1
|
Helium Suicide, a Rapid and Painless Asphyxia: Toxicological Findings. TOXICS 2022; 10:toxics10080424. [PMID: 36006103 PMCID: PMC9412544 DOI: 10.3390/toxics10080424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023]
Abstract
Suicide by helium inhalation has become increasingly common in the last few decades in Europe and the US because it produces a quick and painless death. Inhaled-gas suicides can easily be assessed through death scene investigation and autopsy. However, helium is a colorless and odorless inert gas that unfortunately cannot be detected using standard toxicological analysis. A successful gas analysis was performed following the suicide of a 17-year-old female. For the detection of helium, central/peripheral blood samples and gaseous samples from the esophagus, stomach, and upper and lower respiratory airways (from the trachea and the primary left and right bronchia) were collected with a gastight syringe, ensuring minimal dilution. Qualitative analyses were positive in all gaseous samples. Quantitative analyses were performed using a special gas-inlet system with a vacuum by which the sample can be transferred to a mass spectrometer, reducing the risk of contamination. Helium concentrations were 20.16% from the trachea, 12.33% from the right lung, and 1.5% from the stomach. Based on the high levels of helium, the cause and manner of death were assessed as asphyxia suicide by inhalation of helium. Therefore, toxicological analyses should always be applied in order to gain evidence of inhaled gas in gaseous samples.
Collapse
|
2
|
van den Hondel KE, Punt P, Dorn T, Ceelen M, Aarts F, van der Zande D, van Kuijk S, Duijst W, Stumpel R, van Mesdag T, Vervoort W, IJzermans A, de Vries P, Verweij J, van Remmen J, Van Hooren R, Kruyver B, Buster M, Reijnders UJL. Suicide by helium inhalation in the Netherlands between 2012 and 2019. Forensic Sci Int 2020; 318:110566. [PMID: 33168418 DOI: 10.1016/j.forsciint.2020.110566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In 2012 and 2013 a movie and a book about a 'dignified end of life' were published in the Netherlands. These items described suicide using an 'exit bag' to establish asphyxiation using helium (the helium method). 'Right-to-die-organisations' inform the elderly about this method. The purpose of this study is to investigate whether the use of suicidal asphyxiation by means of the helium method substituted other, related, methods following its publication in the Netherlands. MATERIAL AND METHODS We analysed suicides in the Netherlands over the period from 1 July 2012 to 30 June 2019. We compared the number of deaths caused by the helium method with other, related, cases. Secondly, we related these deaths to the total number of inhabitants and suicides recorded by Statistics Netherlands. RESULTS The study showed a stable trend in the use of the helium method in the period 2012-2019 and this was the same for the other, related methods. Individuals using the helium method were significantly younger than those using other, related, methods. At the scene of death, information about suicide and suicide notes were found more often at 'helium method' cases than with the 'other, related, methods' cases. Family was significantly more often present during a helium method suicide than during suicide by other, related, methods. DISCUSSION The number of suicides by the helium method and other, related, cases is stable in the Netherlands over the past years. Therefore, we conclude that there is no substitution effect within this category of suicides. Whilst 'right-to-die-organisations' strive to inform the old and sick of the helium method, it is noteworthy that the individuals using the helium method are significantly younger than the individuals who choose other, related, methods.
Collapse
Affiliation(s)
| | - Priscilla Punt
- Forensic Physicians Rotterdam Rijnmond, Rotterdam, the Netherlands
| | - Tina Dorn
- Public Health Service, Department of Epidemiology, Health Promotion & Health Care Innovation/Department of Forensic Medicine, Amsterdam, the Netherlands
| | - Manon Ceelen
- Public Health Service, Department of Epidemiology, Health Promotion & Health Care Innovation/Department of Forensic Medicine, Amsterdam, the Netherlands
| | - Francée Aarts
- Public Heath Service, Department of Forensic Medicine, Nijmegen, the Netherlands
| | - Dianne van der Zande
- Public Heath Service, Department of Forensic Medicine, The Hague, the Netherlands
| | - Sieb van Kuijk
- Public Heath Service, Department of Forensic Medicine, Zwolle, the Netherlands
| | - Wilma Duijst
- Public Heath Service, Department of Forensic Medicine, Zwolle, the Netherlands
| | - René Stumpel
- Public Heath Service, Department of Forensic Medicine, Bussum, the Netherlands
| | - Taco van Mesdag
- Public Heath Service, Department of Forensic Medicine, Groningen, the Netherlands
| | - Will Vervoort
- Public Heath Service, Department of Forensic Medicine, Tilburg, the Netherlands
| | - Anke IJzermans
- Public Heath Service, Department of Forensic Medicine, Den Bosch, the Netherlands
| | - Philip de Vries
- Public Heath Service, Department of Forensic Medicine, Leiden, the Netherlands
| | - Jeroen Verweij
- Public Heath Service, Department of Forensic Medicine, Utrecht, the Netherlands
| | - Jacquo van Remmen
- Public Heath Service, Department of Forensic Medicine, Gelderland Midden, the Netherlands
| | - Roland Van Hooren
- Public Heath Service, Department of Forensic Medicine, Maastricht, the Netherlands
| | - Bart Kruyver
- Public Heath Service, Department of Forensic Medicine, Hollands Noorden, the Netherlands
| | - Marcel Buster
- Public Health Service, Department of Epidemiology, Health Promotion & Health Care Innovation/Department of Forensic Medicine, Amsterdam, the Netherlands
| | - Udo J L Reijnders
- Public Health Service, Department of Forensic Medicine, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Sinyor M, Williams M, Vincent M, Schaffer A, Yip PSF, Gunnell D. Suicide deaths by gas inhalation in Toronto: An observational study of emerging methods of suicide. J Affect Disord 2019; 243:226-231. [PMID: 30248633 DOI: 10.1016/j.jad.2018.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/04/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Suicide death by gas inhalation has been the subject of global scientific interest due to a rapid increase in the use of helium and charcoal gas for suicide. These may be particularly amenable to means restriction strategies. There has been little scientific attention of this phenomenon in Canada. METHODS A review of coroner records was conducted for all suicide deaths in Toronto (1998-2015). Deaths were categorized as due to inhalational asphyxia by compressed gas (i.e. helium or nitrogen), charcoal burning or motor vehicle exhaust, with suicide deaths by other methods as a comparator. Demographic, clinical and suicide specific differences between decedents in these four categories were compared using chi-squared or ANOVA global test of significance with additional pairwise comparisons where appropriate. Secular trends were also examined. RESULTS Gas inhalational deaths accounted for 190 (4.7%) of all suicides in Toronto (n = 4062) over the study period and a higher proportion of males used compressed gas or motor vehicle exhaust gases than those who died by other methods (83.3% and 84.0% vs.69.7%, both p = 0.01). Comparing 1998-2003 to 2010-2015 there was a 1075% increase in deaths by helium (4 vs. 43 deaths) and a 533% increase in deaths by charcoal burning (3 vs. 16 deaths) although helium and charcoal burning deaths still accounted for only 4.2% of total suicides 2010-2015. Deaths by helium were more likely to be accompanied by the book "Final Exit" than those by non-inhalational methods (15% vs. 0.7%, p < 0.0001) while 13 of 14 people who died by charcoal burning whose ethnicity could be determined were Asian. LIMITATIONS Ethnicity and specific details of procurement of suicide methods were not systematically available in coroner records. DISCUSSION Suicide by inhalational asphyxia, particularly by compressed gases, has increased substantially over time in Toronto consistent with observations in other countries. Increased surveillance of these deaths, efforts to restrict access to these methods, and timely interventions including minimizing media reporting are all warranted.
Collapse
Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Canada.
| | - Marissa Williams
- Sunnybrook Health Sciences Centre, Toronto, Canada; Athabasca University, Athabasca, Alberta, Canada
| | | | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Paul S F Yip
- Centre for Suicide Research and Prevention, Hong Kong; University of Hong Kong, Hong Kong
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| |
Collapse
|
6
|
Azrael D, Mukamal A, Cohen AP, Gunnell D, Barber C, Miller M. Identifying and Tracking Gas Suicides in the U.S. Using the National Violent Death Reporting System, 2005-2012. Am J Prev Med 2016; 51:S219-S225. [PMID: 27745610 DOI: 10.1016/j.amepre.2016.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/28/2016] [Accepted: 08/03/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Identifying the source and specific type of gas used in suicides is difficult using most data systems owing to limitations in ICD-10 coding. The National Violent Death Reporting System (NVDRS), with its rich collection of both coded and free-text variables, has the potential to overcome these limitations. This study used a multipronged approach to identify gas-specific suicides in NVDRS and to track the incidence of these suicides over time. METHODS Using suicide cases from the 16 NVDRS states that participated throughout 2005-2012, free-text and code searches were conducted for four types of variables-incident narratives, coroner/medical examiner cause-of-death statements, cause-of-death codes, and substance names-to identify suicides by carbon monoxide, helium, hydrogen sulfide, and four other gases. All analyses were conducted in 2015. RESULTS Approximately 4% (3,242 of 80,715) of suicides recorded in NVDRS over the study period were the result of gas inhalation. Of these, the majority (73%) were carbon monoxide suicides (almost exclusively from motor vehicle exhaust and charcoal burning). Other types of gas (most notably helium), once rare, are now more common: At the start of the study period non-carbon monoxide gas suicides represented 15% of all gas suicides; at the end of the study period, they represented 40%. CONCLUSIONS Public health policies to reduce a suicidal person's access to more lethal suicide methods require a reliable source of surveillance data on specific methods used in suicide. Small changes to NVDRS could make it an efficient and nimble surveillance system for tracking these deaths.
Collapse
Affiliation(s)
- Deborah Azrael
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Bouve School of Health Sciences, Northeastern University, Boston, Massachusetts.
| | - Alexander Mukamal
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Yale College, Yale University, New Haven, Connecticut
| | - Amy P Cohen
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - David Gunnell
- Bouve School of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Catherine Barber
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; School of Social and Community Medicine, Faculty of Medicine and Dentistry, University of Bristol, Bristol, United Kingdom
| |
Collapse
|