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A Planned Complex Suicide: Need for a High Index of Suspicion

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Unusual ways of committing suicide are reported in the medico-legal literature, but few refer to the so-called “planned complex suicide” (PCS).1 PCS, also termed primary combined suicide, is defined as the combination of two or more methods of injury by the suicidal person to prevent failure of a single method of suicide alone. In contrast, in secondary or unplanned complex suicide, the victim uses the second method of suicide only after failure of the first method.2 Combinations of shooting, hanging, burning, and/or poisoning have been used as suicidal methods.3–6 Sometimes the double use of one method such as simultaneous gunshot wound from two firearms or ingestion of two different toxic substances has been reported. This gives the suicidal person a high degree of protection against failure of one of the methods, as both modes of injury are relatively certain.2 This case report demonstrates the importance of the treating physician maintaining a high index of suspicion for the possibility PCS with the aim of avoiding a misdiagnosis that may be fatal.
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Document Type: Research Article

Affiliations: From the Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida

Publication date: May 1, 2006

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  • The Southeastern Surgical Congress owns and publishes The American Surgeon monthly. It is the official journal of the Congress and the Southern California Chapter of the American College of Surgeons, which all members receive each month. The journal brings up to date clinical advances in surgical knowledge in a popular reference format. In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts. If you have a manuscript you'd like to see published in The American Surgeon select "Information for Authors" from the Related Information options below. A Copyright Release Form must accompany all manuscripts submitted.
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