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By Barbara Clark
Suicide is the ninth leading cause of death in the United States: on the average, one person dies by suicide every 16.9 minutes. For every successful suicide in the nation, 25 are attempted. Although three females attempt suicide for each male who does so, slightly more than four males manage to complete the act for every one female who is successful. Of the approximately31,000 completed suicides each year, 25,000 are men, and only 6,000 are women. The highest suicide rates are found among white men over the age of 50: although these men make up only ten percent of the population, they are responsible for 33 percent of suicides. The state with the highest suicide rate is Nevada; next is Wyoming, followed by Alaska, and Arizona. The lowest suicide rates are found in Washington DC, New Jersey, New York and Rhode Island, respectively. (Sources: American Association of Suicidology, 1994 Advance Report of Final Mortality Statistics, and American Foundation for Suicide Prevention).
The investigation of a suicide is no less complex than that ofa homicide. The investigator must establish proof that the suspect the insured had not only the intent, but the means, the opportunity and the motive to commit the act that resulted in death. Once homicide has been ruled out as the cause of death if the medical examiner believes the death may have been due to suicide the insurance investigator must then determine whether the death was intentional or accidental. But keep in mind, in the absence of positive proof of suicide, there must be strong evidence to contravene the usual presumption against suicide.
An investigation is usually conducted when the insured’s death occurred within two years of the issue date of the insurance policy. Most life insurance policies have a standard suicide provision that states if the insured, whether sane or insane, dies by suicide within two years from the issue date, the insurer will pay no more under the contract than the sum of the premiums paid. There are some differences from state to state (i.e., some states only allow the limited liability period to last one year; other states forbid the use of the phrase “sane or insane”; still others do not allow the insurer to limit its liability in the event of death by suicide unless there is proof that the insured contemplated committing suicide at the time the policy was purchased).
Suicide investigations are also conducted on Accidental Death Benefits (ADB) Insurance claims even when the death occurs more than two years after issuance of the policy. The exceptions section of the ADB provision of many insurance policies states that no payment shall be made under this benefit for any loss caused or contributed to by suicide or any attempt thereat, whether the insured is sane or insane. Again, certain states do not allow insurers to reject payment of ADB in cases of suicide if the insured was insane at the time and unaware of the consequences of his act.
The job of investigating suicides is simplified when the decedent leaves a handwritten note. However, as Eric Marcus points out in his study of the issue, “Why Suicide? ” only one of every five or six people who commit suicide leaves a note. Even when a note is discovered it often reflects only the emotional state of the individual with notations such as “I’m tired of it all,” or “Nobody understands,” or “I hope you’re satisfied,” without any reference to the actual physical act of ending one’s life or to the motive for the suicide. While the intent to take one’s own life may seem to be implied by such remarks, there have been cases in which the courts have rejected this inference as proof of intent. In the absence of other supportive and compelling evidence to show intent or motive and regardless of physical findings that prove the injury was self-inflicted it is often difficult to convince a jury that the insured’s death was not accidental.
This is particularly common in self-mutilation cases (e.g., cases in which the decedent has cut his wrists or shot himself in the rib cage as opposed to the head or heart). Investigation often reveals that these individuals have engaged in this same self-destructive behavior in the past. Whether it was a means of getting attention, a way to control someone or simply a desperate cry for help, this type of behavior has worked for them in the past: the wrist cuts have been superficial; gunshot wounds have been inflicted in a non lethal manner. Then, suddenly, the halfhearted suicidal gesture goes awry: the cuts on the wrist that were intended to be superficial are made too deeply, or the self-inflicted gunshot wound accidentally hits a vital organ.
Contrary to popular opinion, research has shown that most people who contemplate suicide do not necessarily want to die; part of them does but another part doesn’t. This ambivalence may account in part for the fact that most people whose first attempt at suicide fails will not try it again. Ten percent who try and fail will go on to kill themselves eventually. According to mental health experts, people are ambivalent because although they really don’t want die, they don’t feel that their lives are livable. They can no longer cope with what they perceive to be the insurmountable problems in their lives that cause them so much pain, anxiety and depression. Their coping mechanisms literally break down. Some attempt suicide to solicit help and end up getting the help they need. Others attempt suicide to accomplish the same end but are too successful, accidentally dying when all they really wanted was attention. Still others view suicide as the only logical solution to the overwhelming problems in their life.
It is those cases in which there is no documentation showing intent, the motive is obscure and the physical findings are ambiguous that most challenge investigators. These cases will often have a death certificate indicating that the cause is undetermined or that the death is a possible suicide. And even when a death has been unequivocally classified as suicide by the coroner’s office and the police department, the insurer still has an obligation to conduct an independent investigation to determine whether the facts support a conclusion of suicide.
The investigator’s first step is to examine the evidence already obtained and analyzed by both law enforcement personnel and the medical examiner’s office. The most obvious clues come from photographs of the scene and from all of the physical evidence found there. The specific method of death (gunshot to the head, slashed wrists, hanging, etc.) will dictate which questions are relevant. In “Why Suicide? ” Eric Marcus notes that while some who attempt suicide very much want to die and, therefore, choose the most lethal methods available, most people aren’t nearly as determined, choosing methods that are much less likely to result in death. This is especially true for women. For most people, the choice of method is rarely random.
Guns account for approximately 60 percent of the 31,000 reported suicides each year. Although most gun owners reportedly keep a firearm in their home for protection or self defense, 83 percent of gun related deaths in these homes are suicides, often by someone other than the gun owner. Fewer than ten percent of those who commit suicide actually purchase a gun with the specific intent of killing themselves; but according to the American Foundation for Suicide Prevention guns are the method used most often by both men and women to commit suicide.
The next most popular methods of suicide are hanging, strangulation, suffocation, drugs, carbon monoxide poisoning, jumping from high places and drowning. Crashing a motor vehicle, fire and electrocution are methods chosen less frequently.
The choice of one suicide method over another often varies according to age, gender, personality and occupation. For example, the majority of physicians who commit suicide do so with a drug overdose. In “The Enigma of Suicide,” George Colt notes that the suicide rate for physicians is three times the rate of the general population and that psychiatrists have the highest rate of any medical specialty. Most dentists who commit suicide use anesthetic gas. The majority of police officers use a gun. Elderly people choose more lethal methods to kill themselves than do younger people. Some individuals actually combine methods: they will ingest drugs then shoot themselves. Then there are some who deliberately select methods that will disguise the fact that their death was a suicide. The most common example is the single driver who crashes his car into an abutment or a telephone poll or even into another car. Colt estimates that as many as 15 percent of single car crashes are actually disguised suicides. Other disguised suicides include walking in front of an oncoming car, lying down on a railroad track or setting a room on fire then shooting oneself. Some people even commit suicide by either persuading or deliberately provoking another person to kill them.
Regardless of the method of death, certain basic questions must be asked of every death scene to help determine whether the death was accidental or intentional. How, when and where was the insured’s body discovered? Was there a note? If not, were any letters, wills or insurance policies or instructions found at the scene that convey how the individual wanted his money and/or personal possessions disbursed after death? Did the insured deliberately take precautionary measures to ensure his privacy so that he would not be interrupted or rescued while in the act of killing himself? Did he first lock all of the doors to his home from the inside? Was the body discovered in an abandoned building? Did the insured drive to a remote area that no one frequents? Was there any evidence of foul play? Was there any indication that the insured may have had been drinking, using drugs or on medication at the time of death?
If the death was by gunshot wound, the investigator must first determine when the body was found, its location, why the insured would be there and who else may have had access to this location. What was the position of the body? How was it clothed? Where was the insured’s body in relation to where the gun was found? The photographs should reveal the exact position of the gun, a fact which is vital to the investigation. What type of gun was used and who owned it? If it belonged to the insured, is there any receipt and/or registration to show the date of purchase? Did law enforcement test the weapon to see if it was defective in anyway? Was the gun equipped with an operable safety mechanism? Where were the entry and exit wound(s) of the bullet(s)? What was the trajectory of the bullets? If a rifle or shotgun was used, what was the distance from the trigger to the end of the barrel? Was the insured’s arm long enough to depress the trigger? If not, does it appear that the deceased used a string or his toes or any other object to depress the trigger? How many loaded cartridges and how many empty cartridges were in the gun? Was there any evidence that the insured was cleaning the gun? If any cleaning materials were found at the scene, was there evidence that they had actually been used? Was the gun’s trigger action hard or light? What was the entry site of the bullet(s)? Was there gunpowder residue and/or blood spatter on the deceased’s hands or other area of skin on the body. Note that blood spatter can aid in determining the position of the insured when he was shot and any movement after he was shot. Was the insured right-handed, left-handed or ambidextrous? Did the insured kill himself in a location where it appears he did not want to make a mess?
Most hangings are suicidal, although there are a fair number of accidental deaths that occur as a result of autoerotic asphyxiation (i.e. hanging by a noose to decrease oxygen to the brain in order to become sexually aroused). It is possible to differentiate between these autoerotic deaths and suicide because there is usually an escape mechanism sufficient to allow the individual to release himself from the noose just short of becoming unconscious. Often, too, the ropes applied to the neck will be cushioned by a towel so that the rope doesn’t leave any marks. If the insured is hanging from a tree outside or a beam in the house, there is often evidence of previous activity such as notched marks on the branches or wood beams.
In investigating hangings, the investigator will want to know what material was used for the suspension. Was it a rope, a chain, a belt, an extension cord, a sheet? What was the ligature attached to? How far off the ground/floor were the insured’s feet? Is there evidence that he was hoisted up on the rope by another person? What evidence is there to demonstrate how the insured elevated himself to the height of the noose? Was there a stool nearby or some other object below that he may have stood on and then kicked over to allow himself to become suspended? What type of knot was used?
If the insured died from drowning, the investigator will need to determine from the scene where the body was found in relation to where the insured actually entered or was believed to have entered the water. How was the body attired? Did the deceased know how to swim? How deep was the water? How far from shore was the body recovered? What was the rate of the current? Was there an undertow? Why was the insured there? Were there any trauma marks on the body? What were the weather conditions?
In the case of death by drugs and poisons, how and where was the body discovered? How was it clothed? What was the name of the drug or poison? What was that particular drug(s) used for? If a poison, what is that poison used for? How would this individual have access to it? Did he use it in his job? How were either of these substances obtained? If this was a medication, who prescribed it? When and why was it prescribed? What was the prescribed dosage? When was the prescription originally filled or the date of the last refill? How many pills were remaining in the prescription bottle at the time of the insured’s death? Is there any evidence that the insured had also been drinking?
Death by carbon monoxide poisoning most often occurs as a result of inhalation of exhaust fumes from a motor vehicle. In these cases it is important to know the exact position of the body within the vehicle. Was the key in the ignition and was itin the on position? Was the motor still running; if not how much gas was left in the tank? Were the windows rolled up in the vehicle? Were the doors locked? If the vehicle was inside a garage or other building, were the doors and windows to this building closed? What were the weather conditions that day? If the garage was an extension of the house, were there any towels or other material against the door leading from the garage to the inside of the home? Did the police find any hoses and how were they connected? What was the mechanical condition of the vehicle? Was there any evidence of recent repairs? . Was there evidence that the insured was actually doing any mechanical repair work on the vehicle?
In the case of a fall or jump, the details of the scene should reveal what efforts the insured had to make to get to where the jump or fall occurred. Could anything explain why the insured might have been at this spot? What was the distance and angle of the fall? Were there any barriers or obstructions to the location that the insured jumped or fell from? Did the insured remove a screen from a window? Did the insured climb over or move any piece of furniture or stand on top of a radiator to get to the window? If the insured appears to have fallen or jumped from a roof, is there any reason he would have been up on the roof? Is there any evidence he was repairing the roof? If there was a ledge, how far did it extend out from the walls of the building? If the insured appears to have jumped or fallen from a scaffold, how high was it off the ground? Why would he have been on the scaffold? Were there any defects in the scaffolding equipment itself? If he fell or jumped from a bridge, how did he get there and why would he have been there?
Whenever an autopsy has been performed, the insurance investigator will need to obtain the findings. An autopsy is done to help determine the cause and manner of death. Autopsy findings can help establish the approximate time of death, the state of the insured’s health by virtue of both an internal and external examination of the body, the location and number of injuries, the paths of the wounds, and whether the insured was capable of moving after a suspected self inflicted wound.
The report of the coroner’s investigator should be reviewed to determine any medical sources that may know of the deceased’s past medical and/or psychiatric history. This report will also identify those persons with whom the coroner or his investigator had conversations and what statements were made by friends, family and associates that support a finding of either suicide or accident.
Regardless of the method of death, for each and every case, the investigator needs to determine whether there were alcohol or drugs in the deceased’s body at the time of death. If so, was the quantity consumed enough to kill the insured exclusive of anything else? Did the insured consume a negligible amount that would have no contributing effect on the death, or could the amount ingested impair the judgment of the insured such that he would not have understood the consequences of his actions. The toxicology report from the medical examiner’s office should address all questions concerning chemical substances in the decedent’s body.
The next critical step is to develop as much background information as possible on the decedent. At this point in the investigation, the questions of “what,” “where” and “when” have been answered, but the investigator still may not know “why. “ Even when a note is found at the scene, it usually is more of a description of the victim’s emotion than any literal explanation or motive for the suicide. And, in most suicide cases there is no note at all.
The answer to the question of motive and whether the act was intentional may surface in the subsequent interviews with friends, family, neighbors, employers, coworkers, relatives, physicians, virtually anyone who may have had an association with the decedent. Who was the last person to see the insured alive? Who was the insured’s closest friend and confidant? What happened within the past few months of the insured’s life? What was his reaction to these events, and what was his state of mind during that period?
The questions asked become as significant as the manner in which they are asked. The more knowledgeable the investigator is about the subject of suicide the better equipped he is to extract the information he needs efficiently and sensitively. It would be easy if there was such a thing as a “suicide type,” but research has concluded that there really is no such thing type. The best that researchers have done is to identify “indicators” for possible self-destructive behavior. While these indicators may not be exact predictors of future behavior, their reliability is quite strong.
People who suffer from a wide range of emotional disorders are at a higher risk of committing suicide. MGill’s Medical Guide to Health and Illness, Vol. III, identifies depression as the most common mental illness that causes suicidal thoughts. According to the American Foundation for Suicide Prevention, over 60% of those who commit suicide suffer from major depression. About 15% of the population will suffer from clinical depression at some time during their lifetime, and 30% of all clinically depressed patients attempt suicide. Half of those who try it succeed. In “Why Suicide,” Eric Marcus describes the symptoms of major depression; these include a depressed or irritable mood, a loss of interest or pleasure in usual activities, changes in appetite and weight, disturbed sleep, motor retardation or agitation, fatigue and loss of energy, feelings of worthlessness, self reproach, excessive guilt, difficulty in thinking or concentration and suicidal thinking or suicide attempts.
People who are chronically depressed or in the depths of depression are often too ill even to make the decision to commit suicide, let alone to act on that decision. Often in interviews, the family will acknowledge that though the deceased had been depressed for several months, just preceding the death he appeared to be emerging from depression. The family will often cite behavior that supports this observation (e.g., the insured had returned to work, was planning a trip, had resumed a social life.)
“Facts and Fables on Suicides” by Edwin Shneidman cites research showing that most suicides occur within about three months following the beginning of improvement, when the individual has enough energy to put his morbid thoughts and feelings into effect. That is why we sometimes see a situation in which the depressed person kills himself very shortly after beginning therapy and/or starting on antidepressant medication. But while chronic depression and other mental disorders may be an indicator for suicide, in thousands of cases there is no history of depression or other emotional disorder and where the decision to commit suicide, although seemingly impulsive, is a competent and rational decision.
It is known that people who abuse alcohol and other drugs are at an increased risk for suicide. Studies have shown that about 90 percent of alcoholics and more than a third of non-alcoholics who commit suicide had been drinking prior to taking their lives. American Foundation for Suicide Prevention statistics indicate that 96 percent of alcoholics who commit suicide continue their substance abuse until the end of their lives. Alcoholism is a factor in about 30 percent of all completed suicides. Eighteen percent of alcoholics die by suicide, and 87 percent of these deaths are males. Suicide investigators commonly find that the victim died from a combination of alcohol and prescribed medication. The question then is whether death was due to the synergistic effect of the alcohol and drugs and whether this was a deliberate mixing of the two in order to accomplish the death.
People who are terminally ill or who experience unrelenting pain and discomfort because of some disabling condition will often resort to suicide or assisted suicide to end their suffering. Patients with cancer, respiratory illnesses and AIDS and those being maintained on hemodialysis have higher suicide rates, according to the “1997 Current Medical Diagnosis and Treatment” by Tierney, MePhee and Popadakis. The American Foundation for Suicide Prevention claims that those with AIDS have a suicide risk up to 20 times that of the general population. There is growing support for the idea of assisted suicide. When a CNN Gallup poll from April 1996 asked if doctors should be allowed by law to end a terminally ill patient’s life by some painless means at the request of the patient and his family, 75 percent of the respondents answered affirmatively. For now, however, assisted suicide is still illegal and unregulated, so these suicides are difficult to prove. When the patient is already terminally ill and ravaged by disease, the death may appear natural especially if it was a result of an overdose and did not involve any violent measures. If there is no suspicion, there is also no autopsy.
In light of the above, it is imperative in the investigation of suicide to interview any medical practitioner who may know about the insured’s physical and mental health. As noted by George Colt in “The Enigma of Suicide,” an estimated 75 percent of all suicides see a doctor within four months of taking their lives, and as many as 10 percent see a physician the day of the suicide or immediately prior.
The scope of the investigation must also cover the subject of the suicidal gestures (e.g., the victim claims to want to kill himself then swallows a non lethal dose of pills.) In these cases, there’s no real intention to die so much as there is a desperate plea for help. Unfortunately, the suicide gesture is sometimes botched, resulting in an unintentional death. At the other end of the spectrum are those people who really do want to end it all; no matter how many times they fail at suicide, they keep trying until they succeed. George Colt indicates that a previous attempt is the highest predictor of suicide risk: between 30 and40 percent of suicides have tried before; one percent of those who attempt will complete the suicide within one year, and 10 percent will do so within 10 years.
The investigator needs to determine if the victim was trying to put his affairs in order. Was a will recently drawn up or were codicils added to an existing will? Had the victim suddenly begun giving away personal possessions? Were any packages or letters mailed by the insured on the day of his death?
Approximately 75 percent of suicides give some warning of their intentions to a friend or family, so it is important to discover whether the insured had been making comments that suggested suicidal ideation (e.g., “I’d be better off dead. “, “I might as well check out. “, “You’d be better off without me around” or “You’ll be sorry. “). Did the insured convey feelings of hopelessness (e.g., “What’s the use? ” or “Why even try anymore?”)? If the insured had serious medical problems, had he made statements such as, “They’ll never find a cure,” or “I can’t take the pain anymore.“?
Many individuals methodically plan their suicides over a period of several weeks or months. They seek out information about different ways to commit suicide. They may ask friends about different types of guns, or they may go out and purchase books about various weapons. Some will check out the effects of drugs or combinations of drugs with their doctors or local pharmacists, or they may buy books, such as “Final Exit,” with explicit instructions on how best to accomplish suicide. The investigator should determine if the insured was preoccupied with obituary notices or was talking about friends or relatives who had died.
Another critical consideration is the financial status of the decedent. What was his source of income? Was he employed? Had he recently been fired? If he was working, was he living within his means? Did he have any recent financial losses resulting from a lawsuit, a divorce, gambling, medical expenses, etc.? Had he bounced any checks? Was he behind in payment of alimony or child support payments? Was he behind in his car, mortgage or utility payments?
What was his personal status? Was he married, separated, single, divorced? If he was married, were there any problems in the relationship? Was either spouse having an affair? If he was divorced or separated, how recently did it happen? Many people commit suicide to get revenge or to punish those they believe are responsible for hurting them.
Did the person suffer a sudden loss, such as the death of a best friend, pet or family member? Did he lose his job or experience a demotion? Had he been publicly humiliated or embarrassed in some way? Was there some sort of outside threat (e.g., was the insured being stalked or blackmailed? Was he being audited by the IRS or under investigation by law enforcement? Were there pending criminal charges? )?
A thorough investigation requires supplementing the information obtained through personal interviews with information available through database searches. Accessing online public records can provide additional clues to the insured’s life during the months before his death bankruptcy information, sale of property, civil litigation, divorce data, criminal records, etc. In the majority of cases, the compilation of data obtained and analyzed from all of these sources should clearly resolve whether the death was intentional or accidental.
The loss of a family member to suicide is, without question, devastating to the survivors. Each suicide intimately affects at least six other people. Not only are they struggling with a range of emotions including guilt, anger, grief, recrimination and denial; they often suffer feelings of shame because of the stigma that society unfortunately continues to place on death by suicide. An awareness and understanding of the survivors’ fragile emotional state is crucial. Demonstration of sensitivity to their plight is imperative in conducting suicide investigations.
Barbara Clark has been employed by the Prudential Insurance Company for the past 21 years. She is a special investigator working out of the Florida office.
© Copyright 1997 Alikim Media