Suicide methods

A suicide method is any means by which people attempt suicide, purposely ending their lives. People who attempt suicide and survive may experience serious injuries, such as broken bones or brain injury.[1] These injuries can have long-term effects on their health.[1]

For information on methods of suicide intervention, see Suicide prevention.

Socrates with a cup of poisonous Hemlock
Suicide

Some of the ways to prevent suicides include making methods less accessible such as removing guns from the home of an at-risk person, policies that address the misuse of alcohol, and treatment of mental disorders.[2]

Purpose of studying suicide methods

The academic study of suicide methods aims to identify common methods of suicide and groups at risk of suicide, since making methods less accessible may be useful in preventing suicides.[3][4][5] This information allows public health resources to focus on the problems that are relevant in a particular place, or for a given population or subpopulation. For instance, if firearms are used in a significant number of suicides in one place, then public health policies there could focus on gun safety, such as keeping guns locked away, and the key inaccessible to at-risk family members. If young people are found to be at increased risk of suicide by overdosing on particular medications, then an alternative class of medication may be prescribed instead, a safety plan and monitoring of medication can be put in place, and parents can be educated about how to prevent the hoarding of medication for a future suicide attempt.[5]

Cutting
"Hesitation wounds" redirects here. For for the 2010s punk band, see Hesitation Wounds.

Suicide by cutting might involve bleeding, infarction, sepsis, or drowning from a lung contusion. Significant bleeding is usually the result of damage to arteries. Initial cuts may be shallow, referred to as hesitation wounds or tentative wounds. They are often non-lethal, multiple parallel cuts.[6] While cutting is relatively common it only makes up 1% of deaths by suicide in the United States.[7]

Wrist cutting

Wrist cutting is sometimes practiced with the goal of self-harm rather than suicide; however, if the bleeding is sufficient death may occur.[8]

In the case of a non-fatal suicide attempt, the person may experience injury of the tendons, or the ulnar and median nerves which control the muscles of the hand, both of which can result in temporary or permanent reduction in the person's sensory or motor ability or result in chronic pain.[9]

Dehydration
See also: Terminal dehydration

Death from dehydration can take 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 delirium and deranged serum sodium.[10] Discontinuation of hydration does not produce true thirst, although a sensation of dryness of the mouth often is reported as "thirst." The evidence that 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 edema tend to take longer to die of dehydration because of the excess fluid in their bodies.[11]

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 right to refuse treatment 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.[12] But it also has distinctive drawbacks as a humane means of voluntary death.[13] 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.[14] They also rated fasting and dehydration as causing less suffering and pain and being more peaceful than physician-assisted suicide.[15] Other sources, however, have noted very painful side effects of dehydration, including seizures, skin cracking and bleeding, blindness, nausea, vomiting, cramping and severe headaches.[16] There can be a fine line between terminal sedation that results in death by dehydration and euthanasia.[17]

Disease
See also: Bugchasing

There have been documented cases of deliberately trying to contract a disease such as HIV/AIDS as a means of suicide.[18][19][20]

Drowning
See also: Drowning
A homeless girl contemplates drowning herself

Suicide by drowning is the act of deliberately submerging oneself in water or other liquid to prevent breathing and deprive the brain of oxygen. It accounts for less than 2% of all suicides in the United States.[21] Of those who attempt suicide by drowning 56% die.[22]

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. As the level of carbon dioxide in the person's blood rises, the central nervous system sends the respiratory muscles an involuntary signal to contract, and the person breathes in water. Death usually occurs as the level of oxygen becomes too low to sustain the brain cells.

Electrocution
See also: Electrocution

Suicide by electrocution involves using a lethal electric shock to kill oneself. This causes arrhythmias of the heart, meaning that the heart does not contract in synchrony between the different chambers, essentially causing elimination of blood flow. Furthermore, depending on the current, burns may also occur. In his opinion outlawing the electric chair as a method of execution, Justice William M. Connolly of the Nebraska Supreme Court stated that "electrocution inflicts intense pain and agonizing suffering", adding that it is “unnecessarily cruel in its purposeless infliction of physical violence and mutilation of the prisoner’s body.”[23] Contact with 20 mA of current can result in death.[24]

Fire
Further information: Self-immolation

Immolation usually refers to suicide by fire. It has been used as a protest tactic, most famously by Thích Quảng Đức in 1963 to protest the South Vietnamese government's systematic anti-Buddhist, pro-Catholic policies; by Malachi Ritscher in 2006 to protest the United States' involvement in the Iraq War; and by Mohamed Bouazizi in Tunisia which started the Tunisian Revolution in 2011 and the Arab Spring.

Self-immolation was also carried out as a ritual known as sati in certain parts of India, where a Hindu wife immolated herself in her dead husband's funeral pyre, either voluntarily or by coercion.[25]

The Latin root of "immolate" means "sacrifice", and is not restricted to the use of fire, though in common US media usage the term immolation refers to suicide by fire.

This method of suicide is relatively rare due to the long and painful experience one has to go through before death sets in. This is also contributed to by the ever-present risk that the fire be extinguished before death sets in, and in that way causes one to live with severe burnings, scar tissue, and the emotional impact of such injuries.

Volcano

Suicide by volcano involves jumping into molten lava in an active volcanic crater, fissure vent, lava flow or lava lake. The actual cause of death may be as a result of the fall (see jumping from height), contact burns, radiant heat or asphyxiation from volcanic gases. According to some ancient sources, philosopher Empedocles jumped into the Aetna trying to make everybody believe that he had disappeared from the Earth to become a god; this was frustrated when the volcano spat out one of his bronze sandals. Modern suicides have taken place in numerous volcanoes, but the most famous is Mount Mihara in Japan. In 1933, Kiyoko Matsumoto completed suicide by jumping into the Mihara crater. A trend of copycat suicides followed, as 944 people jumped into the same crater over the following year.[26] Over 1,200 people attempted suicide in two years before a barrier was erected.[27] The original barrier was replaced with a higher fence topped with barbed wire after another 619 people jumped in 1936.[28][29]

Firearm
See also: Multiple gunshot suicide
Suicide rate by firearm[30]
Comparison of gun-related suicide rates to non-gun-related suicide rates in high-income OECD countries, 2010, countries in graph ordered by total suicides. The US was the only OECD country in which gun suicide rates exceeded non-gun suicide rates.[31]

In the United States firearm are used in less than 5% of attempts but result in death about 90% of the time.[22] They are thus the leading cause of death by suicide as of 2017 in the United States.[32] Generally, the bullet will be aimed at point-blank range, often at the temple or, less commonly, into the mouth, under the chin or at the chest. Worldwide, firearm prevalence in suicides varies widely, depending on the acceptance and availability of firearms in a culture. The use of firearms in suicides ranges from less than 10% in Australia[33] to 50.5% in the U.S., where it is the most common method of suicide.[34]

Surviving a self-inflicted gunshot 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 gunshot wounds directed at the temporal bone suffer facial nerve damage, usually due to a severed nerve.[35]

A positive association exists between firearm availability and increased suicide risk.[36][37][38][39] This relationship is most strongly established in the United States.[40] This association is almost certainly not due to confounding, as any confounding risk factor that could account for this association would have to meet multiple implausible criteria.[41] Those who have access to firearms as part of their profession are more likely to complete suicide through the use of a firearm ⁠ ⁠—  91.5% of suicides by police officers in America involved the use of a firearm. The United States has both the highest number of suicides and firearms in circulation in a developed country and when gun ownership rises so too does suicide involving the use of a firearm.[42][43] More firearms are involved in suicide than are involved in homicides in the United States. Those who have recently purchased a firearm are found to be high risk for suicide within a week after their purchase.[44]

A 2004 report by the National Academy of Sciences found an association between estimated household firearm ownership and gun suicide rates,[45][46] though a study by two Harvard researchers did not find a statistically significant association between household firearms and gun suicide rates,[47] except in the suicides of children aged 5–14.[47] Another study found that gun prevalence rates were positively associated with suicide rates among people aged 15 to 24, and 65 to 84, but not among those aged 25 to 64.[48] Case-control studies conducted in the United States have consistently shown an association between guns in the home and increased suicide risk,[49] especially for loaded guns in the home.[50] Numerous ecological and time series studies have also shown a positive association between gun ownership rates and suicide rates.[51][52][53] This association tends to only exist for firearm-related and overall suicides, not for non-firearm suicides.[52][54][55][56] A 2013 review found that studies consistently found a relationship between gun ownership and gun-related suicides, with few exceptions.[57] A 2016 study found a positive association between gun ownership and both gun-related and overall suicides among men, but not among women; gun ownership was only strongly associated with gun-related suicides among women.[58] During the 1980s and early 1990s, there was a strong upward trend in adolescent suicides with a gun,[59] as well as a sharp overall increase in suicides among those age 75 and over.[60] A 2014 systematic review and meta-analysis found that access to firearms was associated with a higher risk of suicide.[61]

In the United States, states with stricter gun laws have lower overall suicide rates.[62][63] A 2006 study found a decline in firearm-related suicides in Australia accelerated after the National Firearms Agreement was enacted there. The same study found no evidence of substitution to other methods.[64] Multiple studies in Canada found that gun suicides declined after gun control, but methods like hanging rose leading to no change in the overall rates.[65][66][67] Similarly, a study conducted in New Zealand found that gun suicides declined after more legislation, but overall suicide rates did not change.[68] A case-control study in New Zealand found that household gun ownership was associated with gun suicides, but not overall suicide.[69] A Canadian study found that gun ownership by province was not correlated to provincial overall suicide rates.[70]

Gun laws

Reducing access to guns at a population level decreases the risk of suicide by firearms.[71] The laws regulating the use, purchase, and trading of firearms are varied by state in the US.[72] The Midwest and Southeast have the least legislature regulating firearm use and purchase where there is missing or unclear legislature on gun control and the open and concealed carrying or handguns and long guns are allowed with or without a permit depending on the state. These regions correlate with the states with the highest increases of suicide rates in the past 17 years.[73]

There are certain areas in the United States where firearms are illegal entirely.[74] In 1976, the District of Columbia banned the possession, sale, transfer, and purchase of handguns by civilians. Since the prohibition of handguns homicide by handguns decreased by 25% while suicides by handgun decreased by 23% in the District of Columbia. The rates of homicide and suicide in the surrounding areas where the restrictions were not applied and noted that there was no significant change in these rates. This study has been criticized.[75]

Hanging
Main article: Suicide by hanging
Giotto's Desperatio, depicting suicide by hanging

Attempted suicide by hanging results in death about 53% of the time.[22] It was the most common method in traditional Chinese culture,[76] as it was believed that the rage involved in such a death permitted the person's spirit to haunt and torment survivors.[77][78] It has been used as an act of revenge by women[79] and of defiance by powerless officials, who used it as a "final, but unequivocal, way of standing still against and above oppressive authorities".[76] People would often approach the act ceremonially, including the use of proper attire.[76]

When hanging oneself, the subject uses some type of ligature, as in a rope or a cord, to form a noose (or loop) around the throat, with the opposite end secured to some fixture. Depending on the placement of the noose and other factors, the subject strangles or suffers a broken neck. In the event of death, the actual cause often depends on the length of the drop; that is, the distance the subject falls before the rope goes taut.

In a "short drop", the person may die from strangulation, in which the death may result from a lack of oxygen to the brain. The person is likely to experience hypoxia, skin tingling, dizziness, vision narrowing, convulsions, shock, and acute respiratory acidosis. One or both carotid arteries and/or the jugular vein may also be compressed sufficiently to cause cerebral ischemia and a hypoxic condition in the brain which will eventually result in or contribute to death. Hanging survivors typically have severe damage to the trachea and larynx, damage to the carotid arteries, damage to the spine, and brain damage due to cerebral anoxia.

In a typical "long drop", the subject is likely to suffer one or more fractures of the cervical vertebrae, generally between the second and fifth, which may cause paralysis or death. In extremely long drops, the hanging may result in complete decapitation.

Hanging is the prevalent means of suicide in pre-industrial societies, and is more common in rural areas than in urban areas.[80] It is also a common means of suicide in situations where other materials are not readily available, such as in prisons.

Indirect suicide

Indirect suicide is the act of setting out on an obviously fatal course without directly carrying out 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, or someone could be provoking an armed officer into using lethal force against them. The latter is generally called "suicide by cop". In some instances the subject commits a capital crime in hope of being sentenced to death.

Evidence exists for numerous examples of suicide by capital crime in colonial Australia. Convicts seeking to escape their brutal treatment would murder another individual. This was necessary due to a religious taboo against direct suicide. A person completing suicide was believed to be destined for hell, whereas a person committing murder could absolve their sins before execution. In its most extreme form, groups of prisoners on the extremely brutal penal colony of Norfolk Island would form suicide lotteries. Prisoners would draw straws with one prisoner murdering another. The remaining participants would witness the crime, and would be sent away to Sydney as capital trials could not be held on Norfolk Island, thus earning a break from the Island. There is uncertainty as to the extent of suicide lotteries. While surviving contemporary accounts claim that the practice was common, such claims are probably exaggerated.[81]

Animal attacks

Some people have chosen to indirectly bring about their death by suicide by being attacked by predatory animals such as sharks and crocodiles, and in some cases the person has been eaten alive; for example, in 2011 in eastern South Africa a depressed man (who wanted to be attacked by a crocodile) jumped into a river and was consumed by a crocodile.[82] Similarly, in 2002 a depressed woman killed herself by jumping into a crocodile pond at the Samutprakarn Crocodile Farm and Zoo in Thailand.[83] In 2014 a second woman killed herself by jumping into the same crocodile pond in Thailand.[84] Both women were eaten alive.

Jumping from height
Main articles: Jumper (suicide) and Self-defenestration
As a suicide prevention initiative, signs on the Golden Gate Bridge promote special telephones that connect to a crisis hotline, as well as a 24/7 crisis text line.

Jumping from height is the act of jumping from high altitudes, for example, from a window (self-defenestration or auto-defenestration), balcony or roof of a high rise building, cliff, dam or bridge.

This method, in most cases, results in severe consequences if the attempt fails, such as paralysis, organ damage, and bone fractures.

In the United States, jumping is among the least common methods of suicide (less than 2% of all reported suicides in the United States for 2005).[21]

In Hong Kong, jumping is the most common method of suicide, accounting for 52.1% of all reported suicide cases in 2006 and similar rates for the years prior to that.[85] The Centre for Suicide Research and Prevention of the University of Hong Kong believes that it may be due to the abundance of easily accessible high rise buildings in Hong Kong.[86]

There have been several documented cases of suicide by skydiving, by people who deliberately failed to open their parachute (or removed it during freefall) and were found to have left suicide notes.[87][88] Expert Skydiver and former 22 SAS Soldier Charles (Nish) Bruce QGM completed suicide[89] following eight years of mental illness and periods under section by leaping from a Cessna 172 from 5000 feet over Fyfield, Oxfordshire without a parachute whilst on a private flight home from Spain to Hinton Skydiving Centre.[90] His military history and the manner of his death resulted in extensive media coverage.[91][92][93] Numerous sources[94][95] have looked to attribute his breakdown and suicide to posttraumatic stress disorder.[96]

Poison

Suicide can be completed by using fast-acting poisons, such as hydrogen cyanide, or substances which are known for their high levels of toxicity to humans.[97] For example, most of the people of Jonestown died when Jim Jones, the leader of a religious sect, organized a mass suicide by drinking a cocktail of diazepam and cyanide in 1978 ("Drinking the Kool-Aid").[98] Sufficient doses of some plants like the belladonna family, castor beans, Jatropha curcas and others, are also toxic. Poisoning through the means of toxic plants is usually slower and is relatively painful.[99]

Pesticide
See also: Pesticide poisoning
Share of suicide deaths from pesticide poisoning[100]

Worldwide, 30% of suicides are from pesticide poisonings. 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.[101] In the US, pesticide poisoning is used in about 12 suicides per year.[102]

Poisoning by farm chemicals is very common among women in the Chinese countryside, and is regarded as a major social problem in the country.[103] In Finland, the highly lethal pesticide Parathion was commonly used for suicide in the 1950s. When access to the chemical was restricted, other methods replaced it, leading researchers to conclude that restricting certain suicide methods does little to impact the overall suicide rate.[104] However, in Sri Lanka, both suicide by pesticide and total suicides declined after first class 1 and later endosulfan were banned.[105]

Drug overdose
See also: Drug overdose

Overdose is a method of suicide which involves taking medication in doses greater than the indicated levels, or in a combination that will interact either to cause harmful effects or increase the potency of one or other of the substances. In the United States drug overdoses represents about 60% of suicide attempts and 14% of deaths.[22] The risk of death in overdose is about 2%.[22]

An overdose is often the expressed preferred method of dignified dying among members of right-to-die societies. A poll among members of right-to-die society Exit International suggested that 89% would prefer to take a pill, rather than use a plastic exit bag, a CO generator, or use "slow euthanasia".[106] Death by helium inhalation however is the more common method preferred in practice, largely owing to its reliability.[107]

In the United States most deaths due to drug overdose are related to opioids.[108] While barbiturates have long been used for suicide, they are increasingly difficult to acquire. Dutch right-to-die society WOZZ proposed several safe alternatives to barbiturates for use in euthanasia.[109]

Analgesic overdose attempts are among the most common, due to easy availability of over-the-counter substances.[110] Overdose may also take place when 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
See also: 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. A failed attempt can result in memory loss and other symptoms.[111][112][113]

Carbon monoxide is a colorless and odorless gas, so its presence cannot be detected by sight or smell. It acts by binding preferentially to the hemoglobin in the person's blood, displacing oxygen molecules and progressively deoxygenating the blood, eventually resulting in the failure of cellular respiration, and death. 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.

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 found on all modern automobiles eliminate over 99% of carbon monoxide produced.[114] 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".[115] As with other suicide methods, charcoal burning suicide attempters can live from the attempt, which typically leaves a person with severe brain damage due to cerebral anoxia.

Other toxins

Detergent-related suicide involves mixing household chemicals to produce hydrogen sulfide or other poisonous gases.[116][117][118][119] The suicide rates by domestic gas fell from 1960 to 1980.[120]

At the end of the 19th century in Britain there were more suicides from carbolic acid than from any other poison because there was no restriction on its sale. Braxton Hicks and other coroners called for its sale to be prohibited.[121][122]

Several creatures, such as spiders, snakes, and scorpions, carry venoms that can easily and quickly kill a person. These substances can be used to conduct suicide. For example, Cleopatra supposedly had an asp bite her when she heard of Marc Antony's death.[123]

Ritual suicide

Ritual suicide is performed in a prescribed way, often as part of a religious or cultural practice.

Sokushinbutsu
Main article: Sokushinbutsu

Sokushinbutsu is death and entering mummification while alive in Buddhism.[124]

Sati
Main article: Sati (practice)

Sati is self-immolation in Hinduism.[125][126][127]

Prayopavesa
Main article: Prayopavesa

Prayopavesa is a practice in Hinduism that denotes the suicide by fasting of a person, who has no desire or ambition left, and no responsibilities remaining in life. It is also allowed in cases of terminal disease or great disability.[128][129][130]

Vatakkiruttal
Main article: Vatakkiruttal

Vatakkiruttal is a form of Tamil ritual by fasting till death.[131][132]

Sallekhana
Main article: Sallekhana

Sallekhana is the religious practice of voluntarily fasting to death by gradually reducing the intake of food and liquids. It is viewed in Jainism as the thinning of human passions and the body, and another means of destroying rebirth-influencing karma by withdrawing all physical and mental activities. It is not considered as a suicide by Jain scholars because it is not an act of passion, nor does it deploy poisons or weapons. After the sallekhana vow, the ritual preparation and practice can extend into years.[133][134]

Seppuku
Main article: Seppuku

Seppuku ("cut-belly", used in writing) or hara-kiri ("belly slitting", used when talking) 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 died by seppuku in 1970 after a failed coup d'état intended to restore full power to the Japanese emperor.[135] 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 tantō 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) stood by, and on the second stroke would perform daki-kubi, where the warrior is all but decapitated leaving only a slight band of flesh attaching the head to the body, so as to not let the head fall off and roll on the 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.

Autosacrifice

Human sacrifice was a religious activity throughout Mesoamerica. In Aztec and Maya culture, autosacrifice involving self-decapitation by priests and kings is depicted in artworks.[136][137] The sacrifice is usually depicted holding an obsidian knife or axe to the side of the neck.[137][138]

Some forms of Durga worship in Indian Hinduism involve a male devotee offering himself as a sacrifice through ritual self-decapitation with a curved sword. This is designed to obtain a favor from the deity for a third party.[139][140]

Self-strangulation

This method involves tightening a ligature around the neck so as to compress the carotid arteries, preventing the supply of oxygen to the brain and resulting in unconsciousness and death. The technique is also associated with certain types of judo holds and restraints, and auto-erotic asphyxiation. This also may be done with twist ties.[141]

Starvation
Main article: Starvation

A hunger strike may ultimately lead to death. Starvation has been used by Hindu and Jain ascetics as a ritual method of penance (known as Prayopavesa and Santhara respectively) or as a method of speeding up one's own death,[142] and Albigensians or Cathars also fasted after receiving the 'consolamentum' sacrament, in order to die while in a morally perfect state.[143] This method of death is often associated with political protest, such as the 1981 Irish Hunger Strike by Irish republican paramilitary prisoners demanding prisoner of war status, of whom ten died. The explorer Thor Heyerdahl refused to eat or take medication for the last month of his life, after he was diagnosed with cancer.[144]

An anorexia nervosa death caused by self-starvation is not listed on death certificates as suicide. In the UK, refusal to adhere to norms regarding food and drink consumption can lead to being detained, treated and even force fed under section 3 of the Mental Health Act 1983. The effects of this can be substantial and may result in 'sectioning/involuntary commitment, with some cases demonstrating a level of persistence from mental health professionals in the resistance of such methods.[145] Force feeding has been described as "extremely unpleasant" and "undignified", with sociologist June Purvis comparing it to sexual assault.[146]

Suffocation
See also: Suicide bag and Inert gas asphyxiation

Suicide by suffocation is the act of inhibiting one's ability to breathe or limiting oxygen uptake while breathing, causing hypoxia and eventually asphyxia. This may involve an exit bag (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 due to the oxygen deprivation before the instinctive panic and the urge to escape due to the hypercapnic alarm response.

It is impossible for someone to die by simply holding their breath, as the level of oxygen in the blood becomes too low, the brain sends an involuntary reflex, and the person breathes in as the respiratory muscles contract. Even if one is able to overcome this response to the point of becoming unconscious, in this condition, it is no longer possible to control breathing, and a normal rhythm is reestablished.[147]

Because of this, one is more likely to die by suicide through gas inhalation than attempting to prevent breathing all together. Inert gases such as helium, nitrogen, and argon, or toxic gases such as carbon monoxide are commonly used in suicides by suffocation due to their ability to quickly render a person unconscious, and may cause death within minutes.[148][149]

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 and 9/11). 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. 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, e.g., "suicide by cop", that is, menacing or assaulting an armed police officer with a weapon or apparent or proclaimed harmful intent which all but ensures that the officer will use deadly force to terminate the attack. 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 bombing. They may use a car bomb or other machinery to cause maximum damage (e.g. Japanese kamikaze pilots during World War II).

Vehicular impact

Another way of completing suicide is deliberately placing oneself in the path of a large and fast-moving vehicle, resulting in fatal impact.

Rail
Lime on rails after a suicide in Mainz-Laubenheim
Members of the New York City Police Department Emergency Service Unit investigate a subway suicide on the Lexington Avenue – 53rd Street subway platform

Suicide is accomplished by positioning oneself on a railway track when a train approaches or in advance, or driving a car onto the tracks.[150] Failed attempts may result in profound injuries, such as multiple fractures, amputations, concussion and severe mental and physical handicapping.[151]

Unlike on underground railways, in suicides involving above-ground railway lines, the person 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 post-traumatic stress disorder.[152]

Europe

In the Netherlands, as many as 10% of all suicides are rail-related.[153] In Germany, 7% of all suicides occur in this manner.[154] To deal with an average of three suicide incidents per day, Deutsche Bahn is cooperating with a hospital in Malente to offer specific treatment to traumatized train drivers.[155][156][157] In recent years, some German train drivers succeeded in getting compensation payments from parents or spouses.[158] In Sweden, less densely populated and with a smaller proportion of the population living in proximity of railroad tracks, 5% of all suicides are rail-related. In Belgium, nearly 6% of suicides are rail related with a disproportionate amount occurring in the Dutch-speaking region (10% rate in Flanders). The rate of direct death is one in two. The location of many suicides occur at or very close to stations, which is also uncharacteristic of suicides in other European countries. The disruption to the rail system can be substantial.[159] In Belgium where rail service is frequently interrupted due to a high level of suicide by rail, families are expected to cover the substantial cost of rail network standstill.[160]

Japan

Trains on Japanese railroads cause a large number of suicides every year. Suicide by train is seen as something of a social problem, especially in the larger cities such as Tokyo or Nagoya, because it disrupts train schedules and if one occurs during the morning rush-hour, causes numerous commuters to arrive late for work. However, suicide by train persists despite a common policy among life insurance companies to deny payment to the beneficiary in the event of suicide by train (payment is usually made in the event of most other forms of suicide). Suicides involving the high-speed bullet-train, or Shinkansen are extremely rare, as the tracks are usually inaccessible to the public (i.e. elevated and/or protected by tall fences with barbed wire) and legislation mandates additional fines against the family and next-of-kin of the person who died by suicide.[161] As in Belgium, family members of the person who died by suicide may be expected to cover the cost of rail disruption, which can be significantly extensive. It has been argued this prevents possible suicide, as the person who is considering suicide would want to spare the family not only the trauma of a lost family member but also being sued in court; however there is insufficient evidence to support this assertion.[162]

North America

According to the Federal Railroad Administration, in the U.S., there are 300 to 500 train suicides a year.[163] A study of completed suicides on railway rights-of-ways by the Federal Railroad Administration found that the decedents tended to live near railroad tracks, were less likely to have access to firearms, and were significantly compromised by both severe mental disorder and substance abuse.[164]

A sign at a railroad crossing in the Netherlands promoting a suicide crisis line (113)

Methods to reduce the number of rail-related suicides include CCTV 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.

In southern Sweden, where a suicide hotspot is located south of the university town Lund, CCTV cameras with direct links to the local police have been installed. Similar packages will be installed on other hotspots throughout the nation.

In the Netherlands, where several suicide hotspots are located by rail tracks next to mental wards, loud speakers and strong lights that activate when trespassing is noted, have been installed next to these hotspots.

Metro system

Jumping in front of an oncoming subway train has a 59% death rate, lower than the 90% death rate for rail-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: for instance, deep drainage pits halve the likelihood of fatality. Separation of the passengers from the track by means of platform screen doors is being introduced in some stations, but is expensive.[165]

Car

Some suicides are the result of intended car crashes. This especially applies to single-occupant, single-vehicle accidents, "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."[166] 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 collide with something else on the road, and the driver could be harmed.

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%".[167] 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.'"[168]

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 people 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."[169]

Aircraft

Between 1983 and 2003, 36 pilots died by suicide by aircraft in the United States.[170] There have been well documented suicide attacks by aircraft, including Japanese Kamikaze attacks, and the September 11 attacks. On 24 March 2015, a Germanwings co-pilot deliberately crashed Germanwings Flight 9525 into the French Alps to complete suicide, killing 150 people with him.[171][172]

Suicide by pilot has also been proposed as a potential cause for the disappearance and following destruction of Malaysian Airlines Flight 370 in 2014,[173] with supporting evidence being found in a flight simulator application used by the flight's pilot.[174]

In media

A number of books have been written as aids in suicide, including Final Exit and The Peaceful Pill Handbook, the latter of which overlaps with euthanasia methods. Some books on this topic have been banned by governments.

There are also suicide sites. These sites include suicide bridges such as the Golden Gate Bridge (which has had 1558 accounted deaths as of 2012, with only 33 having survived).[175]

gollark: *Zoom* has PTT?
gollark: My teachers mostly just vaguely complain about people not being on video a lot.
gollark: I see.
gollark: It mutes and unmutes the microphone via pulseaudio, so it works for stuff like Teams which are bad and do not support PTT.
gollark: Virtually or physically? I have a neat push to talk script (for linux).

See also

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Further reading
  • Hawton, K. (1 June 2000). "Doctors who kill themselves: a study of the methods used for suicide". QJM. 93 (6): 351–357. doi:10.1093/qjmed/93.6.351. PMID 10873184.
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