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At the ending of the movie Andrew talks to Chuck about how he thinks something 'bad' is going on on the Island, and he wants to leave it. He appears to be getting back in his old crazy character (Teddy), as explained in the previous scene ('like a tape').

This made me think he does not know he's fallen back into his old habits, and that he's crazy. Chuck notices this, and signs to the shrink that he's teddy again, and that he should get the lobotomy.

However when Andrew walks away he says the "die as a good person" line, which suggests he knows he's actually crazy, and thinks he should just die.

So which one is it, does he know he's crazy or doesn't he?

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Those question are about whether or not he's crazy. I'm asking if he knows that he is. – user717572 Mar 15 at 17:06

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After understanding his last statement

"Which would be worse? To live as a monster, or die as a good man?"

It is clear that he knows his true identity now but he thinks he live like a monster and now wanted to be free of it and to get lobotomize . So he faked his craziness.

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I doubt the explanation! – Mistu4u Mar 15 at 4:09
Can you explain the doubt. – Ankit Sharma Mar 15 at 8:37
I think the statement you mentioned has a dual interpretation. Before this statement Leonardo was mentioning that they should get out of the island as soon as possible indicating he lost his consciousness about himself being crazy. Leonardo might have told this statement meaning the patient who he thought was lost from the institution, what would have he thought? Did not he think it is better to get out of there (die as a good man) than to living there (live as a monster)! – Mistu4u Mar 15 at 16:43
Going from there doesn't make him a good man at all. But getting lobotomize is equivalent of death. And he is guilty for his action, so hi wana die like a good man(to get lobotomize) – Ankit Sharma Mar 15 at 16:51
I am not sure. That is why I said it can be interpreted in a dual way!! – Mistu4u Mar 15 at 16:54
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On a very deep level he might know he is crazy and know what really happened but he has convinced himself that his alternate story is real.

He cannot face what actually happened and would rather live his life in the different story.

By the end of the film it is clear that he is unable/unwilling to comprehend reality no matter how hard the doctors try to reach him and therefore needs to be lobotomised (according the medical experts).

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