Ray Gosling, AIDS, and Euthanasia

It was a chilling confession, made in the middle of a BBC documentary on death and dying that aired on Monday. "I killed someone once," 70-year-old British reporter Ray Gosling says. "He'd been my lover and he got AIDS. I picked up the pillow and smothered him until he was dead. No regrets." Legal repercussions followed, with local authorities swiftly arresting Gosling—assisted suicide is illegal in the United Kingdom, as it is in most countries—and charging him in his partner's murder.

Gosling's admission and his ensuing arrest was certainly shocking. But it also confirmed what assisted-suicide experts already knew: legal issues of hastening death have long plagued AIDS patients and their doctors. "Certainly, we know it's a community where this type of bootleg assisted suicide occurred throughout the 1990s," says Ian Dowbiggin, the author of A Concise History of Euthanasia and an expert on the right-to-die movement. "This specific example of assisted suicide, I don't know how common it is, but it is likely more common in this particular community than elsewhere."

Much of it has to do with the nature of the disease, which began to disproportionately affect gay men in the 1980s and early 1990s. AIDS patients were ravaged by tumors, seizures, and paralysis, and doctors had little to offer by way of a cure. Early treatments often merely prolonged this suffering. "People who suffered from AIDS were naturally interested in assisted suicide, whether it was legal or not," says Dowbiggin. As Gosling explained on the BBC of his own partner's disease, "Doctors said, 'There's nothing we can do'; he was in terrible pain." Legally, there was nothing his doctors likely could have done: in the United Kingdom, as in the United States (except for Washington and Oregon), physicians are barred from assisting a patient's suicide.

But illegally, in the mid-1990s, some doctors began helping AIDS patients die. These patients were in great pain, many expressing the desire to end their lives. One 1997 study, published in The New England Journal of Medicine, found that doctors working with HIV patients in the San Francisco Bay Area had received, on average, more than 20 assisted-suicide requests during their careers. The same study noted that 53 percent confessed to assisting at least one suicide of an AIDS patient in the mid-1990s (doctors responded to the survey anonymously, shielding themselves from legal prosecution). Further research, on nurses who worked with AIDS patients, found a high level of agreement with assisted suicide as a humane action to relieve suffering. How often patients took matters into their own hands, as Gosling did, is impossible to tell: most incidents go unreported because of the legal issues.

The pervasiveness of assisted suicide in the gay AIDS community made national headlines in 1998, with the prosecution of Toronto doctor Maurice Genereux. Genereux had been writing lethal prescriptions for AIDS patients, an illegal act under Canadian law. His defenders argued that he was only providing a requested service. Genereux was found guilty, stripped of his medical license, and spent nearly two years in jail. "Genereux's activities revealed that there was a euthanasia 'underground' in Toronto's gay community," Dowbiggin writes in his book, "a network of doctors who were willing to provide AIDS patients with narcotics to kill themselves and then write death certificates that covered up their crimes."

It's difficult to tell what those underground networks look like today. Dowbiggin guesses they may have retreated as treatments have improved, but are still "higher than in other communities." Yet while treatment has indeed made strides in recent years, extending life for AIDS patients, the disease can still be crippling. As New York Magazine reported in November, a new crop of drugs has been associated with early aging and senility. As one AIDS activist told the magazine, "It seems like the virus keeps finding new tricks to throw at us, and we're just all left behind going, What's going on?" And as the tricks keep coming, so will the difficult decisions for physicans, patients, and, as Gosling and men like him know too well, their partners.