Mercy killing of a 72-year-old woman through heroin intoxication.

Active euthanasia is legally permissible in only eight jurisdictions worldwide and may only be administered by qualified personnel following specific selection criteria. Mercy killing refers to the deliberate termination of the life of an individual suffering from a terminal chronic medical condition. Detecting both illegally performed active euthanasia and instances of mercy killing presents challenges for forensic pathologists. The presented case describes a mercy killing involving a 72-year-old woman with multiple chronic conditions who was killed by her grandson via heroin intoxication after administration of the anxiolytic alprazolam. Key findings from the external postmortem examination included a single fresh injection site on the inside of the elbow and a superficial T-shaped cut on the flexor side of the left forearm. Toxicological analyses revealed elevated blood levels of heroin metabolites, including 6-monoacetylmorphine and absence of hydroxyalprazolam, indicating an only short survival time following heroin injection. A cocaine concentration in blood was comparatively low but rather high in hair samples. Elderly individuals with multiple chronic conditions are at increased risk of becoming homicide victims. Comprehensive forensic documentation of injection sites is essential to avoid overlooking deaths caused by injection and to differentiate them from medical measures during resuscitation attempts.