, life saving help should be administered by non-professionals. | |||
| Hanging is the prevalent means of suicide in pre-industrial societies and is more common in ] areas than in ] areas.<ref>{{cite book|url=http://books.google.co.uk/books?id=Zi-xoFAPnPMC|title=Comprehensive Textbook of Suicidology|author=Ronald W. Maris, Alan L. Berman, Morton M. Silverman, Bruce Michael Bongar|isbn=157230541X|year=2000|publisher=Guildford Press|page=96}}</ref> It is also a common means of suicide in situations where materials are not readily at hand (such as in ]s); hangings are among the easiest suicides to improvise. | |||
| ==Vehicular impact== | |||
| Some people commit suicide by deliberately placing themselves in the path of a large and fast-moving vehicle, resulting in a fatal impact. | |||
| ===Rail=== | |||
| Some may throw themselves directly in front of an oncoming ], or drive an ] onto the tracks and sit inside while they wait for the locomotive to smash into it.<ref>{{cite journal | |||
| | last = Hilkevitch | |||
| | first = Jon | |||
| | authorlink = | |||
| | year = 2004 | |||
| | month = July | |||
| | date = 4 | |||
| | title = When death rides the rails | |||
| | journal = ] | |||
| | volume = | |||
| | issue = | |||
| | pages = | |||
| | id = | |||
| | url = http://www.ble.org/pr/news/headline.asp?id=10929 | |||
| | accessdate = 2009-03-29 | |||
| }}</ref> Suicide by being hit by a train has a 10% survival rate; a failed attempt typically results in severe injuries, including massive ], ] and ], possibly leading to permanent ] and ]. | |||
| In some ]an countries with highly developed ] networks and very strict ] laws, such as ] and ], railway-related suicide is considered a social problem, and extensive ] has been carried out into this type of suicide. According to these studies, most suicides occur in densely populated areas, but away from ]s and terminal points. ]ed areas, curves and ]s are especially plagued. Most suicides occur at evening or ] time when the driver's visibility is reduced, reducing the chance of a failed suicide. | |||
| People who 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.{{Citation needed|date=June 2009}} Unlike on ], in suicides involving above ground railway lines the victim will often simply stand or lie on the tracks, waiting for the arrival of the train. As the trains usually travel at high speeds (usually between 80 and 200 km/h), the driver is usually unable to bring the train to a halt before the collision. This type of suicide may be traumatizing to the driver of the train and may lead to ]. | |||
| In Germany, 7% of all suicides occur in this manner.<ref>Baumert et al.: Ten-year incidence and time trends of railway suicides in Germany from 1991 to 2000. Eur J Public Health. 2006 Apr;16(2):17 PMID 16093307 </ref> Germany is the country where railway-related suicides account for the largest share of overall suicides. Railway-related suicides are also common in ], ] and ].{{Citation needed|date=June 2009}} | |||
| Methods to reduce the number of rail-related suicides include ] surveillance of stretches where suicides frequently occur, often with direct links to the local ] 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 ]s. Trees and bushes are cut down around the tracks in order to increase driver visibility. | |||
| ====Subway Train==== | |||
| Jumping in front of an oncoming ] train has a 67% survival rate, much higher than the 10% survival rate for ]-related suicides. This is most likely because trains traveling on open tracks travel relatively quickly, whereas trains arriving at a subway station are decelerating so that they can stop and board passengers. | |||
| 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 is expensive.<ref>{{Cite journal|title=Effect of station design on death in the London Underground: observational study|url=http://bmj.bmjjournals.com/cgi/content/full/319/7215/957|date=9 October 1999|author= J Coats, D P Walter|pmid=10514158|journal=BMJ|volume=319|issue=7215|pages=957|pmc=28249}}</ref> | |||
| ===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."<ref>Selzer, M. L., & Payne, C. E. (1992). Automobile accidents, suicide, and unconscious motivation. American Journal of Psychiatry, 119, p 239</ref> There is always the risk that a car accident will affect other road users, for example a car that brakes abruptly or swerves to avoid a suicidal pedestrian may get into a collision with something else on the road. | |||
| 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%".<ref name="accident_or_suicide">{{ cite web |url=http://findarticles.com/p/articles/mi_m2248/is_n118_v30/ai_17150135/pg_1 Accident or suicide? | title=Single-vehicle car accidents and the intent hypothesis. |date= Summer, 1995 | author=Dennis L. Peck, Kenneth Warner}}</ref> 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 an 'accident.'"<ref name="accident_or_suicide" /> | |||
| Some researchers believe that suicides disguised as traffic accidents are far more prevalent than previously thought. One large-scale community survey (in Australia) 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."<ref>{{Cite journal | last1 = Murray | first1 = D. | last2 = de Leo | first2 = D. | title = Suicidal behavior by motor vehicle collision. | journal = Traffic Inj Prev | volume = 8 | issue = 3 | pages = 244–7 | month = Sep | year = 2007 | doi = 10.1080/15389580701329351 | pmid = 17710713 }}</ref> | |||
| ===Aircraft=== | |||
| There have been instances of suicides involving intentionally crashing aircraft: | |||
| *] | |||
| *] | |||
| ==Poisoning== | |||
| Suicide can be committed by using fast-acting ], such as ], or substances which are known for their high levels of ] to humans.<ref></ref> For example, most of the people of ], in northwestern ], died when ], the leader of a ], organized a ] by drinking a cocktail of ] and ] in ].<ref>, Elissayelle Haney, Infoplease, 2006.</ref> Sufficient doses of some plants like the ] family, ], '']'' and others, are also toxic. Poisoning through the means of toxic plants however is usually less quick and relatively painful.<ref></ref> | |||
| ===Pesticide poisoning=== | |||
| Worldwide 30% of suicides are from ]s. The use of this method however varies markedly in different areas of the world from 4% in Europe to more than 50% in the Pacific region.<ref name="Gunnell D, Eddleston M, Phillips MR, Konradsen F 2007 357">{{cite journal |author=Gunnell D, Eddleston M, Phillips MR, Konradsen F |title=The global distribution of fatal pesticide self-poisoning: systematic review |journal=BMC Public Health |volume=7 |issue= |pages=357 |year=2007 |pmid=18154668 |pmc=2262093 |doi=10.1186/1471-2458-7-357 |url=}}</ref> | |||
| Poisoning by farm chemicals is very common among females in the Chinese countryside, and is regarded as a major social problem in the country.<ref>{{Cite web | title=Rural China's suicide problem | url=http://news.bbc.co.uk/1/hi/world/asia-pacific/6711415.stm | date=2007-06-04 | accessdate=2010-03-20}}</ref> | |||
| ===Drug overdosing=== | |||
| {{Main|Drug overdose}} | |||
| ] is a method of suicide which involves taking ] in doses greater than the indicated levels, or in a combination that will interact to either cause harmful effects or increase the potency of one or other of the substances. | |||
| A peaceful overdose is the preferred method of ] among members of right to die societies. A poll among members of right to die society ] has shown that 89% would prefer to take a pill, rather than use a ], a CO generator or use 'slow euthanasia'.<ref>]. ]. Exit International US, 2007. ISBN 0-9788-7882-5, p 33</ref> | |||
| Reliability of this method highly depends on chosen drugs and additional measures like use of ]s to prevent vomiting. Average fatality rate for overdoses in the US is estimated to be 1.8% only.<ref>Stone, Geo. ''''. New York: Carroll & Graf, 2001. ISBN 0-7867-0940-5, p. 230</ref> At the same time, assisted suicide group ] reported no single failure among 840 cases (fatality rate 100%), where an overdose of a former sleeping pill active agent ] was used in combination with antiemetic drug.<ref name="tagesspiegel_interview"> ''Tagesspiegel.de'' Retrieved 2008-04-12</ref> | |||
| While ]s (such as Seconal or Nembutal) have long been considered a safe option for suicide. they are becoming increasingly difficult for potential suicide victims to acquire. Dutch right to die society WOZZ proposed several safe alternatives to barbiturates for use in euthanasia.<ref>Guide to a Humane Self-Chosen Death by Dr. Pieter Admiraal et al. WOZZ Foundation www.wozz.nl, Delft, The Netherlands. ISBN 9078581018.</ref> '']'' mentions the still easy availability of solutions containing pentobarbital in Mexico where they are available over the counter from veterinarians for animal euthanasia. | |||
| However, a typical drug overdose uses random prescription and ]s. In this case death is uncertain, and an attempt may leave a person alive but with severe ] damage, although that itself may in turn eventually prove fatal. Drugs taken orally may also be ] back out before being absorbed. Considering the very high doses needed, vomiting or ] before taking enough of the active agent is often a major problem for people attempting this. | |||
| ] overdose attempts are among the most common, due to easy availability of over-the-counter substances.<ref>{{cite journal |last =Brock |first =Anita |coauthors = Sini Dominy, Clare Griffiths |date=6th |year = 2003 |month = November |title = Trends in suicide by method in England and Wales, 1979 to 2001 |journal = Health Statistics Quarterly |volume = 20 |pages = 7–18 |issn = 1465-1645 |url = http://www.statistics.gov.uk/CCI/article.asp?ID=1538&Pos=4&ColRank=1&Rank=176 |accessdate = 2007-06-25 }}</ref> 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 ] was left behind. | |||
| ===Carbon monoxide poisoning=== | |||
| {{Main|Carbon_monoxide_poisoning#Suicide}} | |||
| A particular type of poisoning involves inhalation of high levels of carbon monoxide. Death usually occurs through ]. In most cases ] (CO) is used because it is easily available as a product of incomplete ]; for example it is released by ]s and some types of ]s. | |||
| Carbon monoxide is a colorless and odorless ], so its presence cannot be detected by sight or smell. It acts by binding preferentially to the ] in the victim's blood, displacing oxygen molecules and progressively deoxygenating the blood, eventually resulting in the failure of ], and death. | |||
| In the past, before ] regulations and ]s, 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. ] may have contained up to 25% carbon monoxide. However, catalytic converters found on all modern automobiles eliminate over 99% of carbon monoxide produced.<ref name="Chest1999-vossberg">{{cite journal | author=Vossberg B, Skolnick J. | title=The role of catalytic converters in automobile carbon monoxide poisoning: a case report | journal=Chest | year=1999 | pages=580–1 | volume=115 | issue=2 | pmid=10027464 | doi=10.1378/chest.115.2.580}}</ref> 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 ], such as a ] in a sealed room, appears to have risen. This has been referred to by some as "death by ]".<ref>, ''British Medical Journal (326:498)'', Chan ''et al.'', 2003.</ref> | |||
| Carbon monoxide is extremely dangerous to bystanders and people who may discover the body, so "]" advocates like ] recommend the use of safer alternatives like ], for example in his ]. | |||
| ===Other toxins=== | |||
| Detergent-related suicide involves mixing household chemicals to produce ] or other ]ous gases.<ref></ref><ref>http://cscs.txstate.edu/icjs/downloads/Safety%20Alerts/DetergentSuicideCase.pdf</ref><ref>http://www.tena911.org/ChemicalSuicideMemo%5B1%5D.pdf</ref><ref>http://www.dcfa.org/Files/Docs%202010/ChemicalSuicide%200210.pdf</ref> | |||
| Several creatures such as spiders, snakes, scorpions, carry venoms that can easily and quickly kill a person. These substances can be used to conduct suicide. For example, ] supposedly had an ] bite her when she heard of ]'s death. | |||
| ==Immolation== | |||
| {{Main|Self-immolation}} | |||
| ] usually refers to suicide by ]. It has been used as a protest tactic, most famously by ] in 1963 to protest the South Vietnamese government; and by ] in 2006 to protest the United States' involvement in the Iraq war. | |||
| Self immolation was also carried out as a ritual in certain parts of ] known as ], where a wife voluntarily immolated herself in her dead husbands’ funeral pyre. | |||
| 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. | |||
| This method of suicide is relatively rare due to the long and painful experience one has to go through before ] sets in. This is also contributed to the ever present ] that the fire is extinguished before death sets in, and in that way causes one to live with severe ]ings, scar tissue and the emotional impact of such horrific injuries. | |||
| ==Seppuku== | |||
| {{main|Seppuku}} | |||
| Seppuku (colloquially ''harakiri'' "belly slitting") is a ]ese ] method of suicide, practiced mostly in the ], though some isolated cases appear in modern times. For example, ] committed seppuku in ] after a failed ] intended to restore full power to the ]. | |||
| Unlike other methods of suicide, this was regarded as a way of preserving one's honor. The ritual is part of ], the code of the ]. | |||
| As originally performed solely by an individual it was an extremely painful method by which to die. Dressed ceremonially, with his ] placed in front of him and sometimes seated on special cloth, the ] would prepare for death by writing a ]. The samurai would open his ], take up his ] (short sword), ], or a ] and plunge it into his ], making first a left-to-right cut and then a second slightly upward stroke. As the custom evolved a selected attendant (], his second) standing by who, on the second stroke, would perform ], where the warrior is all but ], leaving a slight band of flesh attaching the ] to the ], 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. Later still, there would be no sword but something like a fan for which the samurai would reach. | |||
| ==Apocarteresis (suicide by starvation)== | |||
| {{Main|Starvation}} | |||
| A ] may ultimately lead to death. Starvation has been used by ], ] and ] monks as a ritual method of suicide. ] also fasted after receiving the 'consolamentum' sacrament, in order to die while in a morally perfect state. | |||
| The explorer ] refused to eat or take medication for the last month of his life, after having been diagnosed with cancer.<ref>{{ cite news | |||
| | publisher= The Guardian | |||
| | url = http://www.guardian.co.uk/travel/2002/apr/19/travelnews.internationaleducationnews.highereducation1 | |||
| | accessdate = 2009-07-06 | |||
| | title = Thor Heyerdahl dies at 87 | |||
| | year = 2002 | |||
| }} </ref> | |||
| ==Dehydration== | |||
| Dehydration can be hard to bear,<ref>http://www.symptomsofdehydration.com/effects-of-dehydration.htm</ref> and requires patience and determination, since it takes from several days to a few weeks. This means that unlike many other suicide methods, it cannot be accomplished impulsively. Those who die by terminal dehydration typically lapse into unconsciousness before death, and may also experience ] and deranged ].<ref>{{citation|title=Science, Hospice and Terminal Dehydration|author=Baumrucker, Steven|publisher=American Journal of Hospice and Palliative Medicine|volume=16|number=3|date=May/June 1999}}</ref>Discontinuation of hydration does not produce true thirst, although a sensation of dryness of the mouth often is reported as "thirst." The evidence this is not true thirst is extensive and shows the ill feeling is not relieved by giving fluids intravenously but is relieved by wetting the tongue and lips and proper care of the mouth. Patients with ] tend to take longer to die of dehydration because of the excess fluid in their bodies.<ref>{{citation|url=http://www.preciouslegacy.com/chap13.html|title=Treatment of Pain and Suffering in the Terminally Ill|author=Lieberson, Alan D.}}</ref> | |||
| Terminal dehydration has been described as having substantial advantages over physician-assisted suicide with respect to self-determination, access, professional integrity, and social implications. Specifically, a patient has a ] and it would be a personal assault for someone to force water on a patient, but such is not the case if a doctor merely refuses to provide lethal medication.<ref>{{Cite journal|url=http://archinte.highwire.org/cgi/content/summary/153/24/2723|title=Patient Refusal of Hydration and Nutrition|author= James L. Bernat, MD; Bernard Gert, PhD; R. Peter Mogielnicki, MD|date=27 December 1993|volume=153|number=24|publisher=Archives of Internal Medicine|pmid=8257247|doi=10.1001/archinte.1993.00410240021003|issue=24|pages=2723–8|journal=Archives of internal medicine|doi_brokendate=2010-03-19}}</ref> But it also has distinctive drawbacks as a humane means of voluntary death.<ref>{{Cite journal|url=http://www.annals.org/content/128/7/559.abstract|title=Voluntary Death: A Comparison of Terminal Dehydration and Physician-Assisted Suicide|author=Miller, Franklin G. and Meier, Diane E.|publisher=Annals of Internal Medicine|date=2004|pmid=9518401|doi=10.1059/0003-4819-128-7-199804010-00007|volume=128|issue=7|pages=559–62|journal=Annals of internal medicine|doi_brokendate=2010-03-19|url=http://www.annals.org/content/128/7/559.full}}</ref> One survey of hospice nurses found that nearly twice as many had cared for patients who chose voluntary refusal of food and fluids to hasten death as had cared for patients who chose physician-assisted suicide.<ref>{{Cite journal|title=Death by Voluntary Dehydration — What the Caregivers Say|url=http://nejm.highwire.org/cgi/content/extract/349/4/325|author=Jacobs, Sandra|volume=349|pages=date=July 24, 2003|publisher=New England Journal of Medicine|pmid=12878738|doi=10.1056/NEJMp038115|year=2003|issue=4|journal=The New England journal of medicine}}</ref> They also rated fasting and dehydration as causing less suffering and pain and being more peaceful than physician-assisted suicide.<ref>{{citation|title=Terminally Ill Choose Fasting Over M.D.-Assisted Suicide|author=Arehart-Treichel, Joan|journal=Psychiatric News|date=January 16, 2004|volume=39|number=2|page=15|publisher=American Psychiatric Association}}</ref> There can be a fine line between ] that results in death by dehydration and ].<ref>{{citation|url=http://nejm.highwire.org/cgi/content/extract/337/17/1236|title=The Supreme Court and Physician-Assisted Suicide — Rejecting Assisted Suicide but Embracing Euthanasia|date=October 23, 1997|volume=337:1236-1239|number=17|publisher=New England Journal of Medicine}}</ref> | |||
| ==Explosion== | |||
| Another method is death by explosion. High-explosives that are certain to explode and release an extreme amount of energy are often used to avoid unnecessary pain.<ref></ref> | |||
| ==Suicide attack== | |||
| {{Main|Suicide attack}} | |||
| A ] 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. ], ]). 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. the ]). 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 ]. They may use a ] or other machinery to cause maximum damage (e.g. Japanese ] pilots during ]). | |||
| Additionally, teenage students (most often in the US, 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 being killed in combat. Another example would be provoking an armed officer into using lethal force against them. This is generally called "]". In some instances the subject commits a capital crime in hope of being ]. This ] was extremely popular in Enlightenment Era Scandinavia, where law and religion forbade suicide.{{Citation needed|date=November 2008}} Today, this type of suicide is relatively rare. | |||
| ==Further reading== | |||
| * ]. '']''. Dell. 1997. | |||
| * ]. ]. Exit International US, 2007. ISBN 0-9788-7882-5 | |||
| * Stone, Geo. ''''. 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. Published by '''' and others. | |||
| * Five Last Acts by Chris Docker 186pp 2008 | |||
| * ] | |||
| * ] | |||
| ==References== | |||
| {{reflist|2}} | |||
| {{DEFAULTSORT:Suicide Methods}} | |||
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