pact suicides are those wherein two or more individuals mutually agree and execute to terminate their lives together .
the usual profile of persons involved in pact suicides includes those females , older , married and of high social class . if one relies on the media reports , whenever two or more deaths occur together , one of whom is a child ; it is usually considered as a homicide - suicide without the consent of the child . for establishing that the suicides were an outcome of suicide pact , objective evidence in the form of a suicide note
is required to establish that the deaths were an outcome of suicide pact . in indian context ,
pact suicides generally involve issueless couples , disappointed lovers , unmarried sisters , frustrated individuals or a woman ending her own life and that of her children due to family circumstances or financial difficulties .
this usually occurs in the religious , political or military reasons . in our literature search ,
we did not come across a pact suicide involving four persons ( quadruple pact suicide ) . in this report
, we describe a family ( of four persons , three of whom were adolescents ) , which entered into a pact suicide due to the social reasons .
a man and his three children were brought to the emergency department by their neighbors .
he and two of the children had allegedly consumed celphos ( aluminum phosphide ) tablets , which is a commonly used insecticide in this part of india .
the father was found to have respiratory distress and had to be immediately intubated and ventilated .
detail information was obtained from the neighbors who had brought them and the third child .
he was managing a nuclear family with his wife and three children of ages 14 ( girl ) , 12 ( boy ) and 11 ( boy ) years .
two days prior to the alleged suicidal attempt , the man came to know about the extra - marital relationship of his wife . according to the informants , the fact that she was having and extra - marital relationship was true and the extra - marital relationship was continuing for a long time prior to patient coming to know about the same .
due to extreme distress , man discussed the issue of humiliation with his children , who all agreed that they were also having the same distressing emotions and did not know how to face the society . following which the man suggested to his children
that , it would be best to end life to escape the humiliation from the society .
as per the information provided by the child who had escaped with only minor head injury , all of them agreed to end their life and signed a suicide pact , for the same .
the following morning , the man procured eight tablets of aluminum phosphide from a local vendor . after ensuring that the house was securely closed , the man handed over two tablets of aluminum phosphide to each of his three children .
the two elder children consumed the tablets , but as the turn of the youngest son 's came , he tried to run toward a window to escape . to prevent him from escaping the man threw a blunt object , which hit the youngest son on his head , but he managed to escape and raised alarm for help . within minutes , several villagers rushed toward their home and when they managed to break open , they reportedly found the man and the two children vomiting profusely .
they were initially shifted to a local primary care health center and gastric lavage was done . however , the physical status of the man and the two elder children worsened , which led to patients being shifted to our emergency . besides intubating and providing ventilatory support the man could not be saved and he succumbed to the aluminum phosphide toxicity .
the youngest child , who described the whole event , did not have any evidence of intracranial bleeding on the computerized tomography of the brain .
the description of pact suicide involving an adult and a child usually describe the involvement of a mother and her child , in contrast in the present case the pact suicide involved father and children . in the majority of the pact suicides , the two persons who enter into a pact to end their life do so to avoid separation from each other because of love and closeness among themselves .
in contrast , in the case described by us , the people who entered the pact did the same so as to avoid social humiliation .
further , this case suggests that many a time 's children do enter into a pact to end their life impulsively without understanding the consequences .
this was highlighted by the behavior of the youngest child in our report , who initially agreed to end his life along with other family members , but later tried to escape when he realized the consequences .
this fact reflects that adolescents are very vulnerable and many of them may be suggestible to execute the act of self - harm .
another unique situation , which was seen in this case , was that three of the persons who entered the pact survived and only one lost his life .
occasional reports involving pact suicide have given similar descriptions of one of the survivors who is usually a co - operator , rather than the instigator .
in the present report too , the pact suicide was preceded by a psychosocial stressor , in otherwise well - adjusted individual as has been observed in many of the previous reports from india .
in contrast to the commonly described cases of mass suicide , which involves many people for religious , political or military reasons , the current case highlights quadruple pact suicide following a social stressor . from a legal standpoint , the case suggests that the children were influenced to sign on to the suicide note and commit suicide .
the mere act of attempting to commit suicide is punishable as per the indian penal code ( section 309 ) .
however , the survivors being minors may absolve the children of responsibility and hence a trial . otherwise too ,
 pact suicides involving families have been reported in the scientific literature , but reports have been few from india . 
 we report the case of a family , in which the father and three children had entered into a suicidal pact and executed it due to social reasons . a 41-year - old man , with no past psychiatric or substance use history , 
 had reportedly come to know that his wife had been involved in an extra - marital affair . as expressed by him in a suicide note 
 , he could not bear the humiliation due to this and also did not want his children to face disrespect from the society . 
 he along with his daughter and 2 sons , aged 14 , 12 and 11 years respectively , thus entered into a suicide pact to end their lives and wrote a suicide note . 
 man and two of his children consumed aluminum phosphide . 
 however , the youngest son did not consume the poison and raised alarm , following which they were rushed for medical care . 
 the father died , but the three children recovered completely . 
 the case highlights the rare phenomenon of suicide pacts involving an adult and children . 
INTRODUCTION
CASE REPORT
DISCUSSION