A hard way to die: when multiple lethal gunshots mean suicide

Suicide or Homicide? A Case of Self-Inflicted Triple Gunshot Wound by Double-Barrel Shotgun

“…The first group includes the number and localization of the entrance wounds, shooting distance, direction of the bullets' paths, and presence of firearm discharge residues on the victim's hands. Scene findings, such as the location of the weapon in the hand or near the victim's body and the presence of suicide notes, as well as a history of previous suicide attempts, psychiatric disorders, or malignancies, provide fundamental information for the determination of the manner of death 2,7,13,14 …”

“…The CNS can be disrupted or indirectly impaired by bleeding-related cerebral hypoxia and intracranial hypertension due to massive edema or blood loss 8 . Among the reasons accounting for multiple gunshots are lack of knowledge of anatomy, missing vital organs, malfunctioning ammunition, or the shooter's wrong choice of the ammunition caliber 7,13 …”

“…In such cases, circulatory compensation mechanisms can allow residual physical activity in the range of minutes, hours, or even days. When “rapidly lethal” or “delayed incapacitation” targets are involved, evaluation of the victim's ability to act after the first injury represents a fundamental—although sometimes controversial—element for the forensic pathologist to distinguish between suicide and homicide 3,7,10 . The anatomical distribution of injuries in particular represents a crucial element to determine the individual's potential for physical activity after the different shots to properly reconstruct the dynamics of the event.…”

“…In the rare event that the heart was affected in diastole, the hydrodynamic explosive effect on the expanded ventricle muscles may have been so destructive as to be immediately fatal, so the cardiac shot was the last one 12 . More often, people who sustain gunshot wounds to the heart maintain the ability to act for several tens of seconds; therefore, the victim may have fired 1 more shot in the left chest 7,8,12,18 . An unusual case of multishot suicide involving the heart has been described by Habbe et al, 24 with 2 bullets penetrating the lower lobe of the right lung and 7 bullets disrupting the apex of the heart.…”

“…Suicidal deaths by multiple shots, including those caused by 2 guns, are not commonly described in forensic literature 4–6 . If not rare, in fact, multiple suicidal gunshot wounds are very infrequent, with reported incidences ranging from 0% to 5% 7 . In most cases where more than 1 entrance wound is present, it is particularly difficult for the forensic pathologist to differentiate between homicide and suicide, with the evaluation of residual “ability to act” after all but the last gunshot playing a crucial role in the diagnosis of the manner of death 8,9 …”