Spoilers for Act 3
The bit of text about Ethel offering an out surprises me: I’ve done that fight around eight times and she has never once offered me the option.
In the first Ethel fight you need to let her take her turn when she’s at like, 10-15% HP and she’ll offer to give you power (+1 to any stat) if you let her and Mayrina go. If you pass a high intimidate or deception roll you can save Mayrina and get the buff. (Warning though: doing this breaks paladin oath if you care)
I assumed the +1 would come with a curse and finished her off!
Man, that takes me back to the unforgiving text adventure games of yore. A simple screw up in any of the early Sierra titles, or Zork or even the Hugo titles, will condemn you to an unwinnable game without telling you.