Intrusive violent thoughts are a common experience, especially under duress, with or without low empathy or any other chemical issue. It can be important to make the distinction to not further alienate yourself from others.

Euthanasia, for instance... Well. It is all just there in the name. A good death. All things that live do eventually die, after all.

[Hythlodaeus tilts his head and blinks placidly at Steven.]

It sounds as if this is towards the heart of the issue. Very well, I won't tell him.