— When should we allow a person to hasten her own death?

By Brent M. Kious / Margaret Pabst Battin

What counts as a good reason to die? When does a person’s desire to die make sense and when does it not? When should we allow a person to hasten her own death? There is a lot of disagreement about questions like these. Some of us think that death is something no one should ever want for themselves—wouldn’t that be suicide?—and that we should hold on to life for as long as possible, even in the face of severe illness and suffering. Others think a person can reasonably want to die when it is the only feasible way to end severe suffering or to prevent severe suffering that is very likely.

Some think such questions are simply misplaced: anyone of sound mind should be able to choose when she dies, since it’s her life to live or not. But should we—may we—ever seek to die as a way of shaping the narrative of our life, choosing a time and a place that marks our lives as complete? Faith Sommerfield—who died by her own choosing at a Swiss end-of-life clinic—thought that we should. Her story cuts to the core of our ideas about the value of life and the conditions under which death looks reasonable, where wanting to die is understandable. It raises difficult questions about the authority we should have over our own lives and how they end, the importance of living a life in accordance with our plans for it, the considerations we make concerning others who are affected, and about what it is to die well.

Faith died by voluntary euthanasia at Pegasos, one of several Swiss clinics that provide euthanasia for nonresidents, on September 27th, 2022. She was 82 years old. Prior to her death, she had what most of us would regard as a good life—even, viewed objectively, an enviable one. She had children and grandchildren; she had friends; she lived in a spacious apartment in Greenwich, Connecticut. She was highly educated—it’s said that she spoke French like a native Parisian—active in her community, and well-off. For her age, she was healthy and relatively active. Sure, she had some mostly minor aches and pains. She’d had a hip replacement in the past and also bilateral knee replacements. She wasn’t as steady on her feet or as active as she wanted to be, but she seemed to cope. At least on the surface, she seemed happy and fulfilled. Given the evident fullness of her life, it might not be immediately apparent why she would want to orchestrate her own death.

But she did want a death of her own design. Months in advance, she wrote to Pegasos to request their help. Pegasos works some with Swiss clients, but also with people from other countries who are seeking end-of-life interventions but can’t get what they want at home. It’s legal in Switzerland, though still a bit controversial, for non-residents to access medical aid-in-dying (MAiD) or, as they call it, voluntary assisted dying (VAD), through clinics like Pegasos.

In her letter, Faith described her life history and her reasons for wanting to die. “My life,” she wrote, “according to my personal criteria, is completed.” What did that mean? What criteria were those? Faith explained that she had done the things she’d set out to do in her life, fulfilling the purposes she had set for herself. She seemed to regard her voluntary, chosen death as “celebratory,” the culmination of a life well-lived—or at least, lived as well as she could.

Why Switzerland? MAiD is legal in 10 states in the US plus the District of Columbia. Oregon was the first, in 1997, followed by Washington; New Mexico was the most recent state to legalize it. But Faith lived in Connecticut, which despite considerable legislative activity, hasn’t legalized MAiD. You might think she could simply have traveled to another state, like Oregon or Vermont, but that wouldn’t have worked, since until recently, all of the places in the US that had legalized MAiD imposed a residency requirement. That has changed in Oregon as the result of a lawsuit claiming that the residency requirement in the Oregon Death with Dignity Act was unconstitutional, an action which was soon followed by Vermont; it is possible that as MAiD becomes legal in other states, residency requirements won’t be built in.

That still wouldn’t have been much use to Faith, however. All of the jurisdictions that permit MAiD in the US also require that the recipient have a terminal illness—something like cancer or amyotrophic lateral sclerosis (ALS)—that makes it likely that they’ll die within six months. Faith had some chronic pain because of arthritis in her spine, one of the knee replacements that went bad, and a mild heart condition. But none of these things was likely to kill her any time soon.

That’s why she went to Switzerland. Multiple European countries permit (or will soon permit) aid in dying, including the Netherlands, Belgium, Luxembourg, Germany, Austria, Italy, and Spain, in addition to Switzerland, as well as Canada, New Zealand, and Australia. Some of these places allow aid in dying for people who do not have a terminal illness. The Netherlands requires a person to be suffering unbearably and intractably from some illness, though it could be one that isn’t necessarily life-threatening, like fibromyalgia, or even a chronic psychiatric condition, like serious refractory depression. The Netherlands has also considered extending aid in dying to people who are simply “tired of life.” Belgium already explicitly allows aid in dying for that reason. Switzerland is perhaps the most liberal jurisdiction of all, since it has no specific requirements about when it’s permissible to help another person die. It’s simply not a crime in Switzerland to help another person end her life, as long as it is done in good faith and without the prospect of significant personal benefit. That’s why Faith went there.

There are other differences with the US. Canada, Switzerland, and other European countries that permit MAiD all allow both physician-assisted suicide and voluntary euthanasia; in the US, only physician-assisted but self-administered dying is allowed. All 11 US jurisdictions require a person to take the lethal medications—often a compound of as many as five different drugs prepared by a pharmacy—on their own; they must swallow the liquid, or push the plunger to put it through their feeding tube, or in a newer form of administration, push the plunger on a rectal catheter. Voluntary euthanasia, on the other hand, means that someone else administers the drugs, often intravenously. In places that allow both approaches, true of most jurisdictions outside the US, the vast majority of people prefer IV administration (more than 99 percent in Canada), because it is faster, more certain, much less likely to have side effects.

That’s what Faith wanted, something fast, easy, and foolproof. Pegasos reviewed Faith’s case. There were some interviews. But, ultimately, they agreed; she paid the hefty fee and made her appointment.

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In July, a few months before her trip to Switzerland, we met with Faith. Both of us (BMK and MPB) are trained in philosophy and have written about end-of-life ethics; one of us, BMK, is a practicing psychiatrist too. We wanted to get a sense from Faith of how she thought about her decision. But before we met there were some conditions that had to be hashed out. Faith was nervous. She wanted assurances that we wouldn’t use the interview to try to dissuade her. She also wanted us to promise that we wouldn’t use a psychiatric lens to pry up something—a hidden history of mental illness, mainly—that would make her look incompetent and preclude her from carrying out her plan. She wanted to see the list of questions ahead of time. We agreed.

We met by Zoom. We found Faith, tastefully dressed, wearing just the right amount of jewelry, seated in her impeccably decorated apartment. We started with the big question: Why? She said she thought that we all get to choose the purpose of our lives: “Life is such an incredible gift. In so many ways, we are able to shape our own lives, sometimes our own destinies. It’s our responsibility, depending on who and how we want to be, to give our lives as much meaning as possible.”

Faith had admittedly done a lot with her life: she graduated from Smith College and went on to become a fashion editor for Harper’s Bazaar, a public relations director, and a successful interior designer. She married at 25, already afraid at that time that she would become “an old spinster,” but divorced within a year; she remarried shortly to a man 12 years her senior. They raised two children, moving from New York to Greenwich when they were still young. One of her children later described this relationship as difficult, indeed “horrible.” Her husband eventually developed Parkinson’s, and after he became symptomatic, he was removed to an alternative living arrangement. Faith met another man whom she would describe as her “life partner,” although they were only together for six years before he died. After his death, she remained close with his two children, recognizing them as her “chosen family.” After he died, Faith met someone she jokingly called “Mr. Wednesday Saturday” after the days they would spend together; he remained with her until the end of her life.

Faith had inherited a substantial sum of money from her parents, and her mother had given her one directive about what to do with it: “Start a foundation.” So that’s what Faith did. She began to build an organization devoted to end-of-life issues: the Completed Life Initiative, or “CLI” for short, something she would come to see as her crowning achievement. CLI came into being in 2019, just before the 2020 COVID-19 lockdown, so its work has been conducted largely online. Nevertheless, it has assembled a board of academics, physicians, and attorneys who are experts in end-of-life issues (including one of us, MPB).

CLI has a talented staff and connections with other end-of-life organizations. It holds an ongoing series of talks, panels, forums, extended conferences, and other programs. These draw a vibrant online audience, including other people who are exploring how best to approach their own deaths. The goal of CLI, its website says, is to promote new ways of thinking about mortality—to encourage others to see death not merely as a defeat at the hands of some terminal illness, but as a triumph, if it occurs at a time and in a manner of your choosing, in response to the sense that your life has served its purpose. This is just what Faith chose for herself. Seeing this organization bloom was the culmination of her life, she insisted—the completing factor, the goal toward which she had been working all along.

This was quite an achievement, we thought. Even so, we couldn’t help but wonder, why now? “Why not now?” Faith responded. Okay, but why not wait a little? Faith scoffed: “There’s always going to be something that you wish you had waited for. … You can’t help that. I could postpone, but I don’t think it’s possible in any life to complete every thought, wish, desire, activity, or whatever. I can be sorry about, I am sorry about, a lot of things that I haven’t been able to complete the way I hoped. But I can radically accept the fact that I’m not going to be able to do them.”

Faith worried some about pain and suffering. As she described her thinking, part of having a good death was avoiding pain and discomfort that didn’t serve a purpose—they could be borne for a good reason, but it didn’t make sense otherwise. “I’d always thought about suffering at the end of life. I had a lot of thoughts about the non-necessity of suffering at the end of life. I used to get very upset when I read about what I saw as terrible deaths.”

Even more important than suffering, however, was the risk that she would not be able to function in the ways she was used to doing. She wanted to avoid a scenario in which “I’m living a life that doesn’t serve me and which is without purpose. Other people might be perfectly happy to lie in a bed for years and years and have their needs met. If people are able to do that, and that’s their desire, that’s fine.”

Faith placed great stock in her appearance and her fitness, and was vexed by the limitations of age. Perhaps there was some vanity in this—even in the days before her death, she was abstemious with food and drink, worried that she would gain weight. Her personal chef prepared dinners consisting mostly of broccoli, and only three weeks before her trip to Switzerland, she declined to have a glass of wine during one of the biweekly Zoom-dinners she’d been having with one of us (MPB) because she didn’t want to gain weight. (Faith was 5’2” and did not allow her weight to exceed 96 pounds.) But more important to her thinking was the possibility that something catastrophic would happen. “I am troubled by the fact that I fall a lot,” she said. “I don’t feel comfortable being outside on the street or even in lots of people’s houses and for me that’s a really big deal.” She was, she said, “in terror of being just one fall away from not being able to have the death I desire.”

It’s easy to underestimate how much the risk of falling mattered to Faith. One close associate—another bioethicist—who attended a farewell luncheon held just before her trip to Switzerland related that, after the lunch, Faith had almost fallen down the six stone stairs outside the restaurant. He managed to catch her before she tumbled, and in that moment appreciated, for the first time, what a devastating effect a fall could have had and how it would have changed everything for her. Faith, though, knew that falls are a major cause of worsening disability in the elderly. She was determined to avoid that all-too-common scenario. There was, she said, “an enormous satisfaction in knowing that I don’t have to worry about what could hit me or what could happen to me or how I could suddenly not be capable of doing what I’m doing.”

Both of Faith’s biological children were particularly disturbed by Faith’s plan. They urged her to get a trainer to help with stability and strength and perhaps a nutritionist to eat a more balanced diet. They discussed whether mental illness was playing any role. Did she have OCD? Or an eating disorder? Why did she bring up the prospect of her own death so often, even with people who didn’t seem to want to hear about it? What about that early diagnosis of bipolar illness, for which she’d been treated by a psychiatrist for many years, and a suicide threat she’d made after the death of the man she’d recognized as her life partner? Faith described herself as a “control freak,” but mental illness was not the way Pegasos saw it when they reviewed her records. In the end, even her biological children, those most distressed, agreed that her final decision was made with a “relatively sound mind,” though they themselves resented the decision and the almost flippant way Faith let her family know: “I won’t be around in a year—what do you want from my apartment?”

For Faith, then, the decision to end her life seemed to depend on a simple calculus: the purpose of her life having been achieved, she merely needed to weigh the risk that something would happen to make her die badly—dependent, bed-ridden, unable to do things, in pain—against the value of a little bit more time. Life wasn’t bad for her; quite the opposite. But life wasn’t, she thought, something worth living in its own right, just for its own sake. And traditional pleasures, like time with family and friends, pursuing hobbies, experiencing beautiful things, didn’t matter additively: more of them wouldn’t make her life go better. At least, they wouldn’t matter enough to run the risk that things would go sideways. She recognized that by getting euthanasia she was giving something up. In a prerecorded lecture, delivered posthumously to CLI at its fall online conference, she said, “I don’t know, but I believe that I’m choosing to give up some good years of life. But life is only life if it is able to be celebrated and valued. The life of someone with terminal illness, cancer, ALS … I don’t know. If I continue to live, I’m really taking a chance. I don’t want to do that to myself.”

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We made our own trip to Switzerland before Faith did. We had already planned to present a paper at a meeting of the International Association for Bioethics there, and that meeting happened to be in Basel, close to Pegasos. Faith offered to put us in touch with Pegasos so we could see the facility and find out about the procedures they use. After a flurry of emails, arrangements were made; the clinic’s director would pick us up at our hotel in Basel. The plan struck us as somewhat surreal. We would visit Pegasos and then head to a local Spanish restaurant for tapas, where our host had arranged for a private room so that we could have an unfettered conversation.

Both of us experienced a flurry of anxiety before he arrived: getting whisked away by someone we’d never met, whose profession was helping people die? Was that entirely safe? But first impressions were reassuring. The director arrived in an old Volvo station wagon—exactly the car you might expect—wearing a linen tunic and Birkenstocks (also what you might expect), bearded, brimming with energy and solicitous good cheer. Like a countercultural and less rotund Santa Claus, bearing strange gifts.

After a quick trip through the city, marked by lively conversation about the difference between Swiss and American democracy, we left the freeway, picking up a little back road that sidled up against a forested stretch of the Jurassic Hills. Then, after a few miles, to our dismay, our host turned away from those hills into what had been a small medieval town on the edge of Basel. We were now confronted with an aging industrial park. The road in was dominated by piles of asphalt to be melted down at the recycling facility just to the right. Pegasos itself was located in a converted textile factory, later transformed into a photographer’s studio. Next door was a body shop with the remains of old BMWs sitting out front; our host had done his best to dress up the setting by wrapping a few of the most unsightly hulks in silver tarps. Faith, we thought immediately, would hate this. It was a far cry from Greenwich.

Our host seemed to notice our disappointment. He explained that Pegasos had struggled to find a facility that would permit its work; not many landlords would tolerate an end-of-life clinic on their premises, after all. But he and his staff had made every effort to make the interior of the place appealing: there was soft lighting, comfortable chairs, soundproof panels on the walls, a nice stereo system, plenty of greenery. While we enjoyed a Swiss chocolate, the evening sun dipped through the windows overhead, and for a moment the place seemed serene. We looked at the organization’s blueprints for a much nicer facility tucked well away in the hills in precisely the setting you would want—plans that merely awaited a sufficiently generous donor to make them a reality.

But in the actual facility where Pegasos helped people end their lives, there were only two rooms: the waiting area in the front and a procedure room in the back. The area where deaths would take place was more spare, with a few chairs, some modest art on the walls, a stereo. There was a vaguely Buddhist picture hanging on the wall behind the bed, and the bed itself was a converted extra-wide hospital bed with the rails removed, so that family members, even pets, could be with the patient at their very last moments.

The director explained how the euthanasia—Faith had always insisted on calling it that—was usually performed. An IV would be started with normal saline and the lethal infusion, 15 grams of pentobarbital, would be hooked up in readiness. Under Swiss law, the client must initiate the lethal process themselves, which Faith would perform by turning a roller valve on the IV line to release the drug. Having the client perform this last act is seen as providing final assurance that it is what they really want. Family members may remain with the body as long as they wish, but are instructed not to touch the IV apparatus so that when the police and the coroner arrive—they are called immediately after the death—they will see that everything was done in accord with Swiss law.

At dinner in the little Spanish restaurant—surrounded by cases of Rioja, over trenchers of branzino—the director explained how Pegasos provided aid in dying. He acknowledged it was more liberal than other end-of-life groups, each of which has its own policies. Exit Switzerland (not to be confused with Exit International), refuses clients from outside Switzerland. Some groups are warier of providing aid in dying to people who were not seriously ill. But our host was, much like Faith, committed to the idea that anyone should be free to determine the time of their own death, regardless of whether they were medically ill, dying, old, in pain, provided that their thinking was still clear enough that they could make decisions for themselves. For him, it was a question of autonomy, and only a question of autonomy.

Pegasos requires clients to submit a biography—he showed us Faith’s, with her permission. Then, if they seemed to qualify, one of the physicians who worked with the organization would conduct an assessment. Sometimes this was in person, sometimes by videoconference; one of the psychiatrists involved was based in London. Just before the procedure, a physician would check in with them for a second time before the procedure, again largely to assess their ability to make decisions. Unless the patient was arriving by air ambulance, Pegasos required its clients to stay overnight in a hotel near the facility, so that the physician would be able to conduct a second assessment the night before the procedure. If the patient had second thoughts, this might be time to act on them—Faith had been assured that she could stop the process at any time she wanted. But as the director pointed out, second thoughts were almost always evident in advance. Patients who had come as far as Faith had were determined, ready, and resolute.

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Faith herself did not have second thoughts—at least, not that she expressed in any way at all. But where did her resoluteness come from? It might strike some as odd that the achievement she saw as completing her life, thereby making it possible for her to die, was putting together an organization focused on precisely that idea—a sort of self-fulfilling prophecy. But Faith pointed out that CLI, like her own death, is just an expression of something she’d thought about for years: ending her life on her own terms was a lifelong goal. She had been an inaugural member of the Hemlock Society, and had talked with family and friends about her desire to control her own death for most of her life.

Of course, such dedication might itself be hard to fathom: how could she spend a life focused on dying, devoted to choosing the time and the method? Some early, formative, experiences suggest an answer. Faith related how, when she was in sixth grade, her younger sister’s best friend, then aged nine, died of cancer. A large tumor near the spine had already metastasized by the time it was discovered. Faith recalled that, back then, such deaths were drawn out and agonizing, and it was “devastating to watch this little child die. She was in pain, just wasting away.” Watching her “simply disappear” made Faith start to think about the difference between a good death and a bad death. She became determined to have a good one, as she defined it. This determination only deepened when she watched the long, slow declines of her own mother and grandmother.

Faith described how she discovered the metaphysical poets in college, and their preoccupation with death resonated with her own nascent interest. In his poem “Death Be Not Proud,” John Donne regarded death, in Faith’s interpretation, as a way of escaping the risk of sin:

Die not, poor Death, nor yet canst thou kill me.
From rest and sleep, which but thy pictures be,
Much pleasure; then from thee much more must flow,
And soonest our best men with thee do go,
Rest of their bones, and soul’s delivery.

It surely also mattered that Faith’s own first child had died shortly after birth, especially because of the lack of any acknowledgement of what had occurred. “The way they dealt with that at that time was to pretend it didn’t happen” Faith recalled. “My husband was instructed to go home and take everything out of the nursery. Three or four hours after the delivery I went home and … it didn’t happen.” This was so very unlike what Donne might have said. Faith seemed to have been angered by this silence her whole life, which is not a surprising reaction to such a momentous and awful event. Part of CLI’s purpose is to make it easier for all of us to talk about dying, and this may have appealed to Faith as a way of repairing that terrible silence.

Did she think about how her death would affect others? Certainly. For one thing, Faith believed that dying early was an ecologically responsible choice. “If my life is completed, I definitely don’t want to be hanging around taking up resources, taking up space on the planet, housing, food, all those things. There’s something inappropriate about being alive, just being alive, when you feel your life is complete.”

She also thought that her death would be a model. CLI’s announcement of her death says, “Faith intended that her choice serve as a model and inspiration for the expansion of individual autonomy in end of life decision-making.” Her hope was that her death would raise awareness, even help people think about death differently. “Over my lifelong study of death and dying, I came to believe that people were living too long … and [I] was determined to find a way to end suffering at the end of life and give people autonomy to die on their own terms—without pain and with dignity.”

She recognized that her approach wasn’t for everyone, though, and she wasn’t saying that others should hasten their own deaths simply because they were getting old, feeling achy, or able to do less than they used to. Although those things contributed to her sense that her life was complete, she regarded the “completed life” as a highly individual idea that “can only be described and realized by the person living it.”

What about her family and friends? What did they think? She worried about this. Of course, the people involved in CLI, to whom she had become close over the last three years, were supportive. The two children of her life partner, both involved in the administration of CLI, were supportive. But things were sometimes rocky elsewhere. She thought she’d done her best to put her relationships right: “Everyone would want to have the best, most perfect relationship with their spouses, their children, their families. But I have some relationships where I’ve accepted that … it’s not possible to repair the damage done. But I also consider that a positive, because I’ve accepted it. I’ve done everything I can and I can’t control other people.”

The biggest conflict was with her own biological daughter. As Faith saw things, her daughter didn’t want to acknowledge what she had set out to do. This was a source of some frustration, even anguish. “I have a difficult unresolved relationship with my daughter, who says to me, ‘I don’t want to hear you talk about suicide. I’ve listened to you talk about death all your life.’ I say, ‘I’ve never talked about suicide, and I’m not talking about suicide now.’ She says, ‘I don’t care what you call it, you’re talking about it, and I don’t want to hear it.’”

Faith’s daughter did acknowledge her mother’s plan in the end, but continued to regard it as premature and, therefore, wrong. At the funeral, she did not flinch from expressing her true feelings: “It’s difficult to stand here and try to make sense of what seems nonsensical. I think the best shot I have at an explanation is the words mom wrote in her very own obituary. … ‘She died peacefully, at the time of her choosing.’ When I get sad, mad, or confused about the fact that she chose to leave us, I recall those words.” Faith’s granddaughter then echoed this sentiment: “Her choice to leave us, as insane, confusing, and strange as it may be, was something I know that she was confident in. Her stubborn nature is something I inherited and for that reason I am able to understand, to an extent, why she made this decision.”

It’s important that Faith really didn’t think about her death as suicide. Sure, she would be killing herself, and suicide is a type of self-killing. But the main difference, in her mind, was the why: “When people commit suicide they are in desperate situations. They are living lives that torment them. They just can’t bear to be living. I am not attempting suicide. I am not taking my life. If suicide were defined differently, I might say I was. It’s just that the word, the connotations, are so unfortunate.”

What about God? Despite her name, you might imagine that Faith, a lifelong campaigner for euthanasia, was a dyed-in-the-wool atheist, rejecting traditional ideas about God and the afterlife. After all, many religious groups oppose medical aid-in-dying and euthanasia, so surely proponents of euthanasia oppose religion? Surprisingly, however, Faith was quite involved in church. She responded to the metaphysical poets, and though she had grown up with little religion, she identified a need in herself while she was in college, and started going to the chapel. She attended a major mainstream Protestant church in Greenwich for decades. She sang in the choir, took her kids to church while they lived with her, served on church committees, and she was a deacon for a time. She saw the church and God as sources of inspiration for her work. “I have a very close relationship with organized religion, and it’s grown over time. I started out with no religion. Nothing, absolutely nothing. I got religion when I went to college because I decided to go to chapel, since somebody told me that the chaplain was very good. He was interesting, smart, and young. It was just some kind of need that I had.”

Faith had been open about her plan in her church community, and saw that community as a source of support. She said, perhaps over-optimistically, “I’ve … discussed it with my minister, and my minister is perfectly fine with it.” Faith had organized talks in the church about end-of-life topics and her own views. She had lunch with her pastor, a few days before she left for Switzerland. She had arranged quite an elaborate funeral in that very church—all planned out ahead of time, of course. The service made no secret of the fact that she had wrought her own death.

Her spiritual beliefs were a source of courage for her. “I do believe in heaven but I have no idea what it’s like. We definitely go someplace because I believe I have a soul and the spirit of God that was planted inside me, which is eternal, so it has to have someplace to go. I don’t know, but I think it probably does make it easier to do this.”

She took the success of CLI itself as God-given. At the start, she had resources but no connections. Stubborn, bold, knowing no one in bioethics, she found out whose help she should enlist by cold-calling a lot of academics; she interpreted their support as a sign that “the spirit is moving.” It was, far from something God opposed, part of his plan for her, and through her all the rest of us: “God,” she thought, “had not intended us to suffer at the time of our deaths.”

This isn’t to say that everything was easy at the end. Faith and one of us (MPB) were in frequent communication—those Zoom-dinners and other conversations— in the months and weeks leading up to her departure for Switzerland. At times, Faith was quite distressed. She felt she had a great deal still to do, in closing out her life—saying goodbye to friends, emptying out her apartment, attending to her will and financial affairs—but had remarked frequently, literally for months, that she was “running out of time.” At certain points, she seemed to be ensnared in trivialities. She had stipulated in her will that none of her belongings could be thrown away, so that everything needed to be taken by family or donated to charity or recycled. But her last weeks found her pulling the metal spines out of pendaflex hanging files so that they could go into the recycling bin, fretting that there simply wasn’t enough time to do everything. Not the sort of thing you would think a person would be focused on, right before the end.

You might wonder: why not just delay? The director of Pegasos had told us that the organization would be happy to postpone Faith’s visit, for as long as she wanted, just as it did for any of its clients. All the pressure was coming from Faith herself. She saw herself as unable to back down from her decision, even a little, a bit like Ulysses lashed to the mast, minus the ropes. Perhaps she was simply afraid that something—a fall, a disabling illness—would prevent her from doing it if she waited even a little. Perhaps she was afraid that she would lose her resolve. Perhaps she was simply worried what others would think if she, a shining example of autonomy at the end of life, showed hesitation.

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So, what should we make of all this? What should we make of her choice? Was it a good one? Was it made wisely and for good reasons, or made badly for bad reasons? Whether it was good or bad is very much in the eye of the beholder, depending on what one thinks about medical aid-in-dying or euthanasia in the first place. You might think it’s laudable that Faith wanted to exercise her autonomy over her whole life, including its end. But you could also think that there’s something wrong about wanting control for its own sake, especially over something most of us don’t control.

You could even, we suppose, think of Faith as obsessed. You could look at the childhood experience that shaped her desire, at the vicissitudes in her relationships, and think that it betrays something broken. But it’s possible, too, to admire her single-mindedness and determination, whatever their source. It is anyway an error to think that because we, even a psychiatrist, can tell a story about how someone came to want something—especially if that story is punctuated by trauma or some other salacious detail—that their wanting it is wrong or inauthentic. We all have such stories in our lives, after all.

You might think that Faith’s idea that her death was compatible with God’s plan for her—whether theologically tenable we cannot say—demonstrates an admirable devotion. But you could, instead, feel queasy about the fact that she seemed comforted by the thought of a heaven—for what if she was wrong, in the end, and left life sooner than she otherwise would have because eternal reward seemed to beckon?

You might think it’s understandable that Faith wanted to minimize the risk that she’d spend some portion of the end of her life unable to do many of the things she had once enjoyed or thought important, suffering only escalating pains and the burden of a body that is gradually deteriorating. But you could think, instead, that for some, maybe most people in that spot, unless things are really bad, it is possible to find other pleasures, to adapt to difficulties as they mount, and to learn to tolerate the pains. Or you could admire the realism she displayed, including her awareness that a single fall could change the course of her life for what she regarded as the very worst—everything her notion of a positive, cumulative end to a completed life was set against.

We feel tempted by all of these takes on what Faith did. Her death leaves us feeling ambivalent, not quite knowing what to think. It wasn’t easy to watch the story play out, despite our promise not to intercede. BMK had to struggle against psychiatry’s ingrained commitment to preventing suicide when it can; MPB—a bioethicist who has long argued for access to aid in dying—still held out hope that Faith might relent, or at least delay. They were friends, after all, and it was hard to see a friend go. Why, and why now, indeed?

At the funeral, Faith’s daughter summarized her mother’s lesson this way: “While I still grapple with the finality of it, and the moral and ethical pieces, of which there are many, I am learning each day that her sense of completion and accomplishment is a gift to us all. She granted us peace in knowing that she did not live in regret.”

We heard from those who had accompanied Faith to Switzerland that, once on the plane, her anxiety about running out of time had fallen away; she was described as “peaceful.” She was described that way, too, on the evening before the procedure at Pegasos, and the next day, when she was ready in bed with her family members around her. With the IV line in place and running normal saline, Pachelbel’s “Canon” playing in the background, she calmly turned the roller valve to release the lethal medication herself. Her last words, directed to those gathered at the bedside, were almost “I love you.” She died before she could speak the last word. But her intent was clear.

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