CASE REPORT

PATHOLOGY/BIOLOGY

_Ipek Esen Melez,1 M.D.; Abdullah Avs�ar,2 M.D.; B€unyamin Bas�pınar,3 M.D.; Deniz O�guzhan Melez,3

M.D.; Fatih S�ahin,3 M.D.; and Tas�kın €Ozdes�,4 M.D.

Simultaneous Homicide–Suicide: A CaseReport of Double Drowning*

ABSTRACT: Homicide–suicide is a tragic phenomenon which typically does not result in a criminal charge or trial. However, correct diag-nosis and classification of homicide–suicide cases are important to determine the perpetrators and dynamics of each category properly. Thedeaths in the homicide–suicide acts can be divided into two categories with respect to the number of involved individuals: dyadic deaths andtriple or multiple deaths. These two categories can also be divided into two subgroups according to the chronology of the incidents: simulta-neous deaths and consecutive deaths. Herein, a simultaneous homicide–suicide case of a father and daughter where both deaths occurredthrough drowning which was not found in the selected literature review and where the victim was a child is presented. The article aims to clar-ify the term discrepancies about multiple death cases in the literature and to discuss the pathological and psychosocial characteristics of thesimultaneous dyadic death cases.

KEYWORDS: forensic science, multiple death, dyadic death, homicide–suicide, homicidal drowning, autopsy

The terms “murder–suicide,” “homicide–suicide,” “homicidefollowed by suicide,” “murder followed by suicide,” and“dyadic death” are used in the literature to define the act of anindividual committing suicide after committing homicide(1–11).To claim that the homicide and the suicide are linked, one

should not fail to take into account some criteria. One of the cri-teria is the time interval between the homicide and the suicideacts. Some studies indicate that the time interval between thetwo deaths should not be more than 24 h, whereas other studiesargue that the time interval is inconsequential as only the courseof events and the relation of the events should be taken into con-sideration (12–19).Different classifications have been made in different studies for

multiple deaths (15,20,21). According to the number of individu-als who died in an incident, multiple deaths can be evaluated intwo groups: One group is named as dyadic deaths, the othergroup is named as triple or -again- multiple deaths. Consideringthe chronology of the homicide and suicide acts, such deaths canbe evaluated in two other subgroups: simultaneous and consecu-

tive deaths. These two chronology categories are applied and dis-cussed below for only dyadic deaths:1 Dyadic death cases where the homicide and suicide occur

simultaneously:

They are the dyadic death cases where at least one of theinvolved individuals aims to commit suicide while killing theother one with a predominate motivation of getting rid of thatother individual or getting rid of the situation they are in orpunishing a third party and where the deaths occur as a resultof a consciously planned scenario. Examples of dyadic deathcases in this category include traffic accident, toxic gas expo-sure, jumping from a height, suicide bombing (22–24). Char-coal burning is reported to be an important example fromTaiwan for simultaneous maternal filicide–suicide casesthrough toxic gas exposure (25).

2 Dyadic death cases where the homicide and suicide occurconsecutively:

They are the dyadic death cases where one of the involved indi-viduals kills the other individual somewhat unconsciously witha kind of tantrum, then the perpetrator commits suicide as aform of self-punishment due to the feelings of guilt or fear offuture. These kind of dyadic death cases vary from communityto community. In Britain, Wales, and the Netherlands, thiskind of dyadic death case perpetrators are reported to accountfor approximately 0.05 per 100,000 population in differentperiods between 1992 and 2006 (17,26,27), whereas in someregions of the United States and Japan, homicide followed bysuicide accounts for 0.38 per 100,000 population (17,28–30).

The methods of homicide and suicide also vary according tocountries and genders (15,22,31). The vast majority of perpetra-tors are males, and the most common cause of death is firearminjury (22,32,33).

1Department of Forensic Medicine, Medical Faculty, Bezmialem VakıfUniversity, Adnan Menderes Bulvarı, Vatan Caddesi, 34093 Fatih, _Istanbul,Turkey.

2Department of Forensic Medicine, Medical Faculty, Kahramanmaras� S€utc�€u_Imam University, Avs�ar Kamp€us€u Yerles�kesi, Kahramanmaras�, Turkey.

3The Council of Forensic Medicine, The Ministry of Justice, C�obanc�es�me,Kımız Sokak, 34196 Bahc�elievler, _Istanbul, Turkey.

4Department of Forensic Medicine, Medical Faculty, Abant _Izzet BaysalUniversity, G€olk€oy, 14280 Bolu, Turkey.

*Presented at the 22nd International Academy of Legal Medicine Con-gress, July 5–8, 2012, in _Istanbul, Turkey.

Received 19 Jan. 2013; and in revised form 11 June 2013; accepted 17Aug. 2013.

1432 © 2014 American Academy of Forensic Sciences

J Forensic Sci, September 2014, Vol. 59, No. 5doi: 10.1111/1556-4029.12483

Available online at: onlinelibrary.wiley.com

In addition to the above two main categories, in some inci-dents, the perpetrator’s motivation can be in accord with the firstcategory yet the action taken is in accord with the second cate-gory, or vice versa. Here, we present a dyadic death case of adouble drowning, which is characteristic of the first categorygiven above. Double drowning as a homicide–suicide has notbeen found in the selected literature that was reviewed, and thus,this report is considered to be a valuable contribution to the liter-ature.

Case History

A shipyard worker was married for 6.5 years, and he was inthe middle of an ongoing divorce suit for the last 3 years of hismarriage. He lost the custody of his daughter to his wife. On theday of the incident, it was reported that he had taken his 5-year-old daughter from his wife’s house for a day out together. How-ever, when he did not bring back his daughter at late hours, themother called her ex-husband to ask where they were, and heanswered her by explaining that they were still walking around.Later on, when the mother called her ex-husband again, he askedhis ex-wife to make a choice between him and her family. Herreply emphasized that everything was over and the divorce suitwould be completed soon. The last sentence to his ex-wifebefore hanging up the phone was “Then you’ll have to put upwith what’s coming.”The daughter’s body and the father’s body were found in the

Sea of Marmara—near Istanbul—tied together with box tape anda rope. Also, four paving stones were tied to the father’s feetwith a rope. The corpses were referred to the Morgue Depart-ment of the Council of Forensic Medicine by the prosecutionoffice for autopsy to determine the cause of death.

Case 1 (Father)

In the detailed external examination of the 30-year-old male,white froth at the nostrils and the mouth, wrinkling of the skinon both hands and feet, and residual fingerprint ink on the fin-gers of both hands were noted. No evidence of external trau-matic lesions was found on the body.In the internal examination, the right thoracic cavity contained

500 mL of serous fluid and the left thoracic cavity 350 mL ofserous fluid. The right lung weighed 700 g and the left oneweighed 653 g. There was a swollen, stiff, glossy appearance aswell as diffuse anthracosis at the surface of both lungs, whilethere were petechial hemorrhages on the surface and on theinterlobular areas of both lungs.Bloody, foamy fluid discharge was present in the cross sec-

tions of the lungs. White froth was present in the bronchusand bronchioles. Additionally, plenty of foamy fluid wasdetected in the tracheal lumen while the esophageal lumenwas clear. There was 300 mL of water in the stomach andfluid feces in the intestinal lumens. Apart from these findingsand except for edema of the other organs, no other macro-scopic pathological changes were detected to support the diag-nosis of drowning.The skeletal system was intact. The toxicological analysis of

blood and urine was negative for alcohol or any drugs of abuseas well as negative results for routine screening for possibletoxic substances in the internal organs and in the stomach con-tents. Strontium was detected at concentrations of 121.84 ng/mLin the blood of the right heart, 137.52 ng/mL in the blood of theleft heart, and 361.56 ng/mL in the pleural fluid.

The histopathological evaluation revealed findings of edemain the pulmonary tissue and signs of congestion in other internalorgans.

Case 2 (Daughter)

In the external examination of the 5-year-old girl, serous fluidat the nostrils and the mouth, and wrinkling of the skin on bothhands and feet were noted. No evidence of external traumaticlesions was found on the body.In the internal examination, there was no fluid or blood in the

right thoracic cavity. The left thoracic cavity contained 50 mLof serous fluid. The right lung weighed 211 g and the left oneweighed 185 g. There was a swollen, stiff, glossy appearance atthe surface of both lungs, while there was a bloody, foamy fluiddischarge in the cross sections of the lungs without applying anypressure.The bronchus and bronchioles were coated with white froth.

The esophageal and tracheal lumens were described as glossyand watery. In the stomach, 30 mL of semi-digested food con-tent was present. In the intestinal lumens, yellow-colored fluiddischarge was detected. Apart from these findings and except forthe edema of the other organs, no other macroscopic pathologi-cal changes were detected to support the diagnosis of drowning.The skeletal system was intact. The toxicological analysis of

blood and urinary bladder washout fluid was negative for alco-hol or any drugs of abuse as well as the negative results of aroutine screening for the possible toxic substances in the internalorgans and in the stomach contents. Strontium was detected atconcentrations of 134.24 ng/mL of strontium in the blood of theright heart, 168.3 ng/mL in the blood of the left heart, and246.8 ng/mL in the pleural fluid.The histopathological evaluation revealed findings of edema

in the pulmonary tissue and signs of congestion in other internalorgans.

Discussion and Conclusion

The cause of death for both decedents was concluded to be“drowning in water” as a diagnosis of exclusion through sup-portive autopsy findings. Strontium was considered just as a sup-portive parameter for the diagnosis of drowning as manydifferent factors reported in the literature can be effective onstrontium concentrations. The obtained concentrations of stron-tium in the ventricles and the differences in concentrationsbetween the ventricles were not as high as the “typical drown-ing” definition of Azparren et al. However, they were within thecutoff ranges supporting the diagnosis of drowning, especiallysince the bodies had been recovered from seawater within 24 h(34–42).Although generally dyadic death is considered in a pattern of

simultaneous or consecutive homicide and suicide acts in rela-tion to each other (1–11), the possibility of two individuals com-mitting suicide together and consciously should also be aconsideration of the “dyadic death” concept. However, this dou-ble-drowning case we present is consistent with the homicide–suicide concept, since even if the child had agreed with thedecision to commit suicide with her father, the consent of a5-year-old girl is questionable.In studies by Mathews et al., Gregory, and Cohen, the motiva-

tion of the perpetrator in multiple death cases where the homi-cide and suicide occur in a consecutive manner is explained asusually a feeling of an unbearable remorse or fear of his/her

ESEN MELEZ ET AL. . SIMULTANEOUS HOMICIDE–SUICIDE 1433

future (42–44). On the other hand, in multiple death cases wherehomicide and suicide occur simultaneously, the perpetrator’smotivation is usually to prevent difficulties that surviving indi-viduals may face in the future or to punish a third party. Thus, itis believed that perpetrators of the simultaneous homicide–sui-cide cases do not feel any regret for the committed homicide–suicide (22–25,28). For instance, Salari et al. (45) pointed outthat elderly men having tendency to suicide could be also athreat for their wives’ lives, which seems to involve protectivefeelings to prevent future difficulties for their wives. In light ofthe above data, for the simultaneous homicide–suicide case wepresent, the perpetrator’s motivation during the homicide–suicideact can be interpreted in two ways. The first possibility is aweak, helpless feeling to give up living but also a distrustfulfeeling for the future of his daughter when he is not togetherwith her. The second possibility is an angry, selfish feeling touse his daughter for making his ex-wife suffer as a punishmentfrom him. The first possibility is more similar with the psycho-logical condition stated in Salari’s study (45), while the secondpossibility can be included in the wide range of age-groupsbetween 19 and 86 and varying reasons stated in Travis’s study(32).In our case, we interpreted the motivation of the 30-year-old

perpetrator, who was going through a problematic divorce suit,to be the intent to punish a third party because he tied hisdaughter’s body to himself to die together as a simultaneoushomicide–suicide. The recordings of the phone conversationswith his wife who was divorcing him seem to support this inter-pretation. In addition to our interpretation, Cohen’s, Mathews’s,and Gregory’s studies can be considered as a mixture of the firstand second psychological conditions for feeling the desire topunish the victim or a third party through homicide, but notfeeling the strength to continue living after the act of homicide(42–44).In the overwhelming number of multiple death cases, the vic-

tim is a woman, while children or mentally disabled individualscan also be victims in descending order of frequency (17–22,24,27). Actually, child victims are usually killed not as pri-mary targets but become the secondary victims of the motiva-tion between the adults either through a feeling of worry fortheir future or through a feeling of punishment to the partner(17). As discussed above, following these homicides, the perpe-trators usually commit suicide through the motivation ofremorse and/or fear (42,43). In the case we present, the perpe-trator carried out the homicide–suicide act by jumping into thewater with paving stones in a way that leaves no chance ofescape for him or his daughter. The victim’s being a child,being female and being so young, is considered again an accor-dance with the literature related to homicide–suicide victims(17–22,24,27).The study carried out by Travis et al. (32) also concludes that

100% of the homicide–suicide perpetrators in cases between1991 and 2005 in Britain and Wales were men, and in the 21publications, they looked through 90% of the cases involvedmale perpetrators. The perpetrator of the case we present is alsoa male.The methods of killing and suicide also vary according to

gender in multiple death cases. The most common method ofkilling and committing suicide is shooting with a firearm incases where the perpetrator is a male. Stabbing and strangulationfollow in order of frequency (17–22,27). In the dyadic deathcases where the perpetrator is a female, the preferred methodsare perceived as being less violent, such as shoving/jumping

from a height, intoxication, toxic gas suffocation and so on(17,22,24,25,46). In the case we present, the perpetrator chose toend his and his daughter’s life by jumping into the water. Thatis to say he chose a method that he likely considered less vio-lent, a divergence from the usual preferences of male perpetra-tors stated in the literature. The method he chose shows that thesubject of his anger was not his daughter, but a third person,namely his wife.In postmortem examination, classically, the absence of a trau-

matic finding in an autopsy supports the lack of forceful coercion inthe incident. Absence of a traumatic finding usually makes theforensic expert or the prosecutor think that the origin was a suicideeither for an alone death or for a dyadic death of a conscious doublesuicide, especially when there is a suicidal crime scene. Even whenthere are some traumatic lesions seen on deceased individuals in acrime scene of two or more deaths, while one of the deceased indi-viduals holding the firearm or other implement of death, the usualtendency is to consider one of the deceased individuals as the perpe-trator. For the case we present, the public prosecution office ruledthat there were no grounds for legal action after investigating thecrime scene, telephone recordings, and our autopsy report due tothe classical drowning diagnosis without any external traumaticlesion. However, any multiple death case should be handled with-out any preconceived opinion in favor of a homicide–suicide act. Inother words, the possibility that the supposed perpetrator could infact be a victim should be kept in mind. In such cases, the informa-tion gathered during the prosecution process such as the evidencefound in the crime scene, witness testimonies, telephone recordings,and findings of the postmortem forensic examination should bechecked carefully because anything missed could be valuable infor-mation for any unknown perpetrator or perpetrators who had stageda fake homicide–suicide crime scene.

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Additional information and reprint requests:_Ipek Esen Melez, M.D.Bezmialem Vakıf €Universitesi, Tıp Fak€ultesi, Adli Tıp Anabilim Dalı,Adnan Menderes Bulvarı, Vatan Caddesi, 34093 Fatih_IstanbulTurkeyE-mail: ipekesen@gmail.com

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