The right to die has long been discussed by those stricken by cancer or other terminal illnesses, but it is the AIDS community--particularly its gay contingent--that has been the most organized and supportive, watchers say.
"This group is light-years ahead of any other group in terms of empowering themselves," says John Pridonoff, executive director of the Hemlock Society U.S.A., a euthanasia advocacy group.
"The educational level and history of activism in the tightly knit gay community has led to a very assertive movement."
Gay men with AIDS have a harder time staying in denial than other patients do, he says.
"While cancer strikes individual families, AIDS has gutted an entire society," he says. "Cancer patients haven't watched 30 friends die gruesome deaths with no time to grieve in between. They're demanding more of everything--medically, spiritually, socially and politically--because they realize there's nothing left to lose."
The suicides go on mostly in large cities, Pridonoff says, because that's where most of the resources and support for it are.
"The fact that it's against the law doesn't mean anything to people dying," he says. "And those assisting are so proficient at it now that the coroner's office doesn't even get, or want to get, involved. As long as it's not a blatant suicide, they let it go by."
Stephen Jamison, formerly a Hemlock regional director who now runs life and death workshops in San Francisco, estimates that one in four AIDS deaths are assisted suicides. He says many are "managed deaths" brought about by doctors giving deliberate morphine overdoses, ostensibly for the control of pain.
"It's out there and it's epidemic but no one wants to face what's going on," he says. "I'm not a hard-core advocate of the right to die. But I do want to help them make the best decision."
Jamison says the most important part of the right-to-die movement needs to be cautious education.
"People are involving family and friends and they're way over their heads," he says. "I want to see physicians and therapists involved. Instead of keeping it closeted, let's move it out and say, how do we involve families, significant others, friends, nurses and hospices in the process of helping patients make the right decision?"