Suicide pacts in the Milan district (Italy): A retrospective autopsy-based study with literature review

Suicide pacts are unique events, which involve two or more individuals. In such cases, the initiator and the addicted victim decide to end their lives together in the same place and at the same time. In the present research, on the 26,054 autopsy reports assessed at the Milan Institute of Legal Medicine from 1993 to 2020, 4596 suicides were collected. Among them, 6 cases of suicide pacts were registered, which involved two couples of friends, two couples of spouses, one couple of lovers and one couple of identical twins. Gunshots and acute poisonings were the most common suicidal methods that were adopted. Suicidal notes were documented in 4 cases, which reported the reasons and the consent of the victims. Suicidal notes clearly allow the correct identification of suicide pacts. Furthermore, they often explain the reasons which are frequently based on either psychiatric disorders or financial problems. In the other cases, the absence of farewell notes could complicate forensic investigations, especially to establish the differential diagnosis with murder-suicides without the explicit consent of the victims. In this setting, multidisciplinary skills are preferably required, including a full forensic autopsy with ancillary postmortem analyses (e.g., toxicology, histopathology, and forensic genetics). Furthermore, this study aims to discuss the suicide pacts from a medicolegal, criminological, and sociological point of view, providing a review of the literature with a comparison of our forensic cases.