On a wintery day near Philadelphia, local police responded to a tragedy. Two teenage girls, high school sophomores, cut class and went to the tracks where a passenger train traveled from Boston to Washington, D.C., at high speeds. They died in a suicide pact formed after one of the girls lost her boyfriend in a traffic accident.¹

Suicide pacts may be confused with murder-suicides, which are more frequent but also uncommon. Murder-suicides often entail a history of domestic violence and involve an unwilling victim killed by a current or former partner, usually male, acting out of malice.⁶

Some suicide pacts can appear as murder-suicides. A husband in Arizona shot his wife before turning the gun on himself, but a note cited a suicide pact.⁷ An 80-year-old Pennsylvania man killed his 82-year-old wife — but survived despite overdosing on medications and cutting his wrists — as part of a suicide pact, he claimed.⁸ One individual may be unable to use the chosen means, or one may act on behalf of the other. Such deaths may be ruled homicides, as happened with an older New Mexico couple who both died by gunshot.⁹

With few exceptions, suicide pacts rely on less violent methods. A study of murder-suicides and suicide pacts over an 11-year period found that most deaths in murder-suicides resulted from firearms while those in suicide pacts involved ingesting or inhaling toxic substances.¹⁰

Mutual agreement to the act is often evident in a suicide pact. The absence of consent sets murder-suicides apart from suicide pacts, even when there is an allegedly benevolent motive. An 88-year-old Florida man shot his female companion multiple times and wrote a note claiming the killing was part of an uncompleted suicide pact made because she had cancer.¹¹ Police found no evidence of consent or ill health on the woman’s part.

Prerequisites

According to a prevailing theory, suicide occurs when someone has:

• an intense desire to die;
  
• the capability to act on this intent; and
  
• weakened self-preservation because of persistent suicidal ideation, rumination on a suicide plan, or a history of self-injury or prior attempts.¹²

Suicide pacts require shared intent and capability, which may come about similarly. Duality of intent may enhance the capacity for those in the pact to commit suicide.

A suicide pact begins when two people consider dying together preferable to living. One individual often induces the other to join in a pact.¹³ The initiator has been termed the “instigator” and the other the “cooperator.” Depressed men with a history of suicidal behavior typically initiate pacts and influence female partners to join them.¹⁴ It is likely that the party who initiates the pact also plans how it will unfold.

Data from the National Violent Death Reporting System shows that one-third of those who die by suicide divulge their ideation or intent to someone close to them.¹⁵ Such a disclosure may be the starting point for a suicide pact. Once the pact is in motion, the parties may repeatedly discuss and even rehearse their joint demise. This may lessen any ambivalence or resistance to carrying out the plan.

Compelling medical issues are a frequent precipitant.¹⁶ In one account involving a couple in their late 70s who were married over 50 years, the wife, who suffered from a painful rheumatic condition and dementia, took her life by suffocation with her caregiver husband.¹⁷ Among older couples, suicide pacts seem to serve as assisted suicides. An Oregon couple in their late 80s with debilitating health problems died together by assisted suicide under state law.¹⁸

Emergence

Suicides are popularly seen as impulsive acts because they occur suddenly and unexpectedly, but this is a misconception.¹⁹ Though seeming impetuous, a suicide is a consequence of planning — usually when, where, and how it will take place.²⁰ In suicide pacts, these elements appear to be decided beforehand, which implies that they are planned acts, not spontaneous events. A pact adds who to the when, where, and how of suicidal behavior.

Married couples make up most suicide pacts, which may emerge if the relationship is threatened.²¹ Members in pacts focus almost exclusively on each other with little outside social interaction.²² Suicidal individuals weigh their options before concluding they must end their lives.²³ In a suicide pact, the participants carry out this deliberation together.

It is theorized that suicidal behavior advances in three stages.

1. A troubling life event arises that increasingly perturbs the affected person.
2. The individual tries to deal with the situation unsuccessfully, and feelings of entrapment, defeat, or humiliation surface. These sentiments give rise to mounting thoughts of suicide as an escape.
3. Suicidal ideation gives way to intent, a doable plan, the acquisition of means, and an attempt in a manner that may result in death.²⁴

A suicide pact may follow a similar self-destructive trajectory. The reciprocally supportive context of a pact amplifies individual suicidality and movement to the action stage of the process. Suicidal individuals raise their risk by dwelling on their distress.²⁵ In a suicide pact, this takes place interpersonally, which reinforces commitment to the plan and the likelihood of an eventual attempt.

Potential Signs

Suicide pacts are difficult to detect beforehand. However, while signs that one is developing are seldom spotted, there may be hints. The individuals may:

• speak of being hopeless or burdensome to others;
• be unusually fixated on funeral arrangements or care of children or pets, though both are sometimes collateral victims of suicide pacts;
• unexpectedly dispose of valued possessions or abruptly lose interest in favored activities; and
• openly seek means or visit locations that are part of their plan.

Further, they may subtly betray the danger signs of high suicide risk:

• threatening to die by suicide;
• voicing a specific suicide plan; and
• looking for or finding lethal means.²⁶

Those in a suicide pact may say that they cannot live alone and hope to die as one. They may speak to their conditions, such as illness or institutionalization. One suicide pact, purportedly known to relatives, unfolded at a Wisconsin nursing home where a 56-year-old man shot his 59-year-old girlfriend, who had suffered a stroke, before taking his own life so they would always be together.²⁷ As with single suicides, threats or signs may not prompt intercession.

Cybersuicide Pacts

While personal acquaintance is a common denominator in most suicide pacts, the Internet has given rise to a variant without that aspect, which appears driven, in part, by an absence of social connections. Cybersuicide pacts form online among troubled individuals who are complete strangers.²⁸

Depressed individuals searching online for ways to cope with suicidal ideation may visit forums that both encourage suicide and supply instructions.²⁹ Then, they find invitations posted by other emotionally vulnerable persons to join a suicide pact. The parties connect, acknowledge their respective feelings, agree on suicide as a solution, settle on method and timing, and go on to die apart but concurrently.³⁰

Sharing suicidal thoughts online heightens the risk of a cybersuicide pact.³¹ Suicidal communications on social media platforms may elicit responses offering support and assistance.³² Cybersuicide pacts develop in unmoderated corners of the Internet where there are no safety nets or potential rescuers. Parental monitoring of adolescents’ and teens’ online activity may prove valuable.³³ Likewise, inquiring about the Internet searches of depressed individuals may reveal possible cybersuicide interest.³⁴

Prevention

The self-contained nature of a suicide pact diminishes prospects for detection and deterrence. Nevertheless, it is best to divert a suicide pact before a lethal partnership forms or in the early stages. Given the frequent use of prescription medications in older adult suicide pacts, pharmacists should watch for changes in refills.

Early on, stressors at the root of a suicide pact may be amenable to mental health counseling or intervention. In the United States, the new national Suicide and Crisis Lifeline — 988 — may increase access to help for individuals potentially considering a suicidal alliance as an answer. Chat and text options could make 988 amenable to those averse to talking directly to a hotline counselor.

Two withdrawn people in a close association who see themselves trapped in a worsening situation is the basic template for a prospective suicide pact. Screening those fitting this profile for suicide risk is appropriate. For instance, a seclusive older couple with multiple medical needs comes to the attention of police because of ostensible self-neglect. Officers cannot assume the situation is due solely to failing cognitive faculties. Not keeping up care regimens may be intentional self-harm and constitute a suicide pact employing the only route available.

Suicide pacts may be uncovered during routine mental health calls. Police officers dealing with an overwhelmed or despondent individual admitting to thoughts of suicide can ask if someone else in their life feels the same way. Officers may also inquire if the at-risk subject has considered anyone they are close to for inclusion in a potential suicide plan.

Disrupting a suicidal collaboration may break the bond and underlying rationale. A follow-up study of suicide attempt survivors found that many did not make another attempt, and many regained a positive level of mental health.³⁵ Similarly, the members of uncompleted suicide pacts may go on living without later resuming that pact.

Conclusion

Many variables play a role in a suicide pact, but the most dominant is the decedents’ relationship in life. As shown in media reports and research studies, most suicide pacts, and those likely to be encountered by police officers and other emergency responders, involve pairs of individuals falling into two groups.

One consists of older married couples who decide to take their lives in unison because one or both are facing either death or permanent separation because of a serious medical illness or debilitating health condition. The other comprises younger adults or youths in close or intimate relationships or attachments that are likely to end because of outside stressors. The common denominator in this dichotomy is that the connection between the affected individuals is vulnerable and the threat is seen as certain. This sets suicide pacts apart from other forms of suicidal behavior.

Endangered interpersonal relationships also play a role in single suicides and murder-suicides. However, in both of these cases, the impending loss of a strong personal tie brings about suicidal and sometimes homicidal intent in only one individual.

The strong interpersonal bond inherent to a suicide pact may improve prospects for prevention by giving time for it to occur. Suicide pacts take longer to finalize because there is no single decision-maker or actor as in a solitary suicide or a murder-suicide.³⁶