I can’t count how many times my mother attempted suicide.
It first happened when I was 15, in 1999. The final time — when she actually died — came when I was 32, in 2016.
Between that were the other attempts. Two dozen, perhaps? They all run together: the dawning sense that something was wrong, the panic, the grim focus on the logistics of hospitalization and aftercare, the heavy work of accepting her apologies and trying to move on and worrying about what would come next — when it would happen again. It always happened again. Sometimes she might go a year without doing it, but then she would try three times in as many months.
That day in 2016, my husband and I were driving from Northern Virginia to Pennsylvania to meet my month-old niece when my brother called. He was worried: He hadn’t heard from our mother, who lived a half-hour from him. Could I stop by her house on the way to check on her?
I thought he was overreacting, but then I consulted my kludgy mom surveillance system: her Netflix viewing history. Spying on her Netflix often gave me a glimpse into her state of mind — why was she watching that Columbine documentary again? More importantly, as long as she was watching Netflix, I knew she was alive.
As my husband drove, I checked the account. It was Saturday. She hadn’t watched anything since Thursday.
My brother was right. She was dead.
She died alone, her house a mess, leaving behind a rather cruel note. I don’t know whether she truly expected to die this time, or if she assumed that, as had happened every time before, she would wake up in a hospital. She was dead for as long as two days before anyone found her. I hate thinking about that time. While I made a pasta salad to bring to the family meet-up, my mother lay dying or dead, her cats unfed.
In the decade since, I’ve thought a lot about the loneliness of that death and how we might have avoided it. She received massive amounts of medical and psychiatric care, not to mention family support, but none of it worked.
I wish that medical aid in dying had been an option for her. At the very least, it would have offered her a more comfortable death — and my brothers and me a less complicated grief. And maybe, just maybe, it could have saved her.
Medical aid in dying (MAiD) for psychiatric illness is available in just a few countries: Belgium, the Netherlands, Switzerland, and Luxembourg. Canada was supposed to join that list in March 2027, after years of delay, but on Oct. 7, it announced that plans for its MAiD program for mental illness were indefinitely suspended. Justice Minister Simon Fraser pointed to “very real concerns about people who live in communities with inadequate access to mental health services” as well as a recent report questioning whether it is possible to call mental illness incurable.
I understand the objections to mental illness as justification for MAiD. People with mental illness might face pressure from exhausted, frustrated families. There are concerns about equity and access to care, as Fraser indicated. If someone is very ill, they might not have the mental capacity to make the decision — perhaps because their depression is tricking them into thinking there is no hope.
And part of it just … feels wrong. We are supposed to save the mentally ill, not give up on them, right?
But sometimes mental illness is terminal.
At her best, my mother was tough, funny, warm, and brilliant, having received her MBA from Wharton in the 1970s. She liked to say that when she was a student, there was just one women’s bathroom in the building where most Wharton graduate school classes were held, and it was in the basement. (“They didn’t even have a tampon dispenser!” she once told me in an email.) She had a good career in consulting before becoming a stay-at-home mother to three kids in the early ’80s.
After my father died — also by suicide, connected to his gambling addiction — in 1995, she kept it together for a while, even starting a master’s program at Penn in higher education administration. She had cleverly realized that working in higher ed could mean discounted tuition for her children. That plan wouldn’t work out, though.
She had an unexplained seizure a few months after my father died, then a second one in 1996 — this time while driving. She hit a school bus and ended up with a traumatic brain injury. They even gave her the last rites, she bragged.
After she had recovered — as much as she ever would — she completed her master’s degree and started career counseling at universities. But it never really clicked for her. She spent the rest of her life moving from emergency to emergency and eventually couldn’t work at all. It was a relief to everyone when she began to get Social Security Disability Insurance, though she still faced serious financial difficulty. I often gave her gift cards to grocery stores.
Her many neurologists, psychiatrists, therapists, and other providers debated whether she had some sort of reactive depression to my father’s death, or whether it was the traumatic brain injury, or bipolar disorder that she had had since adolescence, or a personality disorder, or maybe whatever had caused those two seizures in the first place. (One suggested encephalitis.) It was probably a combination of everything, complicating her treatment. For instance, she genuinely wanted to try electroconvulsive therapy, but she was told she wasn’t a candidate because of her history of seizures. (Was that true? I don’t know. She could be an unreliable narrator both to me and to her medical providers.)
She would be stable for a while, then suddenly hear the voice of my father or her grandmother telling her that she was worthless, that she should die. Sometimes the stairs moved as she walked on them. Sometimes she saw zaps of light or pulsing walls. She sped along the highways at 3 a.m. in her crappy Saturn Ion and couldn’t explain why. She could be paranoid, cruel, weepy, or overwhelmed with love for my brothers and me.
I saved many of her voicemails and sometimes randomly select one to listen to. It’s a bit of a roulette game: Will it be a cheerful message about an article she read? Will she yell at me for some perceived slight? Will she cry about how she’s going to lose her house? She was always about to lose her house.
She was on more medications than I can possibly remember, but the most effective was the antipsychotic Seroquel — really, really high doses of Seroquel. She hated it — how logy it made her feel, how it fuzzed her thinking, how much weight she gained (she had always been proud of her tall, slender figure). It also came with serious risk of metabolic and cardiovascular side effects, and her cholesterol began creeping up. Periodically, she’d work with her psychiatrist to wean off of it, only to have to restart it when the voices returned and the mania took over. (One option no one ever raised with her: palliative psychiatry, a concept I learned about while editing a fascinating 2024 First Opinion on the subject by the University of Illinois’ Anand Kumar.)
Of course she wanted to die. She was in pain, constant pain. Much of it was physical: Among other things, her right knee had been shattered in a 2006 suicide attempt and hurt to walk on. While hospitalized on Thanksgiving Day 2014 (or maybe it was 2013? It got hard to keep track) after a suicide attempt, she suffered an apparent serotonin storm and wrenched a tooth out of her jaw by hand. She got a nasty infection from that, and despite regular visits to the dentist, it tormented her until she died.
And, of course, there was the psychological pain. She would erupt with rage, flinging wild insults with no basis in reality. After it subsided — which could be minutes, hours, days, weeks later — she was practically pulled inside out by a swirling vortex of regret: over the ways she had hurt my brothers and me, the bad choices she had made, how angry she was at God, how scared she was that God was angry at her, how much she missed my father even as she railed at him, as though it hadn’t been 20 years since he died. In addition to so many modes of therapy and, of course, all the meds, she often sought the comfort of faith — she was born Catholic and repeatedly returned to and left the church. Soon before she died, she renounced the Catholic Church once again over its sex abuse scandals and joined a local Baha’i group. (They were very kind to her. After she died, I found the children’s Baha’i books she was given to learn more about the religion.)
My brothers and I tried as hard as we could to help her without getting ground up. We went to therapy with her, gave her money, helped around the house, answered wild phone calls. Sometimes she would ask me to write her emails or letters about wonderful times together, so she could consult them when she was feeling sad. But a memory about picking raspberries together in the sunshine when I was a toddler could not cure what ailed her.
She gritted her teeth through every moment of the day. She didn’t grin and bear it. She sobbed and bore it until she couldn’t, and then she tried to kill herself, and then we started again.
And through it all, I kept telling her: It’ll be OK.
It was a lie. We both knew it was never going to be OK. She was never going to be OK. It must have been maddening — so much in her life was literally maddening — to keep being told, “It’s OK, you’re fine.”
She was always going to die this way.
If she was going to die by suicide — a phrase I hate for how it removes her agency from the most important decision she ever made — then it should have been better.
Instead of lying to her and ourselves, my brothers and I could have said: Yes, you’re right. Your life is too painful to live this way. We’ve tried everything. If you want to die, we support you.
And her physicians could have said: Yes, you’re right. We’ve done all that medicine can offer you at this point, and it hasn’t worked. You’re an intelligent woman with the insight to make this decision. If you want to die, we support you.
Maybe, best-case scenario, just those words would have offered her some relief, like keeping a bottle of ancient Xanax in the medicine cabinet: break in case of emergency. We could have had candid conversations in which we all acknowledged how hard her life was and stopped pretending that it would get better if only she worked harder.
Maybe those conversations would have made her realize that she didn’t actually want to die, that suicide attempts had just become some sort of compulsion or behavioral pattern. Perhaps offered a chance to truly end her life, she would have balked.
Or maybe she would have actually gone through with it.
I’m not romantic about the reality of assisted suicide. In a 2012 “Frontline” documentary, we see a man die at a Swiss clinic. It looks like a cheap hotel room with an uncomfortable bed. In a 2015 New Yorker article, Rachel Aviv beautifully chronicles the experience of a woman pursuing medical aid in dying for “psychological distress” and her adult son’s difficulty with the experience.
But even a shabby, impersonal room and imperfect death would have been better for my mother. Before the injection, my brothers and I could have been there with her, holding her hand, stroking her hair. She loved to have her hair stroked. We could have sang songs from when we were children. (And I don’t mean nursery rhymes. I mean Warren Zevon. His greatest hits cassette lived in her minivan tape player in the ’80s.) My brothers and I would have bickered at each other, and she would be annoyed with us, and all would feel easy for a moment until we remembered why we were there.
We would have been together. We would have known it was what she really, genuinely wanted.
And she could have had some peace. She might have left us with kind words and notes instead of cruel ones. She would have died with as little pain as possible. My last words to her could have been “I love you.” In real life, I don’t know what they were — we had been on the phone, and then I got another call, and then at some point after that conversation, she died.
I’m not saying that medical aid in dying for mental illness is an uncomplicatedly good thing. There are very real problems of equity, of access, of patient competency. I don’t know how to create a program that addresses these issues.
And it certainly should be used only in rare, extreme circumstances. As I mentioned, my father also committed suicide. He should not have been a candidate for medical aid in dying. His suicide was very different. His professional, personal, and financial lives had fallen apart in the year or so before his death. As far as I know, he never sought any kind of treatment besides Gamblers Anonymous. He might have responded to psychiatric care.
Suicide should not be the first, second, or third option. It should be the absolute last one. For my mother, it may as well have been the thousandth option. She tried all the care available to a well-educated woman who was pretty good at navigating the system. It didn’t work.
My mother — Regina Claire Setzer Bosch, because I want you to know her name — knew what she wanted. She wanted to die. And I wish that someone — I — could have helped her die in a better way.
If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: Call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.
Torie Bosch is STAT’s First Opinion editor.