Autonomous End-of-Life Choice

Autonomous End-of-Life Choice is the principle governing Marco Carrera’s decision to end his life: he insists that the choice is his alone, made in full mental clarity, and not a surrender imposed by pain or helplessness. The novel gives that principle practical form through Marco’s careful explanation of his plan, his preparations for a final gathering, and Miraijin’s agreement to help him. His autonomy is emphatic, but not solitary; the choice is made legible through the care and presence of the people he loves.

Definition and Stakes

Marco frames his decision as an exercise of agency over the manner and timing of his death. At the gathering, speaking in his capacity as a doctor of forty years, he tells those present that what he is about to do is his own act, undertaken in complete autonomy and full mental clarity. He says that Rodrigo will give him only a short interval of peace, and that he could carry out the process himself. This distinction matters to Marco: accepting limited assistance does not, in his account, transfer ownership of the decision to someone else.

The choice is set against a future Marco considers intolerable, not merely against the pain of the present. He imagines renewed treatment and its nausea, sores, loss of mobility, pressure wounds, increasing need for morphine, and dependence on Miraijin for intimate care. In his feared alternative, she would be diverted from the work of saving the world to tending a grandfather whose condition has become a burden to her. The passage presents this prospect as Marco’s own apprehension, not as an objective judgment about the value of a disabled or dependent life. His decision is bound to his view of what he can bear and to his wish not to impose that future on Miraijin.

Deliberation and Preparation

Marco does not present death as a response to a single moment of pain. He has chosen a setting and a form for the gathering, and he works to make the time with his guests feel celebratory rather than mournful. Miraijin’s hospitality is carefully arranged; Marco helps prepare dinner and lunch, drawing on what he remembers about the guests’ preferences, even though he can no longer eat and has been fed through a gastrostomy tube. The meals become part of the gift he wants to give: an occasion his family and friends can carry away as a good memory.

That intention requires him to restrain several reactions he fears could distort the gathering: cynicism, sarcasm, uncontrolled emotion, self-pity, and envy of those who can eat. He wants the guests to feel well rather than to be made responsible for consoling him. His insistence on making the occasion hospitable therefore belongs to the same decision as his planned death. He is not simply arranging the means to die; he is trying to shape how those around him experience his departure.

Marco’s account to the gathering is precise and technical. He describes two infusion bags, the first containing midazolam and propofol to produce deep sedation, and the second containing concentrated potassium. He explains that Rodrigo will activate the second infusion after the anesthetics take effect, allowing Marco to fall asleep without having to remain alert to operate both taps himself. The narration makes clear that Marco’s claim to have obtained the potassium without anyone’s help is a lie: he asked Miraijin, who found Rodrigo, and Rodrigo obtained it. Marco conceals this assistance from the guests, even as he insists that the decision itself is autonomous.

Autonomy and Assistance

The difference between deciding and assisting is central to the scene. Marco tells the group that Rodrigo will provide only twenty or thirty seconds of peace, and explains that acting entirely alone would require him to activate the second tap before sedation took hold. He considers that effort a needless strain that would deprive him of the calm he wants. His plan thus accepts another person’s limited action while keeping the purpose, timing, and responsibility of the choice with himself.

Miraijin’s role begins with an explicit change of heart. In a letter to her grandfather, she apologizes for her earlier distress and says she has understood his request. She writes that he has given her so much, that she will help him in return, and that she is proud of the courage and clarity of his decision. She has suspended her program and plans to return to him; she says Oscar knows the appropriate people and assures Marco that what he wants will happen. Her promise makes his choice possible, but the letter presents her help as a response to his request, not a decision made in his place.

The gathering makes the consequences for others visible without turning their grief into a veto. Marco is careful about how he speaks, hoping to prevent the occasion from collapsing into lament. During his explanation, Marina leaves, while Giacomo’s restrained sobs are the only visible break in the composure Marco has tried to maintain. Miraijin then comes to him and praises him. These reactions show that the decision remains emotionally costly to the people around him, even as Marco tries to spare them the burden of watching him endure the future he fears.

The Final Act

After the gathering, Marco is moved by ordinary closeness rather than by a renewed argument for survival. Luisa kisses him; he returns the kiss, and the moment recalls a desire that began more than fifty years earlier. He registers the possibility that life might still contain other good moments, but he also recognizes this thought as a temptation to postpone the decision. The passage does not erase his attachment to life. Instead, it places that attachment beside his settled choice: a day, a few embraces, and a kiss have made life feel full, yet they do not cancel his intention.

Marco thanks Rodrigo, opens the red tap that begins the anesthetic infusion, and returns his gaze to Miraijin. As the anesthetic takes effect, she changes the position of her hand in his hair and joins her right hand with his, their little fingers and ring fingers interlocking. The narrative identifies this intimate gesture as their shared strong point. Rodrigo is to activate the second tap, the assistance Marco arranged; the decision has already been made by Marco, while the final moments are held in relation to Miraijin.

As he slips into unconsciousness, Marco thinks of Irene, Adele, and his parents, and of the person he is leaving to the world. The ending connects his choice to his family’s history of loss without making his death equivalent to Irene’s earlier suicide. Here the decision has been discussed with Miraijin, prepared in advance, and affirmed by Marco as lucid and autonomous. Its meaning rests in that distinction, and in the difficult bond between individual control over death and the care that makes the final act possible.