John and Cecilia are truly one in the same. John may hate her, may leave her to die, but Cecilia is the true reflection of who John is and he cannot handle it. John hates Cecilia because of her scam, because she gave him fake medicine, because she crushed someone who so obviously wanted to live, because she tortured a child---all things John, himself, has and or will do. John meets himself and he sees that she not only wins her final trap, but revels in the pain she inflicts while doing it, and he cannot, for a moment, believe that to be true of himself. In later films he says he creates traps not for revenge but to help people, yet both Cecil's and the entire scam crew's traps all point to the contrary. John likes hurting people. It's truly encapsulated when he fantasizes about the eyeball trap---he doesn't think about the man surviving the trap, learning from his mistakes, atoning, but of him failing and writhing in agony. And just like Cecilia, he crushes someone who so obviously wanted to live beneath his boot: Amanda.

Amanda and Gabriela are so clearly mirrors of one another---addicts who end up complict in the harm of others to feed their addictions (Amanda with the forced miscarriage, Gabriela with John's scam brain surgery) and end up in traps due to said addictions and win. Amanda clearly sees herself in Gabriela, going as far to say to JOHN FUCKING KRAMER that Gabriela and, intern, herself, do not deserve to be tested in a game because addictions are already tests of will and are not a moral failings. John replies that "we all have free will", an absolutely atrocious take that clearly breaks Amanda's heart. A comment that cements to Amanda that she deserves to be punished, to be tortured, because of her "crime" of addiction. (This comment is likely a contributor to her later self harm---she still thinks she deserves to be punished because she hasn't gotten better. Sure, she may be in recovery for her addiction, but the underlying reasons why she turned to drugs in the first place have not be addressed, but left to fester.) Amanda then delays Gabriela's game, giving her more time to come to terms with her predicament whilst disobeying John. And Gabriela wins her game, just like Amanda, conveying her desire to live. To Amanda this is undoubtedly a confirmation of John's philosophy---traps are tests of will that reveal if people, truly, desire to live; those that win have proved themselves; those that failed deserved it---they "kill themselves".