J Forensic Sci, September 2014, Vol. 59, No.

5
doi: 10.1111/1556-4029.12483 Available online
CASE REPORT at: onlinelibrary.wiley.com

PATHOLOGY/BIOLOGY

_ 1 2 3 3
Ipek Esen Melez, M.D.; Abdullah Avsar, M.D.; Bunyamin€ Baspınar, M.D.; Deniz Oguzhan Melez,
3 € 4

M.D.; Fatih Sahin, M.D.; and Task ın Ozdes, M.D.

Simultaneous Homicide–Suicide: A
Case Report of Double Drowning*

ABSTRACT: Homicide–suicide is a tragic phenomenon which typically does not result in a criminal charge or trial. However, correct diag-nosis and
classification of homicide–suicide cases are important to determine the perpetrators and dynamics of each category properly. The deaths in the homicide –
suicide acts can be divided into two categories with respect to the number of involved individuals: dyadic deaths and triple or multiple deaths. These two
categories can also be divided into two subgroups according to the chronology of the incidents: simulta-neous deaths and consecutive deaths. Herein, a
simultaneous homicide–suicide case of a father and daughter where both deaths occurred through drowning which was not found in the selected literature
review and where the victim was a child is presented. The article aims to clar-ify the term discrepancies about multiple death cases in the literature and to
discuss the pathological and psychosocial characteristics of the simultaneous dyadic death cases.

KEYWORDS: forensic science, multiple death, dyadic death, homicide–suicide, homicidal drowning, autopsy

The terms “murder–suicide,” “homicide–suicide,” “homicide tive deaths. These two chronology categories are applied and dis-
followed by suicide,” “murder followed by suicide,” and “dyadic cussed below for only dyadic deaths:
death” are used in the literature to define the act of an individual 1 Dyadic death cases where the homicide and suicide occur
committing suicide after committing homicide (1–11). simultaneously:
They are the dyadic death cases where at least one of the
To claim that the homicide and the suicide are linked, one
involved individuals aims to commit suicide while killing the
should not fail to take into account some criteria. One of the cri-
other one with a predominate motivation of getting rid of that
teria is the time interval between the homicide and the suicide
other individual or getting rid of the situation they are in or
acts. Some studies indicate that the time interval between the two
punishing a third party and where the deaths occur as a result
deaths should not be more than 24 h, whereas other studies argue
of a consciously planned scenario. Examples of dyadic death
that the time interval is inconsequential as only the course of
cases in this category include traffic accident, toxic gas expo-
events and the relation of the events should be taken into con-
sure, jumping from a height, suicide bombing (22–24). Char-
sideration (12–19).
coal burning is reported to be an important example from
Different classifications have been made in different studies for
Taiwan for simultaneous maternal filicide–suicide cases
multiple deaths (15,20,21). According to the number of individu-als
through toxic gas exposure (25).
who died in an incident, multiple deaths can be evaluated in two
2 Dyadic death cases where the homicide and suicide occur
groups: One group is named as dyadic deaths, the other group is
consecutively:
named as triple or -again- multiple deaths. Considering the
chronology of the homicide and suicide acts, such deaths can be They are the dyadic death cases where one of the involved indi-
evaluated in two other subgroups: simultaneous and consecu- viduals kills the other individual somewhat unconsciously with
a kind of tantrum, then the perpetrator commits suicide as a
form of self-punishment due to the feelings of guilt or fear of
1 future. These kind of dyadic death cases vary from community
Department of Forensic Medicine, Medical Faculty, Bezmialem Vakõf
University, Adnan Menderes Bulvarõ, Vatan Caddesi, 34093 Fatih, Istanbul, to community. In Britain, Wales, and the Netherlands, this
Turkey. kind of dyadic death case perpetrators are reported to account
2
Department of Forensic Medicine, Medical Faculty, Kahramanmaras Su€tcu€ for approximately 0.05 per 100,000 population in different
Imam University, Avsar Kampu€su€ Yerleskesi, Kahramanmaras, Turkey. periods between 1992 and 2006 (17,26,27), whereas in some
3
õ
The Council of Forensic Medicine, The Ministry of Justice, Cobancesme,
õ c _ regions of the United States and Japan, homicide followed by
K m z Sokak, 34196 Bah elievler, Istanbul, Turkey.
4 _
suicide accounts for 0.38 per 100,000 population (17,28–30).
Department of Forensic Medicine, Medical Faculty, Abant Izzet Baysal
University, Go€lko€y, 14280 Bolu, Turkey. The methods of homicide and suicide also vary according to
*Presented at the 22nd International Academy of Legal Medicine Con-
gress, July 5–8, 2012, in Istanbul, Turkey. countries and genders (15,22,31). The vast majority of perpetra-
Received 19 Jan. 2013; and in revised form 11 June 2013; accepted 17 tors are males, and the most common cause of death is firearm
Aug. 2013. injury (22,32,33).

1432 © 2014 American Academy of Forensic Sciences

 ESEN MELEZ ET AL.
In addition to the above two main categories, in some inci-
dents, the perpetrator’s motivation can be in accord with the first
category yet the action taken is in accord with the second cate-
gory, or vice versa. Here, we present a dyadic death case of a
double drowning, which is characteristic of the first category
given above. Double drowning as a homicide–suicide has not
been found in the selected literature that was reviewed, and thus,
this report is considered to be a valuable contribution to the liter-
ature.
Case History
A shipyard worker was married for 6.5 years, and he was in the
middle of an ongoing divorce suit for the last 3 years of his
marriage. He lost the custody of his daughter to his wife. On the
day of the incident, it was reported that he had taken his 5-year-
old daughter from his wife’s house for a day out together. How-
ever, when he did not bring back his daughter at late hours, the
mother called her ex-husband to ask where they were, and he
answered her by explaining that they were still walking around.
Later on, when the mother called her ex-husband again, he asked
his ex-wife to make a choice between him and her family. Her
reply emphasized that everything was over and the divorce suit
would be completed soon. The last sentence to his ex-wife before
hanging up the phone was “Then you’ll have to put up with what’s
coming.”
The daughter’s body and the father’s body were found in the
Sea of Marmara—near Istanbul—tied together with box tape and
a rope. Also, four paving stones were tied to the father’s feet with
a rope. The corpses were referred to the Morgue Depart-ment of
the Council of Forensic Medicine by the prosecution office for
autopsy to determine the cause of death.
Case 1 (Father)
In the detailed external examination of the 30-year-old male,
white froth at the nostrils and the mouth, wrinkling of the skin on
both hands and feet, and residual fingerprint ink on the fin-gers of
both hands were noted. No evidence of external trau-matic
lesions was found on the body.
In the internal examination, the right thoracic cavity contained
500 mL of serous fluid and the left thoracic cavity 350 mL of
serous fluid. The right lung weighed 700 g and the left one
weighed 653 g. There was a swollen, stiff, glossy appearance as
well as diffuse anthracosis at the surface of both lungs, while
there were petechial hemorrhages on the surface and on the
interlobular areas of both lungs.
Bloody, foamy fluid discharge was present in the cross sec-
tions of the lungs. White froth was present in the bronchus and
bronchioles. Additionally, plenty of foamy fluid was detected in
the tracheal lumen while the esophageal lumen was clear. There
was 300 mL of water in the stomach and fluid feces in the
intestinal lumens. Apart from these findings and except for
edema of the other organs, no other macro-scopic pathological
changes were detected to support the diag-nosis of drowning.
The skeletal system was intact. The toxicological analysis of
blood and urine was negative for alcohol or any drugs of abuse as
well as negative results for routine screening for possible toxic
substances in the internal organs and in the stomach con-tents.
Strontium was detected at concentrations of 121.84 ng/mL in the
blood of the right heart, 137.52 ng/mL in the blood of the left
heart, and 361.56 ng/mL in the pleural fluid.
1434 JOURNAL OF FORENSIC SCIENCES
. SIMULTANEOUS HOMICIDE–SUICIDE 1433
The histopathological evaluation revealed findings of edema in
the pulmonary tissue and signs of congestion in other internal
organs.
Case 2 (Daughter)
In the external examination of the 5-year-old girl, serous fluid
at the nostrils and the mouth, and wrinkling of the skin on both
hands and feet were noted. No evidence of external traumatic
lesions was found on the body.
In the internal examination, there was no fluid or blood in the
right thoracic cavity. The left thoracic cavity contained 50 mL of
serous fluid. The right lung weighed 211 g and the left one
weighed 185 g. There was a swollen, stiff, glossy appearance at
the surface of both lungs, while there was a bloody, foamy fluid
discharge in the cross sections of the lungs without applying any
pressure.
The bronchus and bronchioles were coated with white froth.
The esophageal and tracheal lumens were described as glossy and
watery. In the stomach, 30 mL of semi-digested food con-tent
was present. In the intestinal lumens, yellow-colored fluid
discharge was detected. Apart from these findings and except for
the edema of the other organs, no other macroscopic pathologi-
cal changes were detected to support the diagnosis of drowning.
The skeletal system was intact. The toxicological analysis of
blood and urinary bladder washout fluid was negative for alco-
hol or any drugs of abuse as well as the negative results of a
routine screening for the possible toxic substances in the internal
organs and in the stomach contents. Strontium was detected at
concentrations of 134.24 ng/mL of strontium in the blood of the
right heart, 168.3 ng/mL in the blood of the left heart, and 246.8
ng/mL in the pleural fluid.
The histopathological evaluation revealed findings of edema in
the pulmonary tissue and signs of congestion in other internal
organs.
Discussion and Conclusion
The cause of death for both decedents was concluded to be
“drowning in water” as a diagnosis of exclusion through sup-
portive autopsy findings. Strontium was considered just as a sup-
portive parameter for the diagnosis of drowning as many different
factors reported in the literature can be effective on strontium
concentrations. The obtained concentrations of stron-tium in the
ventricles and the differences in concentrations between the
ventricles were not as high as the “typical drown-ing” definition
of Azparren et al. However, they were within the cutoff ranges
supporting the diagnosis of drowning, especially since the bodies
had been recovered from seawater within 24 h (34–42).
Although generally dyadic death is considered in a pattern of
simultaneous or consecutive homicide and suicide acts in rela-
tion to each other (1–11), the possibility of two individuals com-
mitting suicide together and consciously should also be a
consideration of the “dyadic death” concept. However, this dou-
ble-drowning case we present is consistent with the homicide–
suicide concept, since even if the child had agreed with the
decision to commit suicide with her father, the consent of a 5-
year-old girl is questionable.
In studies by Mathews et al., Gregory, and Cohen, the motiva-
tion of the perpetrator in multiple death cases where the homi-
cide and suicide occur in a consecutive manner is explained as
usually a feeling of an unbearable remorse or fear of his/her
future (42–44). On the other hand, in multiple death cases where
homicide and suicide occur simultaneously, the perpetrator’s
motivation is usually to prevent difficulties that surviving indi-
viduals may face in the future or to punish a third party. Thus, it
is believed that perpetrators of the simultaneous homicide–sui-
cide cases do not feel any regret for the committed homicide–
suicide (22–25,28). For instance, Salari et al. (45) pointed out
that elderly men having tendency to suicide could be also a threat
for their wives’ lives, which seems to involve protective feelings
to prevent future difficulties for their wives. In light of the above
data, for the simultaneous homicide–suicide case we present, the
perpetrator’s motivation during the homicide–suicide act can be
interpreted in two ways. The first possibility is a weak, helpless
feeling to give up living but also a distrustful feeling for the
future of his daughter when he is not together with her. The
second possibility is an angry, selfish feeling to use his daughter
for making his ex-wife suffer as a punishment from him. The first
possibility is more similar with the psycho-logical condition
stated in Salari’s study (45), while the second possibility can be
included in the wide range of age-groups between 19 and 86 and
varying reasons stated in Travis’s study (32).
In our case, we interpreted the motivation of the 30-year-old
perpetrator, who was going through a problematic divorce suit, to
be the intent to punish a third party because he tied his daughter’s
body to himself to die together as a simultaneous homicide–
suicide. The recordings of the phone conversations with his wife
who was divorcing him seem to support this inter-pretation. In
addition to our interpretation, Cohen’s, Mathews’s, and Gregory’s
studies can be considered as a mixture of the first and second
psychological conditions for feeling the desire to punish the
victim or a third party through homicide, but not feeling the
strength to continue living after the act of homicide (42–44).
In the overwhelming number of multiple death cases, the vic-
tim is a woman, while children or mentally disabled individuals
can also be victims in descending order of frequency (17–
22,24,27). Actually, child victims are usually killed not as pri-
mary targets but become the secondary victims of the motiva-tion
between the adults either through a feeling of worry for their
future or through a feeling of punishment to the partner (17). As
discussed above, following these homicides, the perpe-trators
usually commit suicide through the motivation of remorse and/or
fear (42,43). In the case we present, the perpe-trator carried out
the homicide–suicide act by jumping into the water with paving
stones in a way that leaves no chance of escape for him or his
daughter. The victim’s being a child, being female and being so
young, is considered again an accor-dance with the literature
related to homicide–suicide victims (17–22,24,27).
The study carried out by Travis et al. (32) also concludes that
100% of the homicide–suicide perpetrators in cases between
1991 and 2005 in Britain and Wales were men, and in the 21
publications, they looked through 90% of the cases involved male
perpetrators. The perpetrator of the case we present is also a
male.
The methods of killing and suicide also vary according to
gender in multiple death cases. The most common method of
killing and committing suicide is shooting with a firearm in cases
where the perpetrator is a male. Stabbing and strangulation
follow in order of frequency (17–22,27). In the dyadic death
cases where the perpetrator is a female, the preferred methods are
perceived as being less violent, such as shoving/jumping
6. Canturk€ N, Canturk€
ol€um€ olgu sunumu. J For Med (Turkey) 2008;22(1):39–43.
Med 1991;30(4):530–2.
from a height, intoxication, toxic gas suffocation and so on
(17,22,24,25,46). In the case we present, the perpetrator chose to
end his and his daughter’s life by jumping into the water. That is
to say he chose a method that he likely considered less vio-lent, a
divergence from the usual preferences of male perpetra-tors
stated in the literature. The method he chose shows that the
subject of his anger was not his daughter, but a third person,
namely his wife.
In postmortem examination, classically, the absence of a trau-
matic finding in an autopsy supports the lack of forceful coercion in
the incident. Absence of a traumatic finding usually makes the
forensic expert or the prosecutor think that the origin was a suicide
either for an alone death or for a dyadic death of a conscious double
suicide, especially when there is a suicidal crime scene. Even when
there are some traumatic lesions seen on deceased individuals in a
crime scene of two or more deaths, while one of the deceased indi-
viduals holding the firearm or other implement of death, the usual
tendency is to consider one of the deceased individuals as the perpe-
trator. For the case we present, the public prosecution office ruled
that there were no grounds for legal action after investigating the
crime scene, telephone recordings, and our autopsy report due to the
classical drowning diagnosis without any external traumatic lesion.
However, any multiple death case should be handled with-out any
preconceived opinion in favor of a homicide–suicide act. In other
words, the possibility that the supposed perpetrator could in fact be a
victim should be kept in mind. In such cases, the informa-tion
gathered during the prosecution process such as the evidence found
in the crime scene, witness testimonies, telephone recordings, and
findings of the postmortem forensic examination should be checked
carefully because anything missed could be valuable infor-mation for
any unknown perpetrator or perpetrators who had staged a fake
homicide–suicide crime scene.
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Additional information and reprint requests:
_
Ipek Esen Melez, M.D.
€
Bezmialem Vakõf U niversitesi, Tõp Faku€ltesi, Adli Tõp Anabilim Dalõ,
Adnan Menderes Bulvarõ, Vatan Caddesi, 34093 Fatih
_
Istanbul
Turkey
E-mail: ipekesen@gmail.com