Hickory: ...a madman who tortures and executes mages without exception. You (the player) knew this; knew the consequences...
Are the "without exception" and "knew the consequences" things necessarily true at this point in the game though? Radovid's madness unfolded over the course of the game, depending on how soon you traveled to Novigrad, saw his handiwork, got the details from Triss, and interacted with the man himself. It's perfectly possible to get to this decision point with Keira in the game without seeing firsthand any of that, or even hearing any major accounts of it. Geralt has a lot to say about how it's suicide during this dialogue but Keira flatly contradicts him with all of her responses.
Trying to think back to a first playthrough, I can't recall the choice feeling anything like an option to send her to her death. Geralt's "sending" choices are both conversation enders, that signify him just walking away. "Do what you want," and "Do what you think is right." I always felt the "oops now she's dead" result was
supposed to blindside you, like a punch in the gut, as a unforeseen consequence of a seemingly innocuous decision to leave someone to their own devices. Of course, I did "For the Advancement of Learning" very early on.
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Regardless, Keira's a shit friend. "Strictly selfish" by her own admission, she manipulates, betrays, and drugs Geralt, and after showing up at Kaer Morhen, says she wishes she hadn't come at all. She has utter contempt for Geralt's relationship with Yennefer ("she treats you like a dog" ...pot, meet kettle). My first playthrough resulted in a fight, not intentionally, though I should have guessed she wouldn't react well to "Can't let you do that."