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Wheelchair-Assisted Ligature Strangulation

An Unusual Suicide by a Quadriparetic

Janík, Martin, MD, PhD*; Krajčovič, Jozef, MD, PhD*; Novomeský, František, MD, PhD*; Straka, Ľubomír, MD, PhD*; Hejna, Petr, MD, PhD, MBA

The American Journal of Forensic Medicine and Pathology: June 2019 - Volume 40 - Issue 2 - p 160–164
doi: 10.1097/PAF.0000000000000475
Case Reports

Multiple sclerosis, currently incurable and potentially profoundly disabling demyelinating central nervous system disease, is associated with higher occurrence of suicide as affected individuals are prone to major depression and psychosis. Despite progressively incapacitating neurologic impairment, well-staffed institutions, and limited repertoire of methods of suicide, which prevents patients from purposefully ending their lives, suicide-determined patients typically commit suicide resulting from a medication overdose, sharp force traumata, self-neglect, or deliberate starvation. Here we describe a successful suicide committed by a 39-year-old wheelchair-bound, institutionalized, quadriparetic male patient with a diagnosis of multiple sclerosis with secondary progressive clinical course who utilized his motorized wheelchair to terminate his life. He tied a rope between his neck and wall bars and then propelled the wheelchair forwardly. The acceleration of the wheelchair resulted in ligature self-strangulation. This case report, with a review of the literature, is noteworthy for the rareness of the wheelchair-related fatality combined with an unusual, if not entirely unseen, suicidal mechanism in severely disabled adult.

From the *Department of Forensic Medicine, Jessenius Faculty of Medicine, Comenius University, University Hospital, Martin, Slovakia; and

Department of Forensic Medicine, Faculty of Medicine in Hradec Králové, Charles University and University Hospital Hradec Kralove, Czech Republic.

Manuscript received December 25, 2018; accepted January 31, 2019.

The authors unanimously confirm that the presented work complies with all required ethical standards.

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent was not required (retrospective case presentation, a deceased individual).

No funding from any organization has been received.

The authors report no conflict of interest.

Reprints: Martin Janík, MD, PhD, Department of Forensic Medicine, Jessenius Faculty of Medicine, Comenius University, 036 59 Martin, Slovakia, EU. E-mail:

© 2019 by Lippincott Williams & Wilkins.