A reader in their eighties has written to The Guardian's advice columnist Annalisa Barbieri, revealing a deeply personal and distressing ethical dilemma. Their close friend, who has inoperable cancer, has spoken about ending her own life and shown them a bottle of pills she says provides her "way out".
The Burden of a Secret
The reader's friend has been living with the knowledge of her terminal illness for several years. While her cancer is not currently causing her pain, she is largely housebound and has limited mobility. During conversations, she has repeatedly brought up the subject of ending one's life, prompting fear in the reader that they might be asked for direct assistance—an act that would be a criminal offence in the UK.
The pivotal moment came when the friend showed the reader a bottle of prescription tablets. She explained that she had been warned that exceeding the dose would be fatal, and for her, knowing the pills were there made coping with her debilitating conditions possible. The reader, torn between loyalty and concern, confided in another friend who suggested the woman might be clinically depressed and that her doctor or adult sons should be informed.
Expert Psychological Insight
Annalisa Barbieri sought expert counsel from Andrew Balfour, a clinical psychologist, psychotherapist, and CEO of Tavistock Relationships. Balfour identified significant themes of anxiety, loss, and grief in the situation, affecting both women. He interpreted the friend's actions not necessarily as a firm plan for suicide, but as an expression of fear—specifically a fear of vulnerability, dependency, and a desire to regain control over her fate.
Balfour also noted the reader's own feelings of being burdened and stuck with the responsibility of this secret. His primary recommendation was for the reader to seek support for herself, suggesting she talk to a trusted person or therapist to process her own emotions. "If such underlying feelings can be put into words," Balfour said, "the conflict about what to do might reduce."
Navigating Confidentiality and Care
The central question remains: should the reader break her friend's confidence and tell the family? Both Barbieri and Andrew Balfour advise against disclosing the secret about the pills. They argue that breaching this trust could be devastating, and removing the pills does not guarantee safety, as she might find another method.
Instead, they propose alternative, supportive actions:
- Seek psychological support: The reader could gently explore whether her friend's medical team offers, or can refer her to, psychological support.
- Contact palliative care: A careful, well-timed connection with the local palliative care team might provide general comfort and address her fears without focusing directly on the pills.
- Check in with family indirectly: The reader could express general concern to the friend's sons without revealing specific confidences.
- Continue being present: The value of listening and providing a safe, trusting space cannot be overstated.
Barbieri concludes by emphasising that the reader also needs support, acknowledging how difficult the situation is for her. The column includes contact details for support services, including the Samaritans on 116 123 in the UK and Ireland, and the 988 Suicide & Crisis Lifeline in the US.
