Suicide pact by mutual simultaneous arm amputation.

BACKGROUND

Dyadic suicide pacts are cases in which two individuals (and very rarely more) agree to die together. These account for fewer than 1% of all completed suicides.

OBJECTIVE

The authors describe two men in a long-term domestic partnership who entered into a suicide pact and, despite utilizing a high-lethality method (simultaneous arm amputation with a power saw), survived.

METHOD: The authors investigated the psychiatric, psychological, and social causes of suicide pacts by delving into the history of these two participants, who displayed a very high degree of suicidal intent. Psychiatric interviews and a family conference call, along with the strong support of one patient's family, were elicited.

RESULTS

The patients, both HIV-positive, showed high levels of depression and hopelessness, as well as social isolation and financial hardship. With the support of his family, one patient was discharged to their care, while the other partner was hospitalized pending reunion with his partner.

DISCUSSION: This case illustrates many of the key, defining features of suicide pacts that are carried out and also highlights the nature of the dependency relationship.