I am in my 80s and an old friend has several health issues. She will probably die in the not too distant future due to the inoperable cancer she has been aware of for some years.

She has two adult children, with domestic and career problems of their own, but she sees them frequently, and I know them both.

Some time ago, talking to her about a mutual friend with dementia, I said if I were diagnosed with it, I would want to end my life while I was still me. She asked how I would do that, and has brought up the subject once or twice since. I was afraid she would ask me to help her end her own life. While I could not bear to see her suffer (her cancer does not currently cause her pain), I’m not sure I would have the strength to do this.

She recently showed me a pill bottle, which she said contained her way out. She was prescribed these tablets and warned not to exceed the dose, as that would prove fatal. She said knowing they are there means she can cope with life with debilitating conditions.

When I told another friend about this, she said I should speak to her doctor and/or her sons, as she sounded clinically depressed. I didn’t do anything – who wouldn’t be depressed by being housebound, with limited mobility and terminal cancer?

And my inclination is to continue to say and do nothing. I realise this means I will have to keep the secret should she use the tablets. But she trusts me, and talks to me in a way she doesn’t to her sons and her siblings. Do you think I should continue to keep her confidence?

I’m sorry to hear about your friend. I must point out that you cannot help her end her own life as that would be a criminal offence. So I’m glad she hasn’t asked you to do that.

I went to clinical psychologist, psychotherapist and CEO of Tavistock Relationships Andrew Balfour. He is also the author of Life and Death: Our Relationship With Ageing, Dementia and Other Fates of Time, and we had a very long chat about your letter. He thought there was a great deal of “anxiety, loss and grief in your letter, which must be difficult to bear for both of you”. We discussed how your friend must be feeling: that she fears vulnerability and dependency and wants to regain control. Hence the pills. By telling you about them, she’s trying to tell you she’s scared.

Balfour felt your letter “conveyed your feelings of being burdened with responsibility for what happens, expressed in your feeling of being stuck in such a difficult dilemma”. Can you find someone you can trust, a friend, or therapist, to think with you about your feelings? He said: “If such underlying feelings can be put into words, the conflict about what to do might reduce and there may be more space for understanding the deeper anxieties which are driving the situation.” Then you can think about how best to respond.

Balfour also wondered if it might be worth getting in touch with your friend’s local palliative care team as there might be someone there who could talk to her in a more general way to help put her mind at rest; this would need to be timed carefully, otherwise you might risk more anxiety. Is there someone in her medical team who could offer her psychological support, or knows of someone who can?

You can continue to support her as you have been doing: by being there and listening. She clearly trusts and feels safe with you: do not underestimate how important that is. By telling others what she’s told you, you would risk her confidence and trust. If they take the pills away, there’s no guarantee that she won’t find more pills or end her life in a different way. So no, I wouldn’t tell them. Balfour suggested you could, if you wish, check in with her children and express concern in other ways.

Also, please ensure you have support too. This isn’t easy for you either.

In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org

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