Aeromedical Aspects 

of Findings From 

Aircraft-Assisted Pilot 

Suicides in the United 

States, 1993-2002

Robert D. Johnson

Russell J. Lewis

James E. Whinnery

Estrella M. Forster

Civil Aerospace Medical Institute

Federal Aviation Administration

Oklahoma City, OK 73125

March 2006

Final Report

DOT/FAA/AM-06/5

Office of Aerospace Medicine

Washington, DC 20591
NOTICE

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of the U.S. Department of Transportation in the interest 

of information exchange. The United States Government 

assumes no liability for the contents thereof.

___________

This publication and all Office of Aerospace Medicine 

technical reports are available in full-text from the Civil 

Aerospace Medical Institute’s publications Web site: 

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i

Technical Report Documentation Page 

1. Report No. 2. Government Accession No. 3. Recipient's Catalog No. 

DOT/FAA/AM-06/5 

4. Title and Subtitle 5. Report Date 

March 2006 

6. Performing Organization Code 

Aeromedical Aspects of Aircraft-Assisted Pilot Suicides in the United 

States, 1993-2002 

7. Author(s) 8. Performing Organization Report No. 

Johnson RD, Lewis RJ, Whinnery JE, Forster EM 

9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) 

FAA Civil Aerospace Medical Institute 

P.O. Box 25082 11. Contract or Grant No. 

Oklahoma City, OK 73125 

12. Sponsoring Agency Name and Address 13. Type of Report and Period Covered 

Office of Aerospace Medicine 

Federal Aviation Administration 

800 Independence Ave., S.W. 

Washington, DC 20591 14. Sponsoring Agency Code 

15. Supplemental Notes 

This work was accomplished under the approved task AM-B-05-TOX-204. 

16. Abstract 

All aviation accidents are tragic, but few are more avoidable than aircraft-assisted suicide. Aircraft-assisted suicide 

may precipitate as a result of clinical depression, marital or financial difficulties, or numerous other problems. 

While aircraft-assisted suicide attempts almost always result in pilot fatalities, they also have the serious and 

unfortunate potential to cause collateral damage to property and life. Our laboratory was interested in evaluating 

the epidemiological, toxicological, and aeromedical findings from pilots involved in aircraft-assisted suicides. Case 

histories, accident information, and the declaration of suicide as the probable cause in the aviation accidents were 

obtained from the National Transportation Safety Board (NTSB). Toxicological information was obtained from 

the Civil Aerospace Medical Institute’s Bioaeronautical Sciences Research Laboratory. Other relevant information 

was obtained from medical certification data systems. Over the 10-year period, 1993-2002, there were 3648 fatal 

aviation accidents. Of these, the NTSB determined that 16 were aircraft-assisted suicides, 15 were from 

intentional crashing of an aircraft, and 1 due to a student pilot exiting the aircraft while in-flight. All 16 aircraft 

were operated as general aviation. All pilots involved in these aircraft-assisted suicides were male, with a median 

age of 40 (range 15-67) years. The pilot was the sole occupant of each aircraft that was intentionally crashed. 

Toxicological findings for 7 of the 14 pilots for which test specimens were available were negative for 

disqualifying substances, whereas 4 contained ethanol at various levels, 2 were found positive for benzodiazepines, 

1 positive for marijuana, 1 positive for cocaine, and 1 positive for venlafaxine. None of the airmen had reported 

intake of these substances during their medical certification process. These limited data indicate that 50% of 

accidents classified by the NTSB as aircraft-assisted pilot suicide involve at least one, if not more, disqualifying 

drug(s). However, based on the few cases conclusively attributed to suicide, death by the intentional crashing of 

an aircraft appears to be an infrequent and uncommon event. 

17. Key Words 18. Distribution Statement 

Aviation-Assisted Suicide, Toxicology, Aircraft Accident 

Investigation, Medical Certification, Safety

Document is available to the public through the Defense 

Technical Information Center, Ft. Belvior, VA 22060; 

and the National Technical Information Service, 

Springfield, VA 22161

19. Security Classif. (of this report) 20. Security Classif. (of this page) 21. No. of Pages 22. Price 

Unclassified Unclassified 14 

Form DOT F 1700.7 (8-72) Reproduction of completed page authorized

1

Aeromedical Aspects of Aircraft-Assisted Pilot Suicides

in the United States, 1993-2002

Introduction

All aviation accidents are all tragic, but few are more 

avoidable than aircraft-assisted suicide. Aircraft-assisted 

suicide may precipitate as a result of depression, domestic 

difficulties, or numerous other problems. While aircraftassisted suicide attempts almost exclusively result in pilot 

fatality, they also have the serious and unfortunate potential to cause collateral damage to property and life. Other 

reports on aircraft-assisted suicide have been published;7, 12

however, none have been published over the time period 

1993-2002 concerning aircraft-assisted suicide in the 

United States. Our laboratory (Bioaeronautical Sciences 

Research Laboratory) was interested in evaluating the 

epidemiological and toxicological findings from pilots 

involved in aircraft-assisted suicide over these years. 

Methods

All information pertaining to case history, accident 

information, and probable cause(s) of aviation accidents 

were available through the National Transportation Safety 

Board (NTSB). Our laboratory gathered medical and 

toxicological information on all civil aviation fatalities 

that were determined by the NTSB to result from aircraft-assisted pilot suicide. The NTSB’s database can be 

accessed online at www.ntsb.gov/ntsb/query.asp. Other 

information related to the incident and the airmen’s medical certification were obtained from the Civil Aerospace 

Medical Institute’s (CAMI’s) Decision Support System 

(DSS) and Aerospace Medical Certification System, including the Document Information Workflow System, 

which records aeromedical information and flight experience, as reported by the pilot (on an FAA Form 8500-8) 

to the aviation medical examiner (AME) at the time of 

the medical examination that is part of the medical certification process.4CAMI’s Forensic Toxicology Research 

Laboratory analyzes postmortem specimens collected from 

pilots involved in civil aviation accidents.1, 5 Toxicological information for each suicide case was obtained from 

CAMI’s toxicology database.2

Case Histories

Case 1

A 45-year-old pilot was arrested and charged with lewd 

and lascivious conduct with a minor. He was released on 

bail 1 day later, which was 3 days prior to the accident. 

Hours before the accident, the pilot met with a friend, and 

they drove around while consuming alcohol. The friend 

later told investigators the pilot was making comments 

pertaining to the intentional crashing of his airplane. 

Shortly after meeting with his friend, the pilot, the sole 

occupant of a Piper PA-46-310, was fatally injured in 

an aviation accident. The accident occurred at 0111 hrs. 

The pilot was found to have ethanol levels of 175 and 

117 mg/hg in the lung and muscle, respectively. These 

impairing levels of ethanol are considerably above the 

FAA’s legal limit of 40 mg/dL ethanol in a pilot’s blood.

The NTSB determined the probable causes of the accident 

to be ethanol impairment and pilot suicide. 

Case 2

A 38-year-old pilot was experiencing emotional 

distress stemming from recent public accusations of an 

extramarital affair and subsequent harassment. These 

actions led to an order of protection for the accuser. 

Details surrounding the alleged affair and subsequent 

harassment were released to the local media, prompting 

the pilot’s wife to leave and take their child with her. 

A coworker told investigators that the pilot attempted 

suicide twice following his wife’s departure, once in a 

closed garage with a running car and once in an airplane, 

both times deciding not to complete the act. Four days 

after the 2 unsuccessful suicide attempts, the pilot was 

fatally injured when the Piper PA-28-180 he was flying 

collided with terrain shortly after takeoff. Witnesses observed the airplane taxi towards the runway at a “faster 

than normal” speed. Following takeoff, witnesses saw the 

airplane dive vertically towards the runway from an altitude of 300-400 feet. The accident occurred at 0030 hrs. 

The accident investigators found no evidence of aircraft 

mechanical problems. Toxicological examination of the 

pilot’s remains revealed no disqualifying substances. The 

NTSB determined the probable cause of the accident to 

be pilot suicide.

Case 3

A 20-year-old pilot was found guilty in a jury trial of 

operating a “pyramid scheme.” According to friends, the 

pilot “did not feel he could go to jail, and since this was 

his second offense for this particular crime, (the pilot) 

felt that if convicted he would spend some years in jail.” 

Approximately 30 minutes after the guilty verdict, the 

pilot rented a Cessna 152. An employee at the airport said 
2

the pilot “seemed somewhat snobbish and in a hurry.” 

Shortly after takeoff, the airplane was observed flying low 

and making a circle over the base of a mountain near the 

airport. The plane was then observed flying straight into 

the mountain, killing the pilot. The accident occurred at 

1515 hrs. A toxicological examination found 1 ng/mL tetrahydrocannabinol (the active compound in marihuana) 

in the pilot’s blood. Furthermore, tetrahydrocannabinol 

carboxylic acid (an inactive metabolite of tetrahydrocannabinol) was found at 6 and 15 ng/mL in the blood and 

urine, respectively. While the presence of tetrahydrocannabinol in the blood indicated the pilot used marihuana, 

an illegal substance, the blood concentration determined 

suggests that there was little cognitive impairment at the 

time of the accident. The NTSB determined the probable 

cause of the accident to be pilot suicide.

Case 4

A 32-year-old pilot was experiencing marital difficulties. The pilot and his spouse had a violent argument that 

resulted in police intervention. The police removed the 

wife and child from the residence and took them to her 

parent’s home for the night to ensure their safety. The 

pilot called his in-laws’ home numerous times that night. 

He continued to call the next day and left a message on 

their answering machine. The message indicated that he 

wanted to “see my son one last time” and “say goodbye 

to my son.” Following the call, the pilot signed and had 

notarized all of the vehicle titles and left them on the table 

for his wife. The pilot then rented a Cessna 150K, and 

shortly after departure, witnesses observed the aircraft 

flying erratically. The airplane then crashed in a steep 

nose-down attitude, killing the pilot (sole occupant). The 

accident occurred at 1158 hrs. Following the accident, 

the pilot’s wife told authorities that her husband had 

often talked about suicide. The accident investigators 

found no evidence of aircraft mechanical malfunction. 

Toxicological examination relealed no drugs in the pilot’s 

system. The NTSB determined the probable cause of the 

accident to be pilot suicide.

Case 5

A 38-year-old pilot was involved in a fatal hit-andrun automobile accident resulting in the police issuing 

a warrant for his arrest. Two days later, the pilot gained 

access to a Cessna 182E. The pilot departed and immediately climbed above an altitude of 21,000 feet. 

Air traffic control (ATC) made contact with the pilot, 

at which time he indicated that he was out of fuel and 

requested an approach. The controller advised the pilot 

of a nearby airport, but he declined and stated, “I prefer 

water.” Communications continued for 20 minutes, 

during which time the pilot continued to request a 

water landing. The pilot made numerous ominous statements to ATC such as, “All things considered, I think 

that would be the best place to go” and “As you might 

have guessed, I have not had a good day...I’m going 

swimming tonight.” The airplane crashed into an icecovered reservoir in a nose-down attitude, penetrating 

the ice and submerging all but the tail of the aircraft. 

The accident occurred at 0117 hrs. The pilot was found 

to have ethanol levels of 64 and 77 mg/dL in his blood 

and vitreous humor, respectively. These findings indicate 

that the pilot was above the FAA’s legal ethanol limit and 

was likely impaired. The NTSB determined the probable 

cause of the accident to be pilot suicide.

Case 6

A 67-year-old pilot was reportedly depressed over 

the recent death of his mother and his own deteriorating health. The pilot departed the airport in a Cessna 

172N. The pilot’s girlfriend contacted the operator, 

who in turn contacted ATC expressing concern about 

a potential suicide attempt. However, airport officials 

were unable to prevent the pilot’s departure. A lifeguard 

reported seeing an airplane complete a loop, level off, 

and then dive vertically into the ocean, killing the pilot 

(sole occupant). The accident occurred at 1352 hrs. A 

hand-written will, dated the day before the accident, 

was found. There was no evidence of aircraft mechanical 

malfunction. A toxicological examination found ethanol 

in the pilot’s system. However, it was determined upon 

further investigation that the ethanol present was a result 

of postmortem microbial ethanol production and was 

not present due to ethanol consumption. The NTSB 

determined the probable cause of the accident to be 

pilot suicide.

Case 7

A 26-year-old pilot and some friends had been consuming alcoholic beverages at a restaurant, after which 

the pilot was driven home. Approximately 45 minutes 

after his return home, the pilot told his roommate that 

he was going for a walk. Approximately 15 minutes 

later, the pilot attempted to gain access to the flight line 

where he was employed as a flight instructor; however, 

the computer security system would not grant him access due to the late hour. He scaled an 8-foot fence and 

gained unauthorized access to a Piper PA-44-180. The 

pilot was given clearance for takeoff and began his flight. 

Approximately 15 minutes into the flight, he requested 

clearance to land. The airplane was observed at a higher 

than normal altitude for landing, and when questioned 

by ATC about this, the pilot responded “This will be my 

final landing.” Witnesses observed the airplane descend 

at a steep angle and high rate of speed and impact the 
3

runway. The accident occurred at 2323 hrs. A note found 

by the pilot’s roommate following the accident said, “I 

do not want to live.” There was no evidence of aircraft 

mechanical malfunction. Toxicological examination of 

the pilot found intoxicating amounts of ethanol. Ethanol was identified in the urine at 141 mg/dL, and in the 

brain and muscle at 103 and 97 mg/hg, respectively. The 

NTSB determined the probable cause of the accident to 

be pilot suicide.

Case 8

A 41-year-old pilot’s marriage proposal was turned 

down by his girlfriend. The following day, the pilot took 

a Cessna 172M for a flight. The operator at the airport 

observed the pilot taxiing at excessive speeds and contacted 

ATC, requesting that they ask the pilot to return to the 

ramp; however, the pilot had already departed. A short time 

later, witnesses observed the airplane flying at an altitude 

of 200-300 feet, then “descend at an increasing speed” 

and nose dive into a field adjacent to the church where his 

girlfriend was attending services. The accident occurred 

at 1125 hrs. There was no evidence of aircraft mechanical 

malfunction. Toxicological examination found diazepam 

(Valium), a benzodiazepine, at a concentration of 28 and 

74 ng/g, in the kidney and liver, respectively. Nordiazepam, an active metabolite of diazepam, was also found 

at a concentration of 69 and 134 ng/g in the kidney and 

liver, respectively. These substances are disqualifying and 

would have legally prevented this pilot from operating 

an aircraft. The NTSB determined the probable cause 

of the accident to be pilot suicide.

Case 9

A 40-year-old pilot, with a history of substance abuse, 

was being sought by police in connection with a recent 

arson. He had previously been convicted of first-degree 

arson. The pilot told a friend that he was going on a trip 

and needed a ride to the airport. Upon arrival, he left 

an envelope in the friend’s car and told him not to open 

it until after his departure. Once the pilot entered the 

airport, the friend opened the envelope and found two 

documents: power of attorney transferring all property 

to the pilot’s brother and a letter entitled “message in a 

bottle.” The pilot rented a Cessna 172S, took off from 

the airport, and a short time later a witness observed the 

aircraft rocking back and forth and stated, “The aircraft 

was no more than 10 feet off the water.” The witness 

also said that the airplane was on a collision course with 

a boat, forcing the boat’s captain to take evasive measures. 

Other boats in the area had similar reports. The pilot then 

made a distress call that was relayed to the appropriate 

authorities by a passing Boeing 747. Approximately an 

hour after the distress call, the Coast Guard found the 

pilot’s body floating in the water. The accident occurred at 

approximately 1832 hrs. After recovery of the aircraft and 

a thorough investigation, it was determined that there was 

no evidence of mechanical malfunction. A toxicological 

examination found cocaine, benzodiazepines, and ethanol 

in the pilot’s body. Cocaine was identified in the blood 

at 5 ng/mL. A cocaine metabolite, benzoylecgonine, was 

found at 113 ng/mL and 215 ng/g in the blood and liver, 

respectively. Cocaethylene, a compound formed from the 

co-administration of cocaine and ethanol, was identified 

in the liver at 31 ng/g. Diazepam, nordiazepam, temazepam, and oxazepam were found in the blood at 57, 76, 

143, and 1 ng/mL, respectively, and in the liver at 1011, 

1504, 758, and 492 ng/g, respectively. Ethanol was found 

in the blood at 42 mg/dL. These findings indicate that 

the pilot had used cocaine, diazepam, and ethanol within 

hours of his flight. The NTSB determined the probable 

cause of the accident to be pilot suicide.

Case 10

A 22-year-old pilot was conducting touch-and-go 

operations in a Piper PA-44-180. During routine communications with the local ATC, the pilot gave the controller a phone number and told the controller, “After all 

of this...that’s the people that you can contact...we’ll be at 

a full stop this time.” The pilot further stated, “...tell my 

family and friends that I love them very much.” On short 

final, the pilot pulled straight up and appeared to stall at 

approximately 1000 feet. The airplane then descended 

at a steep angle and impacted the runway. The accident 

occurred at 1933 hrs. There was no evidence of aircraft 

mechanical malfunction. A toxicological examination 

found no disqualifying substances in the pilot’s system. 

The NTSB determined the probable cause of the accident 

to be pilot suicide.

Case 11

A 43-year-old pilot was served a restraining order at 

his place of residence and escorted off his property. The 

following morning, the pilot, in a Socata TB-20, departed 

the airport on a local flight. According to witnesses, the 

airplane made 4 circular patterns over the pilot’s residence 

then dove directly into the house. The accident occurred 

at 0737 hrs. No evidence of mechanical malfunction was 

discovered when the aircraft was evaluated. Unfortunately, 

due to the severity of the accident and the ensuing fire, 

no toxicological examination was possible. No persons 

on the ground were injured. The NTSB determined the 

probable cause of the accident to be pilot suicide.

Case 12

A 40-year-old pilot was a suspect in a criminal investigation when authorities entered his home and seized 
4

records and his computer. That evening, the pilot obtained 

the keys to a Cessna 152 that he was not scheduled or 

authorized to fly. Additionally, he was not certified to fly 

at night. A witness said the pilot entered the aircraft with 

no preflight inspection, taxied directly to the runway, and 

took off with no pre-takeoff checks or engine run-up. 

Within two minutes of takeoff, the airplane crashed into 

a mountainside at 2158 hrs. The accident investigators 

found no evidence of aircraft mechanical malfunction. 

Toxicological examination found no drugs in the pilot’s 

system. The NTSB determined the probable cause of the 

accident to be pilot suicide.

Case 13

A 15-year-old student pilot was told by his flight 

instructor to pre-flight a Cessna 172R. However, the 

student pilot, without an instructor, untied the airplane, 

boarded it, started the engine, and, without clearance, 

took off. There was no communication between the 

pilot and ATC. A Coast Guard helicopter intercepted 

the aircraft and signaled the pilot to land. The aircraft 

continued its course and crashed into an office building. 

The accident occurred at 1703 hrs. A suicide note was 

found on the pilot’s body. No persons on the ground 

were injured. Accident investigators found no evidence 

of aircraft mechanical malfunction. Postmortem toxicological examination found no evidence of drugs. The 

NTSB determined the probable cause of the accident to 

be pilot suicide.

Case 14

A 54-year-old pilot was being treated by a psychotherapist for severe depression. The pilot departed the airport 

in a Cessna 172K and approximately 30 minutes after 

takeoff, witnesses observed the aircraft flying “abnormally 

low” and then fly straight into a mountain. The accident 

occurred at 1558 hrs. During the ensuing investigation, 

the pilot’s therapist told investigators that the pilot had 

stated, “If he killed himself, he would do it in a plane, 

and crash it with only himself in it.” The NTSB found no 

evidence of aircraft mechanical malfunction. Toxicological 

examination revealed the antidepressant, venlafaxine, and 

its metabolite, desmethylvenlafaxine, in the blood at 446 

and 1462 ng/mL, respectively. These compounds were 

also identified in the pilot’s urine at 3018 and 34,102 

ng/mL, respectively. Based on the drug concentration, 

the volume of distribution (6.8 L/kg) for venlafaxine, 

and the pilot’s weight, it appears that the pilot was taking the maximum therapeutic dose of 225 mg per day, 

which may be accompanied by significant side effects. 

The NTSB determined the probable cause of the accident 

to be pilot suicide.

Case 15

A 43-year-old pilot was the subject of an on-going 

criminal investigation. Local authorities were told by 

numerous people that the pilot had threatened to kill 

himself by deliberately crashing an airplane before he 

would go to jail. Two days before motions were to be 

heard in court, the pilot rented a Cessna 152. The pilot 

did not conduct a preflight inspection, but rather got 

into the airplane and sat motionless for approximately 

15 minutes. He then started the engine and again sat 

motionless for another 15 minutes. The pilot then taxied 

to the runway and departed the airport. Approximately 1 

hour after departure, the airplane disappeared from radar. 

The aircraft crashed with a nose-down angle in a field. 

The accident occurred at approximately 0820 hrs. The 

accident investigators found no evidence of aircraft mechanical malfunction. Toxicological examination found 

no drugs in the pilot’s system. The NTSB determined the 

probable cause of the accident to be pilot suicide.

Case 16

A 47-year-old student pilot scheduled an instructional 

flight in a Cessna 152 to evaluate how his ears would 

feel at altitude following a recent ear surgery. Once at an 

altitude of 9500 feet, the pilot opened the left window. 

Near the end of the scheduled flight, the pilot asked the 

flight instructor to fly the airplane so he could “check his 

ears.” During a subsequent slow turn, the pilot asked the 

instructor to increase the angle of the bank. The instructor ultimately increased the turn to a 45-degree bank, at 

which point the instructor heard “a noise that sounded 

like ... the seat belt hitting the side of the plane.” The 

instructor turned just in time to see the pilot exiting the 

aircraft. The incident occurred at 1344 hrs. Investigators 

found no problems with the aircraft cabin door or the 

restraint system. Friends of the pilot revealed a history of 

“ongoing treatment for depression and a recent intent to 

take his own life by using an aircraft.” A suicide note, left 

in the pilot’s car, stated “I’m tired of being depressed. I’ve 

been this way for almost 2 months. I’m about ready to do 

anything to stop feeling this way.” The pilot was also the 

target of a federal investigation.Biological specimens from 

the pilot were not submitted to CAMI for toxicological 

examination. The NTSB determined the probable cause 

of the accident to be pilot suicide.

Results and Discussion

Epidemiological and Toxicological Aspects

The NTSB is the primary federal agency responsible 

for investigating civil aviation accidents. The NTSB is 

also responsible for determining the probable cause(s) of 
5

an aviation accident. During the course of an aviation 

accident investigation, it may be difficult to differentiate 

between a suicidal and an unintentional aviation accident, 

when considering that the circumstances surrounding 

such accidents can be virtually indistinguishable. The 

NTSB’s determination of suicide as the probable cause of 

an aviation accident is assigned only when there is strong 

supporting evidence for such a claim, such as a suicide 

note, a witness, or suicidal ideation. Therefore, aircraft-assisted suicides are likely under-reported; however, for the 

purpose of this study we examined only general aviation 

fatalities that were reported by the NTSB as suicide. 

Compared to other types of suicide, aircraft assisted 

suicide is unique in that it is almost always successful. 

Over the 10-year period, 1993-2002, there were 3648 

fatal general aviation accidents, 15 of which were reported 

by the NTSB as being suicide as the probable cause. 

Additionally, 1 pilot suicide was reported that did not 

result in an aviation accident (case 16). Therefore, aviation accidents as a result of pilot suicide are rare events, 

accounting for 0.41% of all fatal general aviation aircraft 

accidents (15 of the 3648). The pilot suicide that did not 

result in an aviation accident was not included when deriving this statistic. A previous study by Ungs12 evaluating 

aircraft-assisted suicide in the United States over the years 

1979-1989 found that 0.17% (10 out of 5929) of all fatal 

general aviation accidents were conclusively attributed 

to suicide. While the actual number of aircraft-assisted 

suicides has gone up from 10 over an 11-year period to 

16 over a 10-year period, an increase of 76%, the total 

number of general aviation accidents has substantially 

decreased from 5929 to 3648 over the time periods 

studied, a decrease of 32%. The frequency of suicide by 

year from 1992 - 2003 is presented in Table 1. Five of 

the 16 (31%) aircraft-assisted suicides occurred in 2002, 

while no cases were identified in 1996 or 1999.

All 16 “suicide flights” were operated as general aviation, 

14CFR Part 91. The aircraft used in these suicides were 

predominantly single-engine (14 of 16), fixed-landing 

gear (13 of 16) aircraft, and consisted of 11 Cessna, 4 

Piper, and 1 Socata. All of the pilots involved in these 

aircraft-assisted suicides were male, with a median age 

of 40 years (range 15-67). The pilot was the sole occupant in all of the suicides involving aircraft accidents. 

Epidemiological aspects of the suicide pilots involved in 

the current study were similar to those found by Ungs.12

Ungs reported that all of the aviation-assisted suicides 

were operated under general aviation flight rules, and 

that all the suicide victims were male, with a median age 

of 36 (range 29-87).

Precursors to suicide have been well documented.11

Common suicide precursors include psychological 

problems, substance misuse, domestic issues, and legal 

problems, as can be seen in the case histories discussed 

Table 1. Comparison of aviation-assisted suicides versus 

total fatal general aviation accidents per year (1993-2002). 

Year Aviation-assisted 

suicides 

Fatal general aviation 

accidents* 

1993 1 401 

1994 1 404 

1995 3 413 

1996 0 361 

1997 1 350 

1998 2 364 

1999 0 340 

2000 2 345 

2001 1 325 

2002 5 345 

TOTAL 16 3648 

*Numbers obtained 12/04 from www.ntsb.gov/aviation/Table10.htm
6

Table 2. Suicide pilot’s state of mind prior to the accident. 

Case

#

Domestic 

Stress/Difficulties 

Criminal 

Stress/Trouble Depression Prior Talk/Thoughts of Suicide Prior Attempt at Suicide Left Suicide Note/Letter Summary of Events Leading to Suicide 

1 - Y - Y - Y Father of 4; arrested; worried about jail; lewd behavior w/minor 2 Y - - - Y - Negative publicity; order of protection; extramarital affair 3 Y Y - - - - Worried about jail; found guilty of pyramid scheme 4 Y - - Y - - Fight with spouse; police intervene 5 - Y - - - - Fatal Hit & Run; warrant for arrest 6 - - Y Y - * Mother's death; worried about deteriorating health & FAA license 7 - - - - - Y Spent previous night drinking 8 Y - - - - - Marriage proposal declined 9 - Y Y Y - Y Criminal history; suspect of arson 

10 - - - - - - Undetermined 11 Y - - - - - Restraining order; escorted away from home 12 Y Y - - - - Subject of criminal investigation; estranged from adopted daughter 13 - - - - - Y Undetermined 14 - - Y Y - - Under therapy for severe depression 15 - Y - Y - - Undergoing criminal investigation 16 - - Y Y Y Y Ongoing treatment for depression 

* A hand-written will was found, prepared the day before the pilot’s suicide. 
7

above and in Table 2. Based on available NTSB data, the 

majority of the 16 suicides occurred between the hours 

of 1200 and 0800 (n = 13), most frequently on Monday 

(n = 6), and in the fall or winter seasons (n = 11). Ten 

of the 16 airmen (63%) had thought of suicide, talked 

about suicide, attempted suicide before, and/or left a suicide note. Specifically, 7 of the 16 victims had expressed 

recent thoughts of suicide, 5 left a suicide note, and 2 

had previously attempted suicide (1 twice before). Also, 

13 of the 16 victims (81%) had experienced domestic 

problems (46%), criminal issues (46%), and/or depression (31%) just prior to their suicide. Table 2 summarizes 

these results.

All 16 airmen were medically certified for flight operations sometime in their flying career: 1 – 30 years, 

median = 6, as measured by the length of time between 

their first medical certification to the date of the incident.

Three of the airmen, cases 1, 15, and 16, had allowed 

their medical certification to lapse, where the time span 

between their medical certification exam to the date of 

the suicide was 67, 49, and 302 months, respectively. 

The remainder of the airmen had current medical certification and, therefore, were operating within the FAA’s 

aeromedical certification regulations at the time of the 

accident. Each airman was in good general health as of 

their last medical certification. Nine of the 16 airmen 

were granted “clear” (unrestricted) certification. Five of 

the 6 “limited” certifications were due to the requirement 

of corrective lenses. Definitive information regarding 

the “limited” certification of one airman (Case 2) was 

not available, but may have been related to a Statement 

of Demonstrated Ability (SODA), though we could 

not ascertain the nature or degree of the impairment. 

Likewise, the “Special Issuance” certification granted 

to one airman (Case 6) was likely due to cardiovascular 

problems, as discussed below.

At the time of their flight certification medical examination, one airman (Case 5) reported having “problems with hay fever/allergies.” Another airman (Case 

8) reported his military discharge for medical reasons 

but provided no details as to the date of the discharge 

or its cause. However, aeromedical personnel had noted 

benign essential hypertension in 1992 and 1997 and 

acquired deformities of the forearm, excluding fingers, 

also in 1997. One airman reported “other illness” (Case 

4) and 3 reported “admission to a hospital” (Cases 8, 9, 

and 12), but provided no details. An airman (Case 7) 

reported his appendix had been removed and corrective 

surgery of a broken jaw, both occurring around 1995. 

One airman (Case 6) reported “heart/vascular trouble” 

and “admission to a hospital.” This report was confirmed 

by further medical intelligence, prompting the pathology codes for angina pectoris in 1994 and acute myocardial infarction in 1985. The coroner confirmed this 

by noting evidence of advanced coronary artery disease 

and myocardial infarction on autopsy. Other pathology 

included 2 cases of alcohol dependence with DUI/DWI 

conviction (Case 9 twice and Case 10 once). Six of the 

airmen reported visiting a health professional within the 

last 3 years for treatment of conventional problems (flu, 

hay fever, checkup, back injury, etc).

All 16 airmen exhibited a normal field of vision during 

their medical examination and 15 “passed” their color 

vision test (1 missing data point). Their resting (sitting) 

systolic blood pressure averaged 122 ± 8 mmHg; resting 

diastolic blood pressure averaged 76 ± 6 mmHg; and 

their resting heart rate averaged 70 ± 8 bpm. The AMEs 

medical examination, as described in Form 8500-8 and 

recorded in DIWS, noted no abnormalities or comments 

regarding the self-report items, except for noting scars 

and tattoos for 5 of the airmen. 

Nine of the airmen were private pilots with singleengine land rating. Four airmen were commercial pilots 

with both single- and multi-engine land rating. Flight 

experience, i.e., total flight hours and flight hours in the 

last 90 days and 30 days, is presented in Table 3. The 

majority of the suicides were initiated while maneuvering (6 of 16) or during the descent (7 of 16) phase of 

operation.

Toxicological findings for 7 of the 14 airmen for 

which test specimens were available were negative for 

disqualifying substances (specimens were not available 

for Cases 11 and 16). Positive toxicological findings 

included 4 ethanol positives, 2 positive results for benzodiazepines, 1 positive result for marijuana, 1 positive 

result for cocaine, and 1 positive result for venlafaxine. 

None of the airmen reported intake of these disqualifying 

substances during their medical certification process or 

thereafter. Indeed, the 2 airmen undergoing depression 

therapy had not reported it to their AME, and only 3 

of the 16 airmen (19%) reported taking medications of 

any kind. Toxicological findings for these 3 cases were 

negative for disqualifying substances. Table 4 describes 

these results.

Each of the 4 ethanol-positive values were above the 

FAA cutoff of 40 mg/dL. In fact, 2 of the pilots tested 

positive for ethanol above 100 mg/dL, indicating significant impairment. The benzodiazepines identified in 

2 of the cases were diazepam and some of its biologically 

active metabolites (nordiazepam, temazepam, and oxazepam). Diazepam is prescribed mainly as an antianxiety 

agent and a muscle relaxant. Therefore, the presence of 

diazepam and its various metabolites suggests possible 

cognitive impairment. One of the cases that tested 

positive for diazepam (Case 4) also tested positive for 

ethanol and cocaine, as well as cocaethylene, an active 
8

Table 3. Flight experience of suicide pilots. 

Case # Age 

Class of 

medical

certification 

Pilot license Airplane 

ratings

Total flight 

time (h) 

Flight time, last 

90 days (h) 

Total flight time, 

last 30 days (h) 

1 45 3* Private SEL† 1915 45 20 

2 38 2 Private SEL 320 3 2 

3 20 3 Private SEL 55 - - 

4 32 3 Private SEL 164 5 5 

5 38 3 Private SEL 500 - - 

6 67 3 Commercial Multi- & 

SEL 5550 171 54 

7 26 2 Flight instr., 

commercial 

Multi- & 

SEL 984 1 1 

8 41 3 Private SEL 148 30 4 

9 40 1 Private SEL 200 - - 

10 22 1 Flight instr., 

commercial 

Multi- & 

SEL 1203 - - 

11 43 3 Private SEL 1476 35 15 

12 40 3 Student None 94 - - 

13 15 3 Student None 19 - - 

14 54 2 Flight instr., 

commercial 

Multi- & 

SEL 4676 - - 

15 43 2* Private SEL 85 - - 

16 47 2* Student None - - - 

*Medical certificate lapsed 

†Single-Engine Land 

cocaine metabolite formed from the co-administration 

of cocaine and ethanol. One victim was found positive 

for tetrahydrocannabinol (Case 3), the active compound 

in marihuana, as well as tetrahydrocannabinol carboxylic 

acid, an inactive metabolite of tetrahydrocannabinol. 

However, in view of the low level of tetrahydrocannabinol, it was likely that this compound had little direct 

affect on the pilot’s mental processes. One victim had the 

antidepressant, venlafaxine, and its active metabolite, desmethylvenlafaxine, in his blood at 446 and 1462 ng/mL, 

respectively. Steady-state therapeutic blood concentrations 

of these 2 compounds are typically about 180 and 320 

ng/mL, respectively, following 6 days of a 150 mg daily 

dose.14 The concentrations found in case 14 were significantly higher than therapeutic levels following a typical 

dosage. These concentrations, in conjunction with the 

volume of distribution for these compounds, suggest that 

the pilot was taking at least the maximum dose of 225 mg 

per day. The side effects of venlafaxine - including anxiety, 

nervousness, insomnia, mania, hypomania, seizures, and 

suicide attempts - increase with dosage, and, therefore, 

may have affected the pilot’s mental faculties. This pilot 

had not reported using this drug even though he had 

been in therapy for severe depression. According to the 

NTSB Accident Report, “The pilot’s wife said that he was 

being treated for depression. A psychotherapist reported 

that the pilot had been seeing her for approximately 2.5 

months, twice a week, for severe depression. She said he 

was also taking anti-depressant medication.” 

Each of the compounds found in these 7 aviation 

accident victims have the potential to impair both judgment and physical ability. These disqualifying substances 

may have contributed to the events that led to these 

fatal accidents.
9

Table 4. Postmortem toxicology findings and self-reported medications. 

Case # Self Report: During Medical 

Certification Process•

Toxicological Analysis/ 

Disqualifying Substance Present Substance Amount 

1 None [67] Ethanol 175 mg/hg, lung; 117 mg/hg, 

muscle 

2 None [<1] None N/A 

3 None [13] 

Tetrahydrocannabinol-THC 

(marihuana) 

THC carboxylic acid 

1 ng/mL, blood 

6 ng/mL, blood; 15 ng/mL, urine 

4 "1 med", unspecified [20] None N/A 

5 None [8] Ethanol 64 mg/dL, blood 

77 mg/dL, vitreous humor 

6 None [12] None† N/A 

7 None [8] Ethanol 

141 mg/dL, urine; 103 mg/hg, 

brain 

97 mg/hg, muscle 

8 None [14] Diazepam (Valium)

Nordiazepam 

28 ng/g, kidney; 74 ng/g, liver 

69 ng/g, kidney; 134 ng/g, liver 

9 None [16] 

Ethanol

Cocaine

Benzoylecgonine 

Cocaethylene

Diazepam

Nordiazepam 

Temazepam 

Oxazepam 

42 mg/dL, blood 

5 ng/mL, blood 

113 ng/mL, blood; 215 ng/g, liver 

31 ng/g, liver 

57 ng/mL, blood; 1011 ng/g, liver 

76 ng/mL, blood; 1504 ng/g, liver 

143 ng/mL, blood; 758 ng/g, liver 

1 ng/mL, blood; 492 ng/g, liver 

10 None [10] None N/A 

11 None [17] N/A* N/A 

12 None [10] None N/A 

13 Isotetrinoin (Accutane),

unspecified dosage [2] None N/A 

14 None [16] 

Venlafaxine (Effexor)

Desmethylvenlafaxine 

446 ng/mL, blood; 3018 ng/mL, 

urine 

1462 ng/mL, blood; 34,102 

ng/mL, urine 

15 Ranitidine (Zantac), daily, 

unspecified dosage [49] None N/A 

16 None [302] N/A* N/A 

•

 [ ] indicates the approximate number of months from last medical to suicide. 

* No specimens submitted for analysis. 

†

 Postmortem microbial ethanol production. 
10

Certification Aspects

The FAA’s medical regulatory responsibilities, that 

consider public safety as paramount, are different from 

clinical medicine, where the physician-patient relationship takes precedence.9

 However, that both have the 

health of the patient as a common factor, both rely on 

what an individual reveals in their medical self-report 

and both depend on what is found during the medical 

(history and physical) examination. The information 

gathered on the 16 suicide victims during the medical 

certification process could not have alerted AMEs of 

suicidal ideation. In retrospect, it is also doubtful that a 

psychological examination would have been helpful, as 

the majority of the accidents seem to have been triggered 

by events that occurred long after the medical certification 

process was completed (median 14 months). Further, 

since an AME’s “regulatory” duties would generally not 

be appreciated by pilots that fear losing their certification, 

it is especially challenging for the physician to inspire 

a trusting physician-patient relationship - much less 

discern if a pilot may be suicidal or expect him to report 

issues or medications that would put his privilege to fly 

in jeopardy. Still, to develop potential suicide mitigation/prevention strategies, it is necessary to understand 

and recognize the stress factors contributing to a person 

taking his own life. Understanding suicide, as it relates 

to aviation safety, is a function of aeromedical research, 

including the integration of toxicology, bioinformatics, 

accident investigation, and the psychosocial disciplines. 

Recognizing these factors in a patient seeking medical 

certification for flight operations is an issue of training 

and the certification process itself.

According to Remick,11 “there are no pathognomic 

markers of depression.” Specific criteria an AME would 

address to identify major depression as a concern would 

include factors such as the individual’s sleep pattern, 

interests, mood, level of energy, concentration, appetite, 

etc. However, a pilot seeking to be medically certified will 

typically present himself as happy and healthy, especially 

to the physician he believes whose job it is to restrict flying 

activities if found otherwise. Major depression is a significant risk factor for the development of coronary artery 

disease andstroke, compounding the medical certification 

assessment process. The most prevalent avenue for the 

treatment of depression is the use of Selective Serotonin 

Reuptake-Inhibitors (SSRIs); however, SSRIs have drawn 

high interest from the aerospace medical community in 

terms of their effects on psychomotor performance and 

the persistence of symptoms after weeks of receiving an 

adequate dose of these antidepressants.3, 6, 8, 10

To address psychosocial issues, Yanowitch et al.13 proposed that “increasing pilot insight into the role of emotional and situational stress in accident causation” should 

lead to more effective accident prevention programs. They 

proposed the “psychosocial autopsy” approach, developed 

in 1955, by composing a “psychosocial reconstruction 

inventory, that attempts to answer the WHY of the accident. It includes a “retrospective portrait” of the victim 

in terms of lifestyle, as learned from family and friends. 

This approach implies the need for an aeromedical research 

scientist to be an integral component of the accident 

investigation team. Also, investigating the circumstances 

surrounding the accident would lead to improved security 

processes that could frustrate the efforts of the emotionally vulnerable pilot. Finally, the integration of this type 

of information with existing data from the NTSB and 

aeromedical certification databases, along with autopsy 

and toxicological reports, could advance the contribution of the bioinformatics sciences in the development 

of better avenues to aircraft accident prevention.

Unfortunately, while one could say that 100% of the 

victims were experiencing depression at the time of suicide, 

probably no one could have stopped their making the final 

suicidal choice. Witness the 2 victims who were apparently 

undergoing professional treatment for depression or the 

8 cases where the victims discussed suicide with friends 

or family immediately prior to doing so.

Conclusion

Most of the “suicide” pilots had significant domestic/criminal difficulties at the time of their suicide. The 

limited data presented here indicate that 50% (7 out of 

14) of all aviation-assisted pilot suicides, for which toxicological specimens are available for analysis, involve at 

least one, if not more, disqualifying substances, and 43% 

(6 of the 14) had potentially cognitive impairing levels 

of such substances in their system. During the medical 

certification process for the 16 suicide victims, no information gathered would have identified suicidal ideation. 

The majority of the suicides were likely triggered by events 

occurring long after the medical certification process 

had been accomplished. However, it must be stressed 

that pilot-assisted suicide appears to be an uncommon 

event, accounting for less than one-half of 1 percent of 

all fatal general aviation accidents. Also significant is the 

fact that, over the 10-year period of this study, no one 

other than the pilot was injured during the course of an 

aviation-assisted suicide.
11

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