How Safe Is BDSM? A Literature Review on Fatal Outcome in BDSM Play
A 2022 forensic literature review by Schori, Jackowski and Schön (University of Bern) that gathers seventeen published cases of death during BDSM play, including one case labeled shibari.
A. Schori, C. Jackowski and C. A. Schön of the Institute of Forensic Medicine at the University of Bern published this review in the International Journal of Legal Medicine (volume 136, 2022, pages 287–295; online August 2021). It is open access.
The authors searched PubMed, Embase and Medline for German- and English-language reports of non-natural deaths connected with consensual BDSM activity and found seventeen cases. They report that strangulation during erotic asphyxiation caused most of the deaths (fifteen of seventeen), that alcohol or drugs were involved in about two thirds of the cases where this was recorded, and that in nine cases both the person who died and the partner were experienced in BDSM.
Rope bondage appears in the review mainly through one case: the 2013 Italian report by Roma and colleagues, which the review summarizes as a double hanging in which a traditional Japanese rope technique was combined with rope around the neck. The authors also list rope bondage, Japanese bondage and suspension among the bondage activities in their overview of BDSM practices, and they agree with a published response to the Roma report that it is wrong to call all BDSM activities extremely dangerous.
Their conclusion is that such deaths are rare and preventable. They describe the safety culture of BDSM communities (education, mentoring, safewords), urge practitioners to keep tools at hand to free someone from bondage quickly, and recommend that sex education cover these risks.