AIDS-Suicide Link Worries Health Professionals

Last month, a waiter received a heart-breaking request from his best friend, recently diagnosed with AIDS-related brain cancer: Would the waiter please drive him to a remote spot so he could test a gun he planned to use to end his life?

After agonizing over the request for a week, the waiter declined. He would do almost anything to help his friend, he said, but this was the one favor he could not grant.

The story was recalled last week, shortly after a murder-suicide at Cedars-Sinai Medical Center involving a man dying of AIDS and his companion. AIDS patient Steven Charles Jenkins and his companion, Philip Lee Saylor, died when they carried out what hospital officials believe was a secret suicide pact. Saylor shot Jenkins through the head before turning the gun on himself, according to police.

The incident underscored another grim side of AIDS. Faced with a bleak prognosis, the choices for many AIDS patients seem frighteningly clear--try to ride out the deadly disease with as much hope and dignity as possible, or end it quickly with one last, desperate act.

The violent outburst at Cedars-Sinai was viewed by health care officials as dramatic evidence of the need for expanded counseling programs and other forms of psycho-social support for both AIDS patients and their loved ones.

At the same time, they acknowledged that it is impossible to say whether any amount of counseling could have prevented the tragedy at Cedars-Sinai, or any other involving a determined and depressed AIDS patient.

“It may be too simplistic to say, ‘this happened because there wasn’t enough psychosocial support,’ ” said Robin Rose, director of the Shanti Project’s model counseling program for AIDS patients and their loved ones at San Francisco General Hospital.

“Such a violent, public, outrageous act goes to the core: It is a powerful reminder of the horror of the epidemic and the pain it can evoke,” Rose said.

Daniel Warner, executive director of the Shanti Foundation in Los Angeles, said the group’s 13 staff members and 150 volunteers have helped to prevent a number of violent episodes--including a potential homicide--by referring troubled clients to psychological professionals.

“We’ve had incidents,” Warner said, “that have come close to this in the past that we have been able to defuse with our skilled volunteers and staff.”

Doctors and other health professionals said such support is clearly necessary, given the social stigma attached to AIDS and the specter of an inexorable illness that, before it kills, can cause pain, disfigurement, dementia, blindness and emaciation.

Officials at AIDS treatment centers throughout Los Angeles County said that patients often discuss suicide, especially in the terminal phase of the illness. Officials from AIDS Project Los Angeles said that last month they had attributed five deaths to suicide out of the agency’s 2,100 clients. They said, however, that the figure was unusually high, in part because of the holiday season, which is commonly believed to exacerbate depression in some people.

“Certainly there have been mercy killings and suicides in this community even when there was a lot of psychological and psychiatric counseling available,” said Dr. Joel Weisman, founding director of the AIDS unit at Sherman Oaks Community Hospital, the first of its kind in Los Angeles. “But we’ve taken care of thousands of patients over the past 10 years and this appears to be an unusual, abhorrent action.”

Still, the link between AIDS and suicide remains. Men diagnosed with AIDS were 36 times more likely to take their own lives than similarly aged men who did not have the disease, according to a study of New York suicides published in 1988 in the Journal of the American Medical Assn. However, the study also found that less than 1% of all the people with AIDS commit suicide.

“Part of the treatment of an AIDS patient should always involve an assessment of his or her mental state,” said Dr. Peter M. Marzuk, the research psychiatrist at Cornell University Medical College and the study’s author.

Marzuk said the Cedars-Sinai tragedy, which authorities have labeled a mercy killing, was “quite unusual.” While a pair of homosexuals one of whom had AIDS, killed themselves in New York by jumping off an Upper East Side apartment building together in 1985, he said he knew of no AIDS-related “suicide pacts” or mercy killings that involved gunfire.

“Most mercy killings, in AIDS and other illnesses, are surreptitious,” he said. “They are done quietly and secretly, usually with an overdose of drugs.”

Marzuk and other mental health professionals said that the Cedars-Sinai killings demonstrate that the need for psychological support goes beyond the individual who is sick. “There are a lot of families and significant others (partners of AIDS patients) who have great stress and anger, and few outlets for it,” Warner said.

Health professional said support groups offer one safe outlet for such feelings. “When there is someone around to listen and hear, and be emotionally supportive in a non-judgmental way, it can usually defuse a violent situation,” said Rose, director of Shanti’s San Francisco General Hospital Program.

The program, widely praised by AIDS professionals as a model, keeps counselors on hand seven days a week--and their services are available not only to AIDS patients but to families, friends and lovers. Support groups for visiting friends, relatives and lovers are offered every weekend.

“It helps people to process the turmoil, the angst, when someone they know is dying,” said Dr. James Dilley, director of the AIDS Health Project in San Francisco.

Weisman said the suicide-slaying dramatically underscored the need for the expansion of AIDS treatment units in Los Angeles, where patients can receive a wide variety of psychiatric and medical services. The centers also provide counseling and referral services for friends and relatives of AIDS patients, as well as specially trained doctors, nurses and social workers.

“Discussing suicide is something that comes up a lot with AIDS--it’s just an expression of the pain and suffering that they are going through,” said Ian Stulberg, a clinical social worker at the Sherman Oaks Community Hospital AIDS unit. “Sometimes just to entertain the thought of suicide allows them to go on fighting” by allowing patients to believe they have another option. “But it’s something they talk about much, much more than they do.”

Some gay activists said they hoped that the tragedy would force health care professionals to examine the role of euthanasia in dealing with terminal AIDS patients.

“We have to develop an ethic on the subject of euthanasia,” said activist Morris Kight. “The more quickly we start the debate the better off we are.”

Dr. Stephen Gabin, medical director of the 20-bed AIDS treatment facility at Century City Hospital, said the Cedars-Sinai episode demonstrated the need to give each patient a thorough psychosocial evaluation to determine if they have specific needs or problems. He said Century City’s unit now employ only nurses, doctors, laboratory technicians and other workers who want to work with AIDS-infected patients.

“We can’t say that what happened at Cedars would never happen here, but we certainly go out of our way to make sure that it doesn’t,” he said.

AIDS health care workers said that despite the wide array of services offered, there is no way to stop premeditated acts of violence at hospitals and clinics, which are not geared for heavy security. They said security should be upgraded only in specific cases, such as Martin Luther King Jr./Drew Medical Center’s decision last year to install metal detectors to stop armed gang members from entering the 430-bed county facility.

“It’s impossible to determine the mental condition of every visitor at a hospital,” said David Langness, a spokesman for the Hospital Council of Southern California. “Los Angeles is on the front lines of a lot of society’s ills, including gang violence and AIDS, and inevitably it spills over into the hospital area. These things are almost unavoidable.”

Times staff writer Stephen Braun contributed to this report.