Describe the medicolegal aspects of suicide.

Definition and the Legal Position

• Attempted suicide has been effectively decriminalised. It was formerly punishable under IPC 309. Section 115 of the Mental Healthcare Act 2017 now provides that a person who attempts suicide shall be presumed, unless proved otherwise, to have severe stress, and shall not be tried and punished; and the government has a duty to provide care, treatment and rehabilitation. The BNS 2023 contains no equivalent of IPC 309
• Abetment of suicide remains an offence under BNS 108 (formerly IPC 306), punishable with up to 10 years; and abetment of the suicide of a child, an insane person or an intoxicated person is punishable under BNS 107 with death or life imprisonment
• The presumption in dowry cases — BSA 117 (formerly IEA 113A) provides that where a married woman commits suicide within seven years of marriage and it is shown that her husband or his relatives subjected her to cruelty, the court may presume that the suicide was abetted by them
• Suicide pact and physician-assisted suicide — the survivor of a suicide pact may be liable for abetment or for culpable homicide; and physician-assisted suicide is unlawful in India

Risk Factors and Methods

• Psychiatric risk factors — depression above all; alcohol and substance dependence; schizophrenia; personality disorder; and a previous attempt, which is the single strongest predictor
• Social and personal factors in India — family problems and marital conflict, which are the commonest recorded reasons; illness, particularly chronic and painful disease; examination failure and academic pressure in the young; farmer indebtedness; unemployment and financial ruin; dowry harassment; and bereavement and isolation. Young adults account for a very large share of Indian suicides, and the overall burden is among the highest in the world
• Common methods in India — hanging; poisoning, characteristically with organophosphate and other pesticides, which is a defining feature of the Indian pattern and reflects their ready availability in agricultural households; self-immolation, particularly among women; drowning; jumping in front of a train or from a height; and drug overdose
• Restriction of access to means works — the regulation of the most toxic pesticides has been shown to reduce suicide mortality substantially, and is among the most effective public health interventions available

The Autopsy and Applied Aspects

• The questions — was it suicide, accident or homicide; what was the cause and method; was there a psychiatric illness; was there abetment; and, in a married woman, was she within seven years of marriage
• Findings supporting suicide — the site accessible and elective; hesitation cuts; a note; the doors secured from within; the weapon or container present, sometimes in cadaveric spasm; a psychiatric history or a precipitating event; and the absence of defence injuries
• Always exclude homicide staged as suicide — a second ligature mark, defence injuries, injuries the account cannot explain, lividity inconsistent with the position, and evidence of prior incapacitation on toxicology
• Preserve the note and the container, and take viscera for toxicology in every case; the agent used may be the whole question
• Ask the duration of the marriage in every suicide of a married woman; within seven years the presumption of abetment under BSA 117 may operate and a magistrate’s inquest is required
• Treat first and never demand police clearance; refusal or delay in treating a person who has attempted suicide is unlawful and has killed people
• Ask directly about suicidal ideation where there is concern; asking does not plant the idea, and the failure to ask is a recognised omission — and arrange psychiatric assessment before discharge after every attempt
• A previous attempt is the strongest single predictor, and its presence should change the disposal of every case
• Restricting access to pesticides reduces suicide mortality, and is among the most effective public health measures available in India
• Abetment of the suicide of a child or insane person carries death or life imprisonment under BNS 107, far above ordinary abetment
• Look for a second mechanism in any apparent suicide; homicide staged as suicide is the differential that must always be excluded
• Self-immolation is characteristically used by women in India, and such a death within seven years of marriage raises the dowry presumption
• The survivor of a suicide pact may face abetment or culpable homicide, and the case needs investigation rather than assumption