Two cases of firearm-related murder–suicide: Forensic implications of the ability to act

Introduction

One of the most important tasks in forensic medicine is differentiating between a homicide and a suicide. Single gunshot wounds located in the victim’s vital organs, usually the head and thorax, represent a typical scenario in firearm-related suicides. In most of these cases, a penetrating gunshot wound to these parts of the body lead to incapacitation of the victim and an immediate fatal outcome.¹ However, in rare occasions, the forensic pathologist will be faced with multiple gunshot suicides where one shot did not have an instant lethal effect, enabling the victim to inflict more injuries by firing further missiles. When the deceased’s body at the crime scene shows multiple gunshot wounds to the vital organs, in everyday forensic practice, the death is regarded as a homicide, leading to misinterpretation of the victim’s ability to act after two or more gunshots.² The following text describes two cases concerning multiple suicidal gunshot wounds to the head and thorax. They involve rare cases of multiple self-inflicted gunshot wounds to the vital organs in which the victim was able to shoot himself twice, yet preserving his cognizance.

Case reports

Case 1

A 45-year-old man killed his ex-girlfriend while having an argument. He then committed suicide, with two contact wounds to the submental area. An external examination and autopsy discovered two gunshot wounds to the head, 0.6 cm apart (Figure 1).

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Figure 1.

The appearance of two close-range gunshot entrance wounds in the submental area. Wound A (red arrow) showed characteristics of close contact. Wound B (green arrow) showed characteristics of near contact.

Gunshot wound A

The entrance wound in the submental area presented as an oval skin defect with a diameter of 15 mm, with the aspect of a close-contact entrance wound without surface burning, propellant soiling or powder tattooing. The exit wound located in the left part of the forehead presented as an oval skin defect with a diameter of 5–6 mm (Figure 2). The wound trajectory connecting both defects ran from the right to the left, upwards from below, through the tongue, hard palate, facial bones, left frontal lobe and upper layer of the squama of the frontal bone, in which a channel 17 mm long and 12 mm wide was created.

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Figure 2.

The appearance of the exit wound in the left temporal area.

Gunshot wound B

The oval-shaped entrance wound (diameter of 7 mm) was located in the submental region, lower than the previous one, with the aspects of a close-range but not firm-contact wound. Concentric abrasion collar and powder tattooing were present around the wound. The wound channel went from right to left, upwards from below, through the tongue, soft palate, the left cerebral crus, left lateral ventricle and left parietal lobe, exiting through the upper layer of the squama of the left parietal bone. The cause of death was brain contusion due to the penetration of the bullet. Thorough police investigation and autopsy excluded homicide and deduced that the victim committed suicide. Concerning the victim’s ability to act and keeping in mind the gunshot trajectories, the first gunshot (gunshot A) affected only the soft tissue of the frontal face region, without any serious brain tissue damage, which did not limit the victim’s ability to act. The second shot lead to the contusion of the left parietal hemisphere and the left cerebral crus destruction and ultimately death.

Case 2

A 49-year-old man killed his wife with a handgun, shooting her in the chest twice while having an argument. A few hours later, he was found dead in his car, sitting in the front seat with a handgun next to his body. An external examination and autopsy disclosed two gunshot wounds to the chest, 20 mm apart (Figure 3).

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Figure 3.

The appearance of two close-range gunshot entrance wounds to the chest. The laterally positioned wound (green arrow) showed characteristics of close contact. The medially positioned wound (red arrow) showed characteristics of near contact.

Gunshot wound A

The close-contact entrance wound presented as an oval skin defect with a diameter of 8 mm. There were no marks of surface burning, propellant soiling or powder tattooing. The wound track connecting both defects ran front to back, slightly downwards and slightly to the left through the fourth left rib, left lung and finally through the ninth left intercostal space in the vertebral line.

Gunshot wound B

The second entrance wound, located lateral to the first, had aspects of a close-range but not firm-contact wound. Namely, it presented with a concentric abrasion collar and oval powder tattooing. The bullet had passed through the fourth left intercostal space, the upper and lower lobes of the left lung, and through the eighth left intercostal space in the midclavicular line. The direction of its tracing was from front to back, slightly downwards and slightly to the right. Damage to the clothing demonstrated the similarity to the entrance wound (Figure 3). In both cases, all toxicological investigations of blood and urine were negative. Gunshot residues were present around the entrance wounds and on the right hand.

Discussion

In both previously described cases, there was no doubt about the cause of death: multiple vital organ destruction (brain or lungs) due to the penetration of a bullet. However, these two cases are important, as suicides with multiple gunshot wounds are very uncommon. The recent literature has reported that multiple gunshots account for 0–3.6% of all suicidal shootings.³ In these cases, lethal suicidal gunshot wounds are usually located to the head (81%) and the chest (17%), with other regions not as common as those previously mentioned .⁴ The importance of the two cases described here is even greater when it comes to situations when numerous self-inflicted gunshot wounds are not lethal, enabling the victim to act voluntarily after the first gunshot. The extent of ability usually depends not only on the location of the wound and damaged structure, but also on the physical and intellectual status of the victim.⁵ Hence, the question over the victim’s ability to act after the first injury represents an ongoing forensic controversy, especially in cases of numerous suicidal gunshot wounds.

In the cases described here, lack of immediate incapacitation occurred because the first gunshot did not affect the vital organs of either the central nervous system (the brain stem or vital regulatory centre) or the chest cavity (the heart or vital blood vessels). In such cases, acute blood loss is relatively slow, which may explain the duration of the survival period and victim’s ability to act, although this varies from individual to individual. According to Di Maio, blood loss causes difficulties in basic functioning when it exceeds 20–25% of the total blood supply. On the other hand, in cases when someone loses more than 40% of the total blood supply, the condition is certainly life-threatening. Thus, the rapidity and pace of bleeding, the amount of blood loss, the characteristic of the injury and the body’s physiological response (vital stress reaction) all determine the duration of the victim’s ability to act until final incapacitation and death. According to the literature, that period varies from seconds to hours.⁴

With all of this in mind, there is no doubt that these cases often raise suspicion of homicide, given that the victim’s ‘ability to act’ is one of the most important questions in everyday forensic practice. Consequently, the appearance of the entrance wound, as well as the nature of the gunshot wound, can provide strong evidence of suicide.

In cases dealing with multiple gunshot wounds, the appearance of the entrance wounds can be one of the important factors indicating the possible manner of death. In the first case presented here, although both entrance wounds had characteristics of close-range wounds, the difference in their appearance made the distinction between the first and second shots clear. The laterally placed wound showed traits of a close-contact entrance wound, while the medially positioned wound presented characteristics of a close-range but not firm-contact wound.

The first case suggests that the craniocerebral trajectory of gunshot wounds going through the anterior fossa are not necessarily incapacitating. In this case, the base of the anterior cranial fossa and the sella turcica functioned as a bony barrier, protecting parts of the brain located in the immediate environment relative to the projectile tracing against overpressures and cavitational tissue translation. Thus, the appearance suggested that the close-range, laterally positioned, tight entrance wound was the first to be inflicted. The differences between these two entrance wounds could be explained by the fact that after the first gunshot, the victim may not have been able to determine the behaviour of the second shot, probably due to the pain, vital physiological stress reactions and damage to the affected structures – in this case, the facial bones and the frontal lobe of the brain. In this case, injuries made by the first gunshot did not lead to instant incapacitation, enabling the victim to pull the trigger once again. The second shot through the brain stem led to instant incapacitation due to the disruption to the brain-stem tissue. In this case, the victim’s ability to act after the first gunshot can be explained by the fact that the first gunshot injury preserved the area of the central nervous system responsible for immediate incapacitation. Additionally, according to the literature, oxygen reserve in the central nervous system provides the potential for physical activity for about 10 seconds – enough to pull the trigger once again. The literature also suggests that in most suicides dealing with more than one gunshot wound to the head, only the frontal or one of the temporal lobes of the brain are injured, as was the case here.⁵

In the second case, the lack of immediate incapacitation occurred because the first gunshot did not affect any of the vital organs in the chest cavity (the heart or principal blood vessels). Thus, the acute but relatively slow blood loss resulted in a period of survival and ability to act, which varies from individual to individual. In cases of self-inflicted wounds located in the chest, particularly the precordial region, apart from the potential differences in the appearance of the entrance wounds, the interpolation of clothing between the open end of the barrel of a firearm and the skin could also affect the appearance of the entrance wounds. In particular situations where the reconstruction of a shooting is necessary in order to assess muzzle-to-target relation, the most common point of interest is the victim’s outerwear. In these cases, the estimation of the distance between the firearm muzzle and the skin is based on patterns of burned and partially burned particles on the clothing. In the second case, the victim did not remove his clothing to expose the skin, enabling the projectiles to penetrate all layers of clothing.⁶ Thus, the appearance of the disintegration of clothing at the entrance sites indicated the contact distance with radial tearing. The fact that the winter jacket that the victim was wearing did not exhibit stippling perforations also indicated the contact distance (Figures 4 and 5). These findings are in accordance with the data presented by Kusluski et al. who pointed out that fabric sections in most cases exhibit stippling perforations at a distance of ≥2.5 cm, but not in cases of contact distance wounds.⁷

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Figure 4.

The larger outer damage corresponding to the entrance wounds had an irregular shape and slightly burned margins.

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Figure 5.

The inner damage to the clothing corresponding to the entrance wounds, indicating contact distance with radial tearing.

Toxicological analyses were negative in both cases, contrary to the literature dealing with high levels of ethanol or illicit drugs in such cases. This fact is important because there were no extenuating circumstances that could have influenced the decedent’s determination to commit suicide.⁸

The importance of the two above-mentioned cases also lies in the fact that they represent homicide–suicide events that are widely covered by the media, affect whole communities and are therefore an important public-health problem.⁹ By definition, homicide–suicide alludes to an individual who commits homicide and subsequently takes their own life.

The main problem is that the risk factors for homicide–suicide at the level of the individual, family or community are deficient and are almost always limited to separate investigations conducted by the police and legal services or by forensic pathologists. In the two cases presented here, the data concerning the tragic events are in accordance with the general standing points – the offenders were previously mentally and physically healthy, male, middle-aged men. Both victims were the female intimate partners of the offenders, who were killed using the firearms.^10,11 Furthermore, the homicide–suicides in both cases resulted from situations and everyday life situations associated with intimate partner strain and general psychological stress, but in the absence of any organic reason that could excuse the perpetrator’s violent act. Additionally, it is worth mentioning that in both cases, the perpetrators used firearms as a highly lethal method to commit not only homicide, but also suicide. This could further explain the perpetrator’s firm will to commit suicide after the homicide.¹²

Conclusion

The cases presented here are interesting reports in the forensic literature concerning multiple suicidal gunshot injuries, with the main focus on the fact that autopsies dealing with more than one gunshot wounds should be primary treated as homicide until proven otherwise. The most important issue in these cases is to rely on the crime-scene circumstances and clinical history, with particular emphasis on the seriousness of the injuries, which could explain ability to act, thereby excluding potential homicide. Only in that way can the forensic pathologist prevent any wrong conclusions concerning conditions relevant to the lethal event.