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Suicide With Inert Gases: Addendum to Final Exit

Gilson, Thomas MD; Parks, Bruce O. MD; Porterfield, Cynthia M. DO

American Journal of Forensic Medicine & Pathology: September 2003 - Volume 24 - Issue 3 - pp 306-308
Case Report

Suicide by asphyxiation with a plastic bag placed over the head is a method that has been advocated by right-to-die groups. Recently, such groups have proposed the introduction of helium into the plastic bag as a means of hastening death. Helium is readily available at toy stores, where it is sold in tanks for balloon inflation. It produces asphyxiation by the exclusion of oxygen in enclosed spaces. We report 7 fatalities throughout an 18-month period involving plastic bag suffocation in conjunction with helium use. These fatalities coincide with publication of an update to a popular right-to-die text in which this method is described. Although right-to-die literature was absent from all scenes, this method was not previously observed in our jurisdiction, and the deaths likely reflect exposure to this information. Because of analytical difficulties in testing for helium in biologic specimens, death certification rests on scene investigation.

Suicide by asphyxiation with a plastic bag placed over the head is uncommon and represents only a small fraction of suicide deaths in North America. 1–3 This method of suicide received increased attention after the publication of Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying4 in 1991. Final Exit included a detailed description of the process of plastic bag suffocation, and a 4-fold increase in this type of suicide was noted in New York City in the year after publication. In 2000, an update, Supplement to Final Exit: The Latest How-To and Why of Euthanasial Hastened Death, 5 was published and recommended insufflation of an inert gas into the suffocating plastic bag as a means to hasten death. Since the publication of Supplement, we have observed 7 fatalities in which a helium source was present at the death scene in conjunction with a plastic bag or mask. These cases form the basis of this report.

From the Office of the Medical Examiner, Tucson, Arizona.

Manuscript received December 12, 2002 accepted April 4, 2003.

Address correspondence and reprint requests to Cynthia M. Porterfield, D.O., Forensic Science Center, 2825 E. District Street, Tucson, AZ 85714 E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.