Plastic bag asphyxia results from decreased oxygen concentration in the available inspired air and physical obstruction of the mouth and nose (257). The latter mechanism arises when a plastic bag becomes electrically charged and adheres to the face, aided by
(A) Elderly woman. (B) Neck pallor created by condensation (242,257). Alternatively, the placement of the plastic bag on the face may stimulate the sympathetic nervous system, resulting in a terminal arrhythmia.
As a method of suicide, plastic bag suffocation is more common among the elderly (Fig. 51; refs. 307-309). This could be because of the availability and easy use of plastic bags (307,309). Death is relatively painless and would appeal to older and more debilitated individuals (307,309). Plastic bag asphyxia has been described in Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying, published by the Hemlock Society, a right-to-die group (56,307,309,310). In the year after its publication, the number of plastic bag asphyxial suicides in New York increased, but the overall suicide rate did not (310). Similarly, after the book had been translated into Danish, this method of suicide rose in that country (56). Three series of plastic bag suicides are summarized in Table 3.
Asphyxiating gases (propane, ether, helium) have been used, and the gas tank is usually situated beside the body (311-313). A modified bag has been described and was removed by the deceased's helpers in an attempt to mask the death as natural (312). A victim can be assisted by a helper who positions the plastic bag. If propane is used in conjunction with the plastic bag, a prominent odor caused by ethyl mercaptan, which is added to propane, may be detected (311,314). A 13-yr-old committed suicide using a bag containing aerosol deodorant (257).
The following scenarios have been described:
• Autoerotic asphyxia (see Subheading 2.7.1.).
• Drug misadventure—volatile inhalants (e.g., chloroform, propane [257,308,315,316]).
• Inhalation of volatile hydrocarbons (e.g., trichlorethane) or fluorocarbon propellants. If the bag does not cover the head, arrhythmia is the likely mechanism of death (315, 317,318).
• Children (e.g., plastic bag in crib [48,114,115,117]).
• Plastic sheet—institutional deaths (e.g., patient's face covered by plastic sheet placed for bed wetting ).
A death scene can be altered to make a suicide or homicide appear to be an accident (257).
In an Ontario series of suicides, the bag was secured in 95% of cases (Fig. 51; ref. 307). A rubber band was most commonly used to secure the bag (22%). A large, clear plastic bag covering the head and secured at the waist has been described (311). Eight cases (7%) studied in Ontario used more than one bag (up to three; see Fig. 51). About one-fourth made additional efforts to assist their deaths, e.g., obstructing the nose and mouth with a gag to ensure death, placing a mask over the nose and mouth to prevent the discomfort of the bag sticking to the face, tying the hands and/or feet to restrict movement, inhaling a noxious substance in the bag (e.g., carbon monoxide, propane), or modifying the bag (insertion of a breathing tube with electrical device/timer to simultaneously pull out the tube and shut off the lights). Use of a breathing tube may also be used to prevent panic by allowing the victim to breathe while ingested drugs begin to take effect.
In a Seattle review, the bag was in place in 65% of cases. In about 80%, a single bag was used (309). It was fastened in two-thirds of cases. Condensation was noted in the bag in half the cases. None of the individuals used additional efforts to assist their deaths.
A Scottish series (27 suicides, 3 accidents) showed 19 bags secured (257). In five cases, two or more bags were present, and in six cases, noxious agents were in the bag (e.g., aerosol glue, chloroform).
One case has been described in which a 40-yr-old woman hanged herself with a plastic bag over her head (308).
Plastic Bag Asphyxia (Suicide)
Plastic Bag Asphyxia (Suicide)
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