The one interesting facet of this episode is that it represents quite a subtle culmination of an, at times, on-the-nose thematic arc about the morality of people living on past their sell-by date which came to the forefront this season: Jeremy was in communion with ghosts who almost got Elena killed because Bonnie brought him back from the dead at the end of season two; Esther’s whole motivation for wanting her children dead was a conviction that they should have died as humans; Alaric became a serial killer because he used his ring to cheat death — and even when he chose to die rather than transition he was turned against his will by a possessed Bonnie; in last season’s finale “As I Lay Dying” we saw Damon accept death on the grounds that he had lived long enough (and we already know that he was forced to transition against his will by Stefan in 1864). It’s no coincidence that Matt tells Elena that “this isn’t how our lives were supposed to be” right before the car they’re in swerves off the same bridge she should have died on in 2009. If she had died that day then everyone she knew who died or was turned during the course of the show would still be alive, still human — even Tyler never would have become a werewolf — and the Petrova bloodline would have been made extinct. In every way, in every episode, the show has been leading up to this moment where she goes over the bridge a second time — and dies. It was inescapable.
D: Where is she?! M: Damon wait! You need to know, when Jeremy brought Elena in here earlier, her injuries were worse than I let on. It wasn’t a concussion. It was a cerebral hemorrhage - bleeding on the brain… I helped her. She needed my help.