Suicide versus self-inflicted: is it time to change manner of death classification?

Abstract

Suicide is ‘‘the act of taking one’s own life’’ [1]. Hanzlick et al. [2] deem that suicide ‘‘results from an injury or poisoning as a result of an intentional, self-inflicted act committed to do self harm or cause the death of one’s self.’’ No other manner of death classification carries the same stigma, or is likely to provoke as much protest from relatives, as a classification of suicide. The other reason the term is found to be so objectionable is because of the reduced indemnity paid to surviving family members by some insurance companies in comparison to payments they might make if a death is classified as accidental [3]. The stigma attached to suicide is universal. In some societies successful suicide elicits condemnation from certain religious groups and the denial of certain religious rituals, such as the body not being buried on sacred ground. It was only in 1983 that the Roman Catholic Church changed cannon law to allow proper funeral rites and burial in church cemeteries for those who had died by their own hand [4]. In other societies and organizations, including the US military, a person who has made an unsuccessful suicide attempt still faces legal sanction for committing the crime of attempted suicide [5–7]. Neighbors of the victim may also perceive them to be ‘‘weak,’’ ‘‘reckless,’’ ‘‘selfish,’’ or ‘‘mad,’’ while in other cases family members are thought to be partly responsible [8]. In contrast a homicide ‘‘is the killing of one person by another’’ [1]. Essentially a strict liability definition applies. The perpetrator’s intent is inferred from their actions regardless of whether they actually intended to kill or not. The task of determining what charges will be made, if any, is left to the legal authorities, who have fashioned various classifications of homicide to address different circumstances. No such mechanisms exist to punish the successful suicide. The victim/‘‘perpetrator’’ cannot be held responsible for their ‘‘homicide.’’ Would these cases be better classified as ‘‘self-inflicted’’ with degrees of self-infliction to be determined by other agencies independent from the medical examiner’s office? The following three cases are described to illustrate the point: