On the ultimate decision

Last week, an old friend got what she wanted most. Death was her wish, and it arrived in the way she had hoped it would — in her own bed in the apartment where she had lived for more than fifty years, the person she loved most in the world at her side.

A year ago she had tried to end her life, and the intervention that saved her was not welcome. She had always been fiercely independent and the thought of becoming increasingly reliant on the small community in which she lived was untenable to her. Her vision of her situation was realistic and pragmatic. With no living children to care for her, she was adamant that she would neither move from her apartment nor become a burden to her only relative, the grandson she had raised for most of his childhood.

Her home was a walk-up apartment in central Nice that she had shared with her lover for 40 years –they married only shortly before his death – and she would not consider any other, under any circumstances. She gauged her ability to cope with her advancing age by the frequency with which she was willing to go down and up four flights of stairs – over the last few years it had dropped from four times a day, to once, then to only a few times a week, until finally she had only enough energy to leave the building when absolutely necessary.

The first time she spoke to me of suicide was several years ago, when she revealed that she had accumulated enough medication to deliver herself a fatal overdose if and when she reached the point where life was no longer livable. My first reaction was shocked rejection of her intention. In remarkably good health for someone in her late eighties, she walked to the shops every day, went to the cinema regularly and treated herself to a weekly restaurant meal. She was keenly interested in politics, changing societal mores and the influence of the internet, and her plan to choreograph the end of her life seemed completely incompatible with the person she was.

But over many discussions with her, I began to see how suicide could be considered the reasonable act of a rational person who refuses to be taken hostage by diminishing physical capacity and declining health. She was clear-eyed about the future and would frequently remark that at her age, there were no miracles left.

After she failed in her first attempt a year ago, suicide became a frequent, almost obsessive reference in her conversations. She still went to the hairdresser once a week, still watched the evening news, still took an interest in what went on around her – but she had started down a path from which she would not be diverted.

A few months ago her eyesight began to fail rapidly and although she was willing to undergo treatment to try and save what was left, the effort so exhausted her that she stopped it after the first session. We had lunch together a few weeks later and she talked of her distress at no longer being able to read a newspaper, a bank statement or even to watch television. She knew of ways to put an end to her life but candidly admitted to her fear of suffering pain in doing so. It was difficult not to protest her single-minded intention, or to offer her empty reassurances, but I had no basis from which to argue that her life could be improved or would even be bearable.

All I could give her was my attention. As much as I could try to put myself in her shoes, it was impossible for me — forty years younger and in very good health — to imagine how hostile her future had become and how untenable was the prospect of needing help to function in her daily life. I believed she had the right to do whatever she chose with her life, and that it was not mine to moralize.

In the end, she tried again. She didn’t succeed, at least not immediately, but during the brief period of hospitalization that followed her second attempt a cancerous tumour was discovered. She refused both treatment and nourishment; her beloved grandson acceded to her wishes and took her back home. I don’t really know if I, or others, failed her, but I doubt she would think so. I only wish she had been carried off by a heart attack in her sleep and so been spared her terrible decision.

If ever I get to the age she was, I might then truly understand her determination to live — and die — on her own terms, but I could not admire it more than I already do.