An unintended asphyxiation of a para-suicide: Forensic challenges in determining the circumstances

Hanging is a common method of suicide in Sri Lanka, conventionally considered a mode of asphyxia. Partial hanging, where the entire weight of the body is not applied for the constriction of the neck due to the use of a separate rope tied around the waist for controlling the force, is a complex circumstance leading to a query regarding the intention of the individual. A 41-year-old male with a history of four previous suicidal attempts by hanging was found dead in a partial hanging in his bedroom. The body was discovered within 15 minutes after the incident in a seated position, with his neck stretched with a saline tube fixed to a rafter. There was also a nylon rope attached to his waist and to the point of suspension so that he could control the force applied around the neck by clinging on to this guy-rope. He has, on four previous occasions, done the same thing to frighten his wife. The scene examination revealed a body in a partial hanging remaining in the seated position. The family members have cut the saline tube, taking this for yet another impulsive suicidal attempt. Otherwise, the scene was undisturbed. Postmortem examination did not reveal any injuries to neck muscles, skeletal and vascular structures of the neck, except for the faint ligature mark. The rest of the body was devoid of injuries and prominent cardinal features of asphyxia. The deceased had seemingly attempted to modify the constricting force around the neck by controlling the bodyweight with a second rope. Though these types of applications are recorded in sexual asphyxias, it is virtually unheard of in suicidal hanging. In the context of his previous para-suicidal attempts, it is a challenge for the pathologist to decide whether the circumstances as accidental or suicidal. This warrants the need for a ‘psychological autopsy’ in such ambiguous cases.