My Friend Chooses How and When to Die Does death lose its sting if it is the triumph of the will, and not an act of submission?

Fussier friends would shiver in the mid-October wind, but Ann Mandelstamm is in her eighties and still hiking, so I grab a table on the patio. Just as I open the menu, she arrives, clad in a sporty navy sweater and jeans and wearing her trademark red lipstick, her red-gold hair pulled back with combs. She sits, her movements as lithe and graceful as ever. She has always had a quiet, midcentury glamour about her—the Kate Hepburn sort, impatient with frippery. Neither of us even mentions moving indoors.

It is good to see her; it has been more than a year. She is animated and fun, teasing the server as she orders: “I had authority in my voice, didn’t I? I used to teach high school.” We talk about books and, with a sigh, politics, then split a pizza. Somehow Ann has always managed to go deep—think hard, read tough stuff, fight for justice—yet remain delighted by the world.

As the plates are whisked away, she says, “I have something for you,” and hands me a sheet of paper. “Not many people know,” she says. “I’m going to mail this to my dearest friends just before.”

“Before….?” I smile and take the sheet, wondering what she is up to. Skimming, I catch phrases: not something I arrived at without deliberation…. I have lived my life as well as I could…. limited resources on this planet…. what purpose could I serve by living on another five or ten years?

She has decided to end her life.

My mind goes blank with shock. “But—you’re still so vibrant!” I finally stammer.

She gives a half shrug. “I look healthy. But there are issues. And I decided years ago that my mid-eighties would be a pretty good run.” She says she knows she “may have to leave something on the table.” Her gamble is with timing, and she is determined to beat fate to the punch, not wait until a stroke or accident renders her incapable of making this decision. Besides, she repeats, she is not doing as well as it might seem. She is blind in one eye, falling frequently, losing control over her body in practical and embarrassing ways. She has painful neuropathy. Leg cramps keep her awake every night. “And I can feel my cognitive bandwidth shrinking.”

“You just used the word ‘illustrative,’” I point out dryly. “Slid it, perfectly pronounced, into a complicated analysis of political stakes.” She shrugs again and takes out her grandson’s wedding photos to show me her whole family on the beach, dressed up and gorgeous. But she is not evading the larger issue—that would not be Ann. We talk a long time, until a chill settles and the light starts to fade.

“Would you trust me to write about this,” I ask, “knowing I have reservations about your choice?”

“Of course I would.”

“So…when are you thinking?” I venture, suddenly awkward. “A year from now?”

“Early next month.”

•  •  •

Ann Mandelstamm with Maggie, a friend’s pup. (Photo courtesy of Ann Mandelstamm)

I throw dinner together haphazardly, my mind on Ann. Can I talk her out of this? Do I have the right to even try? After the dishwasher is loaded, I sit down heavily and reread her statement. She has slid one of her homemade bookmarks into the envelope, laminated pink with a cute sketch and the words: “I’ve had a nice long turn on the swing!” She means to reassure, but I slide the bookmark under a pile of books until I cannot see it.

The impulse of denial is—I can hear Ann saying this—part of the problem. We plan our weddings and babies and careers and investments and retirement. But when it comes to our death, the capstone of our life, we shrug and leave it to fate.

Which might be where it belongs, I argue silently. I did not bring myself into being. Maybe it is that simple: if we did not ask to be here, we cannot ask to leave. On the other hand, life is a long lesson in assertiveness. We are taught to act in the world, to initiate, innovate, and above all, to alleviate suffering. Surely our own would fall within that purview?

Ambivalence whiplashes me. Still, writing about my friend’s decision feels like an honor.

Or does it make me an accomplice?

•  •  •

We begin not with her death but with her life. Born in 1939 in Terre Haute, Indiana. An easy childhood, surrounded by cousins and two younger sisters. The freedom of long, meandering bike rides, picnic lunches stuffed in the basket. Magical Christmases, her parents trimming the tree and setting out presents on Christmas Eve while the girls slept. “I always imagined I heard Santa on the roof,” she says. “We always left a snack for the reindeer.”

She inherited, I deduce, her dad’s sense of fun and her mother’s sweet attentiveness. Also their strong Catholic faith. “I believed in the catechism—I believed it 100 percent,” she says. “I had my own May altar in my room, and I remember kneeling on the hardwood floor instead of the rug because it would be hard penance.” Because her father ran a funeral home, death was not spooky to her: “We could walk into the casket room whenever we wanted, or play the organ in the chapel.” She never thought about what happened after death because she already knew: heaven, hell, or purgatory.

In college, her mind lit up, as she saw how “music, literature, philosophy, art, and history were all interrelated.” In her second year, Saint Louis University entrusted her with Linda Hope, daughter of the comedian (and major donor), as her roommate. Senior year, she won a Ford Foundation scholarship—and met her future husband, a young dentist in the Air Force. By the time she earned her master’s in English, she was several months pregnant. Two more children followed, and the marriage began to crack. When her husband slapped their two-year-old for crunching her breakfast cereal too loudly, Ann told him, “Either you go into counseling or we will go together.” He refused, so she went alone.

The psychiatrist briskly corrected her assumption that “you can’t raise children without a man.” Meanwhile, she had hoped to take the Pill. “You cannot take babies away from women,” her parish’s eightysomething monsignor informed her. “What would the women in Pruett Igoe do if they didn’t have their babies?”

She left furious and began a lifetime of seeking, defining herself in turn as a “Buddhist, Unitarian, potential Reform Jew, Episcopalian, Quaker, agnostic, atheist, non-believer, and finally, as an existentialist.” Either we give up our integrity and convince ourselves of some religion or philosophy we know cannot fully explain the world, she thought, or we accept that life is basically absurd, mysterious, contradictory. Accepting that freed her to think for herself, struggle against illogic, create meaning and purpose wherever she could.

Ann taught English for years at Ladue High School. “I’m crazy about teenagers,” she tells me. “They have candor, humor, emotional intensity, and healthy irreverence. They’re less defensive than adults, less afraid to risk being wrong. The rhythms of their bodies and emotions are quicker, more subtle than ours.” Former students often wrote to say, “You saved my life” or “I wouldn’t have gotten through my parents’ divorce if you hadn’t talked to me on the steps that day.” She had a rare ability to love and appreciate people for exactly who they were, never imposing what she thought they should be or asking for anything they could not give. This made her affection count: you could trust it, fall back on it, use it to heal.

Kids came to stay when they were in trouble, angry, or lost. When one wound up graduating college, she recalls, “We really whooped it up.” When another was incredulous—“I don’t know how you got me through that”—Ann smiled: “You just needed one person you weren’t fighting against.”

A friend died, and when the will was read, she learned he had made her a guardian for his son, who was living with schizophrenia. Ann did not have to accept, but of course did. She made herself an expert on the illness and soon was volunteering with the National Alliance on Mental Illness.

She also volunteered with the Final Exit Network, a right to die advocacy group, because she felt that “people who are suffering terrible illnesses should have a way out.” Surely it was a basic human right to end your life on your own terms? People with money had always had the option; they could trust their doctors to come to their home and quietly give whatever help was necessary.

“These days,” I remark, “the wealthy can pay to prolong their lives.” I ask what she thinks of the Immortalists who want tech to keep them alive practically forever. She politely affirms their right to try, then adds, “I think it’s asinine, actually. Everything dies. Animals die, trees die, rivers dry up. It’s a cycle. If you are 102, how much good can you do for anybody?”

A year ago

Last December, one of Ann’s teeth became so badly infected, the doctors wanted to replace the bone. She raised an eyebrow and reminded them she was eighty-four years old. When they saw that her refusal was adamant, they suggested at least vacuuming out the infection. “Absolutely,” she agreed. Striding down the hospital hall in her red tartan pajamas, she told her daughter Amy, “I want to be at that wedding,” meaning her grandson’s. She requested as much physical therapy as possible, to get stronger, and she and Amy did yoga in the deserted waiting room.

Ann recovered, but the episode had stiffened her resolve. Anything could happen, at any moment, that would make it impossible for her to end her life on her own terms: peacefully, without needless suffering or expense.

In summer, she flew out to California for the wedding. She visited her granddaughter in Scotland. On a family vacation, she insisted on kayaking because she wanted to see the seals. She longed to see her younger grandsons graduate—but the time had come. She would complete her life in autumn, after her August birthday.

She told her children she did not want them with her. It had taken her years to shake the images of her dying parents, she said. “I want you to remember me when we were having fun!” Also, she wanted no possible suspicion that they were involved, that they should or could have stopped her.

This was fine with her son, who respected her decision but could not bear to talk about it. He did not want to know what day she had chosen. For her two daughters, knowing the date felt easier than always wondering. Still, it was surreal to know, months ahead of time, exactly when they would lose her.

“I think you’re calling it early,” Amy protested. “You’re a superager.” But in the next few months, spending more time with her mother, she saw the changes. Ann’s weight was down, and caught off guard, she did look frail. She fell often, sometimes hitting her head or bruising her face. The next fall could cause a brain bleed or break a hip. She could lose her chance to die on her own terms.

•  •  •

I do not share her need. Passive by nature and a bit cowardly, I prefer to accept whatever comes along. It would be nice to reach a point where my mind and body agreed it was time to die. But Ann’s emphasis on planning does not persuade me, probably because I never had to seize the reins, break with convention, raise three children alone. The best parts of my life have all come to me unbidden.

Besides, I come from glum, resigned people who waited—some patiently, some impatiently—to die. “It’s easier coming into this world than getting out of it,” my grandfather used to mutter. When a friend phoned to see how my mother was, she drawled, “Marvelous, darling,” as she drew a slender finger across her throat.

She never would have dared lift that finger to hasten her end. Rebel though she was, she was still Catholic at the core. Maybe I am, too. If the world really is random, with no higher purpose knitting it together and nothing awaiting us “on the other side,” then life is not a gift with strings attached but a condition to be evaluated and negotiated. Intellectually, I find this more likely. Emotionally, I cannot quite get there. There is a briskness, a cool efficiency to Ann’s calculus that I do not like. She is, her daughters observe, in “admin mode,” maybe has to be, to get this done.

A month before

The next time we meet, Ann invites my dog along. Part of one wall is covered with photos of her friends’ dogs, and she has a sturdy bowl of water and a toy bear and fish waiting. Thrilled, Willie tosses the fish in the air, then bops it as it falls. It skids under a cabinet. He bows and tries to push his nose under, then backs up and looks at us with dismay. “I’ll get it, Willie!” Ann calls, and before I can move, she is on her hands and knees, reaching way back for the toy, then rising, fluid as a dancer, without holding on to anything. When I comment on her agility, she explains that she climbs the terrazzo marble stairs of her apartment building every day, starting in the basement and going up to the eleventh floor. She does this six times.

I do the math—seventy-two flights a day? She says she started not for fitness but to burn anxiety, and it works better than pills.

Gobsmacked, I change the subject. “What do you still love about being alive? What will you miss?”

“Almost everything,” she says instantly, “except the lack of world peace and the environmental destruction. I’ll miss good conversations. Hot baths. Good books. Trees. Water. Silence.”

“Are you scared?”

“I’m not really feeling fear. I don’t love not knowing what to expect. But I feel great love right now—for life, for everyone on the planet, for friends and family, for animals and birds and all kinds of creatures, for our environment. Feeling so filled up with love, it’s impossible to feel great fear. One cancels out the other.”

•  •  •

The clearest way for me to think about this is to shift to another species. How often has someone said, “If only we were as humane toward one another as we are toward our beloved animals”? I have always known when it was time to put a dog into a final sleep. Their eyes go dull, the spark of curiosity and play extinguishes, and their body becomes a heavy sack of boulders they must drag everywhere with them. But if Ann were a dog? I would look at her, smile, and shake my head. She still sparkles with wit and interest and caring. She polished off the rest of our Clementine’s saltine-caramel ice cream later that evening. If Ann were my dog, I would say, “It’s not time yet. She’s still having fun.”

Which is exactly why she wants to leave now, before that changes. She reads me a quote from Mary Pipher: “I want to die young as late as possible. I don’t want to live beyond my energy level. I don’t want to suffer dementia or lie helpless in a hospital. I want to die while I still believe that others love me and that I am useful.” Ann repeats that last bit: “while I still believe that others love me and that I am useful.” No matter what the rest of us protest, it is herself she needs to convince.

I play devil’s advocate: “What if we’re here to learn that life has value even when we are useless, and letting others care for us might be the final challenge?”

“Yeah, I think it’s that second part,” she says. “The second part is a little tough.”

See, the thing about dogs is, they do not mind depending on us. They do not worry about the future or even much mind most infirmities, as long as we keep loving them and feeding them. Would we be wise or dumb, I wonder, to emulate them?

Two weeks before

Ann keeps catching herself. She starts to renew a library book, then thinks, I can’t do that! At the grocery store, she murmurs, “I need another bottle of—” then realizes, No, you don’t.

Her son and daughters spend the last weekend in October with her. When her son leaves, she and the girls roll up their sleeves and talk through logistics. There are tears, but also the deep laughter that comes only when people know one another intimately.

She is sure her kids will be fine, but she worries about shocking her friends. One is also a neighbor, a dear friend for more than twenty years. He asks her advice regularly about holiday gifts: “I’ll have to leave him a note and tell him to Scotch tape it to the inside of a cabinet!” She asks a mutual friend to look out for him.

One week before

In her last week of life, Ann goes to a meeting of Beyond Housing. Schleps stuff to the Salvation Army. Walks through the fall color in Forest Park. Reads her beloved Jane Austen. (At her wits’ end trying to cancel an old email account, password forgotten, she made her daughter Maria call and pretend to be Ann. The customer service clerk suggested using the security questions: “Who’s your favorite actor?” Panicked, Maria looked at her mother, who mouthed Colin Firth. When Maria hung up, task accomplished, they laughed helplessly. “Colin Firth?” Maria asked, and Ann nodded and said solemnly, “He was Mr. Darcy.”)

Every day, Ann makes the long drive to visit her sister, who has dementia. Her hands grip the steering wheel tight, cars coming at her at speeds impossible to gauge because her depth of vision is gone. At the care home, which is one of the best, she looks at the fretful, confused dementia patients and thinks, This is what happens when people just let life take them away.

•  •  •

I spend Ann’s last Saturday with her, in the cozy Central West End apartment where she has lived for thirty-four years. It feels more of an occasion than any birthday, and I find myself wanting to bring a present. But what do you buy for a woman who is about to die?

I ask what is she doing, now that she has no fear of consequences. Mischief, indulgence, decadence? Well, she bought herself the expensive honey yogurt she loves, and she may stop climbing all seventy-two flights, just to have more time to wrap things up. An unwitting friend called for help, and Ann spent hours researching mental health professionals for her. And after handwriting hundreds of letters to voters, there is the last-minute push before the election….

Passing her tidy bedroom, I imagine those nighttime risings, calves pretzeled into agony, needing to walk out the cramps but terrified of tripping and smashing into a sharp corner. I envision her most recent fall, her foot tangling in bedclothes while she changes the sheets, and her body pitching forward until she manages to break her fall against the dresser. Small daily terrors that are not so small. (I used to wonder why people grow more nervous and fearful as they age. Now I can see how much there suddenly is to be frightened of.)

In a stupor after our talk, I sit a minute on a park bench. On the ground in front of me, a fuzzy bee lies on its side. Dying, I presume. Staring at its shadow, I see the antennae waver. Should I end this little life quickly, spare the bee its suffering? Or let it have a natural death at any cost? Is wanting to end the suffering selfish on my part, because watching tightens my throat? Or is refusing to intervene a failure of compassion? What does the bee want? Is its brain clever enough to wish for greater agency?

I sometimes wish for less.

The day before

It is November 7, and now Ann is worried. Not about what she plans to do, but that people will think the election results clinched her decision. Quite the contrary: “If I weren’t feeling so frail and in decline, I would cancel all plans and help with the resistance!”

She has had “a really great day,” she tells me in the evening, visiting an old friend and writing notes to others, reliving funny moments and “some bumps in the road that we lived through together.”

Maria calls her to say, “Mom, if you wake up in the morning and think, This does not feel right to me, I’m going to give you a one-word code word. You text me that word, and I’m on that plane. I don’t want you to feel you have to go through with this just because you have made a plan.”

Ann promises that she will not hesitate to cancel but adds, “I feel completely at peace with this.”

Early the next morning, she will email me a link to a documentary about Stoner, a book we both love—followed by another email saying she hopes the link is still live.

Then nothing more.

November 8

Ann chooses “everyday sloppy and comfy clothes” and her favorite Chanel red lipstick, Etienne.

Amy calls at 9:30 and, holding back tears, asks her mom if she feels nervous. “Not at all,” Ann says. “I’ve seen this many times,” accompanying people with terminal illnesses for Final Exit Network. “It’s a very comfortable thing. I just have a little bit of worry that I left too many closets for you to clean out!”

There is little left to say; they have had a year of heart-to-heart conversations—“but at a great restaurant or on a long walk” rather than around a deathbed. Amy says her last goodbye, hangs up, and sobs so hard she gasps for air. Then a strong sense of peace comes over her.

At 10:30, the friend Ann asked to be with her arrives, armed with a good bottle of Champagne for one last sip. Ann waves it aside. She has had her pleasures, has pulled every ounce of fun and delight from this last year. Now, she just wants to get on with her plan.

At 11, she begins. Her friend will play no part; Ann just wanted someone there to make sure she had in fact died. Around 11:30, the friend calls Maria to report that her mother lost consciousness in a little over one minute, and her heart stopped about twenty minutes later. The death was as peaceful as Ann hoped—and planned—it would be.

Maria calls the non-emergency number for the police. “This is a little bit unusual,” she begins, her voice shaky. “My mom has completed her life. This has been planned for many years. She left a key for the first responders under her doormat.”

The dispatcher is silent for a few seconds, then says, “Okay. I’ll send out a car.” But she also sends a fire truck and ambulance, causing the flurry Ann hoped to avoid for her neighbors’ sake. Several hours later, the medical examiner calls Maria.

“She sounded a little officious at first,” Maria will tell me later. “She asked if there was a history of suicide in the family, and she said it looked like my mom had thrown away her medications. I said, ‘She doesn’t take any.’ Then she asked if she could take off her medical examiner’s hat for a minute, because she was just really curious. She’d read my mother’s letter. She said she’d done more than a thousand deaths, and this was the first time she’d gotten choked up. Even the policeman had a tear in his eye. She said that this was so obviously well planned and supported by her family, and there were beautiful cards and notes all over the apartment; she was clearly beloved. And it was such a peaceful setting. Then she said, “This just doesn’t happen in St. Louis. It’s a different way to go about this.’ And I said, ‘That’s exactly the point.’”

•  •  •

Ann Mandelstamm (left) with her daughter Maria during a hike at Point Lobos State Natural Reserve in Monterey, California. (Photo courtesy of Ann Mandelstamm)

It was hard, giving up the gauzy notion of a good death as one surrounded by your loved ones. “It felt strange not to be with her,” Maria says. “My mom has been by my side for my whole life.” But Ann’s last gift was substituting, for a deathbed scene, a memory of walking in Forest Park, then driving Maria to the Metrolink station and blowing her kisses goodbye.

Maria emails Ann’s statement to all the friends Ann listed as “inspiration, partners in crime, and great fun.” She prefaces the statement with a carefully worded explanation that she promised her mother not to make “gooey.”

“Yesterday, on Friday November 8, my mother completed her life,” Maria begins. “She was 85 years old…. Hers is not the most common of ways to leave this world. To be honest, the idea of a self-directed completion of life felt unusual and unsettling to us when she first raised it nearly a decade ago. It’s not for everyone, nor was that her belief. However, over time we have come to understand, support, and deeply admire her for her independent thinking and commitment to her values in how she chose to live, and finally, to die.”

Also attached is a poem Ann loved by Wendell Berry, “The Peace of Wild Things.” My eyes slide down to the last line:

I rest in the grace of the world, and am free.

If she had stayed instead of dying, she would have felt shackled. And—I force myself to be honest—if I had watched her grow older and more frail, in pain, having less and less fun, would I still have craved her company? Yes, but in a different way, shadowed with sympathy. And she would have sensed and hated that.

In another of Ann’s favorite poems, Mary Oliver writes of being able “to love what is mortal;/to hold it/against your bones knowing/Your own life depends on it;/and, when the time comes to let it go,/to let it go.” Ah, I think, those words must have given her strength.

Then I realize it is the rest of us who need them.

Two weeks after

The last time I saw Ann, she gave me an anthology called There at the End: Voices from Final Exit Network. In one of the most moving pieces, “The Right to Write Your Own Life’s Story,” her friend and fellow volunteer Lowrey Brown remarks, “We want to be able to end our own lives, in our homes, at a time of our choosing, without society getting its collective knickers in a twist that our considered, personal choice is somehow an affront to—and I stumble here—how things are supposed to be.” Brown urges people to dispense with such fanciful imaginings and also with “any romantic notion of a natural death. We have always done everything in our power to wrestle death from the hands of nature.”

Now, Maria makes a similar observation: why is it that no one quibbles at the use of artificial medical technology to prolong life, yet deciding to die is deemed an unacceptable intervention?

She, Amy, and I are sitting in Ann’s apartment, drinking tea. The place looks the same: Ann cleaned out the insides of cabinets and closets but left the surfaces intact, the couch still fluffed with pillows, the bookcases still full of books. Every few shelves, there is a Post-it naming the category, so her kids can box them in organized fashion for the Greater St. Louis Book fair. (“They’ll be tossing around the F-word,” she told me, “by the time they get to the third shelf.”) There are more than 1,800 books—her kids have done a rough count—so, yeah, there will be some profanity. But they could not have borne the sight of those shelves empty.

The place still feels homey and warm, as though their mom could pop back from an errand any minute. She left good coffee for them, and Cokes for their sons, and the special granola they all love. The family gathered here a few days ago, as Ann had hoped they would: “Open some of my wine and tell funny stories, and if I’m the butt of the jokes, so much the better!”

Heartfelt responses to Maria’s email are pouring in. People describe meals they had at Ann’s big table, marvel at how much fun she was, mention ways she helped them and ways they have tried to be more like her. A woman who moved into Ann’s apartment building describes finding a “colorful paper sack hanging from my front door knob” filled with fresh-baked cookies, a warm welcome, and Ann’s contact information, because “you never know when you may need a ride to your doctor or help in the middle of the night.”

“I felt loved whenever I interacted with her,” says Lowrey Brown. “I’m guessing everyone did.”

Engulfed by this tidal wave, her kids and grandkids find themselves drenched in admiration as well as grief. “We knew she did a lot of good,” Maria says, “but the scale of it!”

People who disapprove of Ann’s choice, Amy adds, have been kind enough not to say so. A few close friends have expressed shock; one is furious at Ann for leaving her; another admits feeling abandoned. This was not a typical death, and the responses are not typical either; people are documenting not only their love for Ann but their struggle to understand. Saul, who does maintenance for the building, exclaims, “I loved your mom! She treated us like family. I didn’t get it—she was healthy. She seemed great. The landlord had to show me what she wrote.”

Ann was careful to end her statement with two dates: the first date of writing, years ago, and the current date. She let people know how carefully she had thought about this, so they could be sure it was not impulsive, and how content she was with her life, so they did not worry that this was a death of despair. She assured them that she had her children’s support and at the same time made it clear that this was not their idea or wish.

As her last act settled into people’s minds, many started asking questions for their own sake, wondering how she had managed this, and whether they might make the same choice.

•  •  •

Ann was always ahead of her time, Maria points out. In the seventies, her mother was so worried about the environment that she gave up her car—“and we lived in the suburbs! She said, ‘We’ll ride our bikes,’ and she got this little moped.” In the eighties, she marched for AIDS research and volunteered in a study for a vaccine. As a teacher, she risked her job to stand up for equal pay for women. A newspaper photo of a Black Lives Matter protest showed one White protester in the crowd—Ann.

Maria and Amy have made peace with their mother’s decision. But eleven years ago, when she first announced her plans? “I was in disbelief,” Maria recalls. “Why would you just randomly pick an age and take yourself out? I couldn’t get my head around it.”

Amy nods. “I thought, what are you talking about? You make those decisions when you get a terminal illness; you don’t make them preemptively! Why would you risk cutting your time short?”

Over the next decade, though, she saw, in her work, “a lot of bad deaths, deaths that were unnecessarily difficult. And a lot of opportunities to die well that were lost in the process,” because people, too ill or distracted to think it through, had made small decisions along the way that led to situations they never would have chosen.

“I still think what she’s doing is on the outer edge of what’s acceptable,” Maria says. “But she made me question my own thinking. I said I didn’t ever want to be in a memory care facility for years. She said, ‘Nobody does. People say things like “just shoot me, or snuff me with a pillow.” That’s not a plan. That’s just wishful thinking. It’s a way of saying, ‘I don’t want to live that way.’ But you have to plan for it. It’s your life. And it’s very difficult in older age to come up with a plan at the last minute. People don’t know what to do, or they’re scared.”

Her logic is hard to ignore. I want to think that I do not need such a plan, that advance directives are enough. Except: advance directives only kick in when there is a terminal diagnosis, not when health is failing because of—said with a kindly shrug—“old age.” And our sophisticated healthcare system has decided that old age is no longer terminal, given the fancy machines that can resuscitate and repair and prolong us indefinitely.

•  •  •

Am I resisting Ann’s insistence that she was frail only because she hid it so well? Or because the complaints she listed, I can already imagine having, and I do not want to equate them with the end of life? Pointlessly, I argue with her in my head. Maybe those seventy-two flights of marble stairs worsened the neuropathy. Maybe a little Xanax would not have ended the world. Uber drives you in the dark. Your kids and friends would have been delighted to help.

But what if she managed to die just before some nightmarish disintegration no one would have wished for her? She could not know. An uncertainty as hard, in its own way, as infirmity.

There is no point placing a halo on that red-gold hair. What Ann did was generous, loving, and thoughtful—but also a refusal to be vulnerable. She was extraordinarily disciplined and principled—but also scared. She set incredibly high standards for quality of life, sharpness, and vigor; she craved autonomy, independence, and choice. Maybe the self-reliance she was forced to muster early made vulnerability especially hard to face. “She was fiercely independent,” Maria says. “She refused help, she refused gifts. Someone would offer her a ride, and we’d say, ‘Let them take you!’ and she’d say, ‘No, no, I can get on Metrolink.’ But she was very close to needing assistance. And she found that untenable.”

Both daughters had begged her to come live with or near them; she had thanked them and said she did not want to. She had built a life she loved right where she was. “Parents die; it’s part of life,” she reminded them, adding lightly, “Nobody wants to lose a parent who totally adores them and tells them so every day. You don’t get that kind of love again!”

When Maria exclaimed, “I talk to you almost every day. What am I going to do?” Ann said calmly, “You can sit down with your tea and keep talking to me.” It was hard, Maria admits, “to get my head around the ease with which she could leave. Part of her logic was that death is inevitable anyway. The question is how to do it with the most autonomy and joy and peace. And she never wavered, not once in the last decade. So, yeah, I’d like to have her longer, but not at the expense of her peace and comfort.”

•  •  •

Would old age be so frightening if we venerated it? Is the recoil we feel, seeing people we love shrink and shrivel and falter, engraved in our psyche, or could culture erase it? Could we learn to take diminishment in stride; to accept dulled senses and occasionally fuzzy brains as trade-ins for wisdom; to care so gladly and respectfully for the old that their shame and misery dissolved?

Ann was appalled to see her tall, strong father withered, but seeing death’s approach does make the parting easier. That is the natural cycle she talked about: leaves browning, crinkling, then falling. I have seen plants start to die and yanked them up by the roots, unwilling to watch what I sensed was an inevitable failure. But it always felt violent, and I admired my husband, the more patient gardener who tended them to the bitter end and never lost hope.

Hope changes form as we age. We are no longer hoping for new things or adventures or lovers or careers. We are not “living for” any particular cause or project. We are simply living. Hope is now a compact with the universe: a resolve to keep trying, keep giving, keep reaching out. So when the world tells us it would rather we die already, that we are about to become a great deal of bother, why would we not bow out gracefully? Like Ann, our culture prizes (and maybe overvalues) usefulness, independence, and vigor.

It is easy, on a sunny day, to spout fine words about going on without those capacities. But when the sky turns gray and cold and I wake creaky and dispirited, I try to project twenty years forward. At what point will living become far harder than dying? And should that be a call for courage or a sign to quit?

•  •  •

As I write this, the U.K. legalizes, after much emotional argument, medically-assisted death for those with terminal conditions. By the Brits’ new law, someone is eligible if they have been “given” six months to live. Ann’s worry was that she might only have six months to live well.

I am used enough to the idea now to see its merit. But then I read an article from Canada, which expanded medical assistance in dying three years ago to people with incurable but nonfatal conditions. The Ontario chief coroner recently warned of cases in which people were euthanized because they suffered “from untreated mental illnesses and addictions.” Often they were poor, had unclear diagnoses or inadequate pain control, or were “suffering from inadequate housing, a lack of social supports, and simple loneliness.” A man in his forties had a history of depression and substance abuse, the report noted, and was not even offered addiction treatment before being approved to die.

Approved to die. The phrase is chilling. I prefer Ann’s route, seeking only the support of her family. But how many people are as resourceful as she is, with the money and education it takes to figure this out on her own? And if it becomes the norm, how do we protect people who are not yet ready to die?

In just one month, her thinking has lost its stigma. When a friend suggests long-term care insurance, I think, Nah. I’ll just do what Ann did. Which, if I am honest, feels a little like using abortion as birth control. Has death already become too easy an option?

And if so, what would be wrong with that?

•  •  •

For weeks after Ann’s death, I talk about it incessantly. Surely the next time I go over it, the ambivalence will have resolved….

It never does. She had a perfect right to end her life as she chose, but selfishly, I wish she had waited. And socially, I am scared this will become commonplace and pressure people to conform—or help adult children rationalize their eagerness for the care expenses to cease and the will to be read.

Ann shrugged off that fear, pointing out that each of us is responsible for our own choices. Besides, she said, 95 percent of the people who came to Final Exit to learn more never went through with it.

When I repeat this, Maria smiles ruefully. “I think that was a Teflon shield she put around herself at the end. Elder abuse is a real concern, and not everybody is as faithful as she was to high values.”

“Also, she’d spent so many years advocating for the right to die,” Amy adds.

We talk about safeguards. “There’s always a slippery slope around bodily choice,” Amy notes. “But if we just expanded the criteria for a medically assisted death,” then physicians—or small committees of doctors, ethicists, and lawyers—could be vigilant. Maria also thinks that shining more light on the issue, letting the conversations become more broader, will make it easier “to find out if there’s any nudging or inappropriate pressure. Someone making this decision needs multiple points of support.”

•  •  •

Palliative care experts offer criteria for one’s last days: environmental comfort (Ann’s warm, book-lined nest), a sense that one’s life is complete, with nothing more to do, a sense of pleasure still alive, independence, physical and psychological comfort, not being a burden on others, good relationships with family, being respected as an individual.

By these and any other measures, Ann Mandelstamm’s life ended well. You could say—and she might agree—that she rushed her death. But she was well aware that medicine “postpones the end of life, often until the time when we no longer have the mental and physical capacity to deal with it.” The observation comes from philosopher Roger Scruton, who urges Friedrich Nietzsche’s idea of a timely death, voluntary and free, a completion of life rather than a simple stoppage of brain and heart. “Hang up no more withered wreaths in the sanctuary of life,” Nietzsche wrote. Though he saw no need to hasten death, he found prolonging life, especially if you are no longer able to live fully and creatively, undignified.

I read this and wonder if Ann was familiar with Nietzsche’s ideas. It is too late for us to talk about it—and I am the only one in need of the discussion.

Read more by Jeannette Cooperman here.