This weekend, Brittany Maynard took her own life. At 29 years old, Ms. Maynard took her prescription for assisted suicide to end her life before her terminal brain cancer pushed her into a quality of life that she found unacceptable. She was young, articulate and facing a very short lifespan in which she would lose control of her body and mind, becoming increasingly dependent on others to complete activities of daily living.

Ms. Maynard had stated her intention to take her life in an internet message that has been viewed more than 10 million times on youtube.com. She moved from her California home to Oregon in order to take advantage of the state’s “Death with Dignity” law. Ms. Maynard became the center of a Compassion and Choices campaign—an organization with origins in the “right to die” movement.

Oregon legalized assisted suicide in 1997. Since that time, close to 1,200 people have secured prescriptions; however, only 752 have taken the drug. Many do not take their lethal prescription because they die before they turn to suicide. Others change their mind. Some studies suggest that what people seek is a sense of control when dealing with diseases that strip them of independence. In 2014 alone, seven states introduced “Death with Dignity” bills. In all but two, the bills were defeated or expired. In New Jersey and Pennsylvania, the bills are under consideration. Assisted suicide in the United States is currently only legal in five states: Oregon, Washington, Montana, New Mexico and Vermont.

In a highly divided nation, assisted suicide is a contentious issue- much like same-sex marriage and abortion. Most palliative care and hospice organizations oppose it. Some see assisted suicide as cowardly, immoral, reprehensible, in violation of God’s will, and a choice that removes the possibility of salvation. Some believe that healthcare providers writing such prescriptions are violating the Hippocratic Oath and the healing, treating role of physicians. Others hold that the consideration of suicide is a sign of mental illness; such people should be treated for depression and not considered to have the capacity to make such a decision with such permanent implications.

Suicide holds a very strong stigma in mainstream America and in the Catholic, Jewish and Islamic traditions. A suicide in the family has historically been considered shameful; the person taking his or her own life has long been believed to have committed an egregious sin. Americans are divided on their approval/disapproval of assisted suicide. Those with strong evangelical or Catholic religious identities are more likely to oppose assisted suicide than others. Minorities are more likely to oppose assisted suicide than whites. People with more education as well as those identifying as Democrats and independents are more likely to approve. Individuals who have participated in the process of advance care planning are also more likely to favor such legislation. These numbers are fairly close to beliefs about suicide in general, more lenient to those with disease-related pain than to those physically healthy.

Despite cultural and religious taboos, suicide may be the right choice for some. For Ms. Maynard and her family, that seems to have been the case. It was also the right choice for Gillian Bennett, who took her life earlier this year to avoid the indignities stemming from her dementia. A common question we ask healthy people when they are completing the process of advance care planning is to think about what makes life worth living when deciding treatment preferences. We emphasize freedom of autonomy. However, when it comes to suicide, there is a knee-jerk reaction that those considering it must be depressed or irrational. Therefore, his or her autonomy should be curtailed. There may also be a feeling that such people have a disability; being in a tyranny-of-the-abled culture, they are pressured to kill themselves in order to avoid being a burden upon loved ones. In such a case, our society fails at offering support and creating caring environments.

Clearly, assisted suicide is not the answer for every terminally ill patient. A patient and family must weigh many factors in end of life decision-making that include prognosis, personal values, relationships, the notion of what makes life worth living, what gives life meaning, and tolerance for pain. As the Oregon experience has demonstrated, assisted suicide is about having a feeling of control among many making this choice. The decision is a very personal one that must take into account not only the patient, but the patient’s family. That this was, controversially, the right decision for Ms. Maynard does not mean it is right for anyone else.

Many proponents of palliative and hospice care feel that their work negates the necessity of assisted suicide. Such sentiments are held upon the assumption that suicide is a bad thing. Sudden and unplanned suicide by healthy people is tragic, leaving survivors with questions and often guilt that they could have done more. But that is not the case here. Even though palliative care could help Ms. Maynard with acute symptoms, it could not assist with her existential ones—the loss of control over her body and mind, the loss of what she felt was her dignity as others took on more of her daily activities of living, and the knowledge that this diminishment was not a life she wanted to experience. The patient must know what other options exist. The patient and family need social and spiritual support. Pain needs to be mitigated. A person in severe pain has trouble making decisions; the pain clouds everything. I would suggest that a person’s pain must at least be tempered- if not under control- to make a rational choice about suicide.

The other consideration is that Ms. Maynard and her family moved to Oregon in order to participate in assisted suicide. The fact that her family felt forced to pick up and move away from their friends and support network to fulfill their autonomous desires is shameful. Assisted suicide should be a last-choice option, taken only after rigorous screening and consideration of all others. But at the end of the day, if a patient is rational, not clinically depressed, and has the support of family, then he or she should have the legal right to leave this life according to his or her conscience when faced with a debilitating, painful and terminal disease.

Suicide is legal. Ms. Maynard could have opted to stop eating and drinking. But many are unsuccessful in suicide attempts, often causing themselves more pain and suffering as a result. Ms. Maynard wanted to be sure that their suicide was a successful one minimal pain.

No patient should be forced into suicide. No physician should be required to or be reprimanded for not writing a prescription. But for a small subset of those with terminal illnesses and the ability to fulfill a rigorous review of their situation, such an option should be a compassionate, human option that allows a person to maximize living and minimize time spent dying. There may be pills to help with physical pain, but there is no pill that alleviates existential suffering.

Rest in peace Ms. Maynard. Rest in peace.