A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Death certification of ‘‘suicide by cop’’ is controversial among some medical examiners and coroners. We present five such deaths that were certified as suicides and discuss the medico-legal issues involved with these certifications. To certify such a death as a suicide, certain criteria should be met. Suicide by cop is a circumstance that involves competing intentional acts that may result in dichotomous determinations of the manner of death. Despite the absence of direct self-infliction, there is overwhelming evidence that these five individuals intended to end their own lives. Their use of an unusual method to accomplish this goal may inappropriately result in a reflexive certification of homicide. All of the decedents possessed weapons or a facsimile of a weapon. We present five instances of suicide by cop and contend that these types of deaths are best certified as suicides. KEYWORDS: forensic science, forensic pathology, suicide, police, gunshot wounds, manner of death

Situationer där polisen skjuter kan uppstå till följd av att gärningsmän uppvisar provokativa suicidbeteenden. Detta fenomen är känt som suicide by cop (SbC) och har visat sig utgöra en betydande andel av undersökta skjuthändelser i Nordamerika. Studien syftar till att ge en deskriptiv bild av SbC i Sverige utifrån förekomst och karakteristika gällande situationer och gärningsmän, samt att beskriva hur dessa händelser kan upplevas och hanteras av poliser. Skjuthändelser som inträffat under tidsperioden 2005-2009 granskades och intervjuer genomfördes med tio poliser som upplevt SbC-händelser. Resultatet visade att SbC svarade för 26 % av skjuthändelserna. Intervjuade poliser upplevde ofta gärningsmännen som både aggressiva och suicidala och en osäkerhet över vem som egentligen haft kontroll över situationen var att betrakta som en central problematik. Vidare beskrevs akuta stressreaktioner och posttraumatiska minnen till följd av dessa händelser. Ökad kunskap om psykologin bakom SbC är att betrakta som viktigt för hanteringen av dessa incidenter. / Officer-involved shootings (OIS) sometimes occur as a result of provocative and suicidal behavior among offenders. This phenomenon, known as suicide by cop (SbC), has been shown to represent a significant part of OIS-cases in North American samples. This study aims to provide a descriptive picture of SbC in Sweden based on frequency and characteristics of situations and offenders. It also aims to describe how SbC can be experienced and handled by police officers. OIS-cases that occurred during 2005-2009 were investigated and ten officers were interviewed. Results showed that SbC accounted for 26 % of the OIS-cases. Interviewed officers often perceived perpetrators as both aggressive and suicidal and an uncertainty over who actually had control was considered a key issue. Officers also reported acute stress reactions and posttraumatic memories as a result of SbC. Increased knowledge about the psychology of SbC is considered as an important factor for dealing with SbC-situations.

Approximately 44,965 people committed suicide in 2016 in the United States, and the rate has been rising for a decade and a half. Suicide has far-reaching consequences which affect not only the victim, but those close to the person as well. For every suicide, an estimated six people are futher traumatized, bringing the current loss survivor estimate to over 5 million. Additionally, suicide costs tax payers about 70 billion dollars annually. Despite outranking homicide as a leading cause of death, the long-standing stigma associated with suicide creates a barrier for open and effective communication about the issue. This paper investigates the changing attitudes about suicide across time, the impact of the interacting factors of gender, age, sexuality, and depression, current suicide myths, the trend of suicide by cop, and discusses future needs for research and effective intervention and prevention.