Summary
A BMJ qualitative study of 30 adults actively pursuing assisted suicide in Switzerland identified six interacting motivations, from autonomy and relationships to multidimensional suffering and fear of losing capacity.
A qualitative study of 30 adults actively pursuing assisted suicide in Switzerland found that the decision was shaped by several interacting motivations rather than by one immediate cause. Participants described a combination of personal autonomy, relationships, experiences of suffering, trust in the Swiss system and concern about losing the physical or cognitive capacity needed to proceed.
The study, published in The BMJ, examined people while they were still engaged in the assisted-suicide request process. Fourteen participants subsequently died by assisted suicide within weeks of their interviews. The researchers organised the participants’ accounts into six themes and concluded that assisted suicide was understood not only as a response to illness or distress, but also as a deliberate way of shaping the end of life.
How the study examined the decision
Researchers conducted semistructured interviews between October 2023 and July 2025 with adults recruited through three Swiss right-to-die associations and healthcare professionals, including palliative-care clinicians and general practitioners. Interviews took place in participants’ homes or hospitals and were conducted in French, German or Italian.
All 30 participants had decision-making capacity, could communicate verbally and had contacted a right-to-die association to begin an assisted-suicide request. The group included 17 women and 13 men, with a mean age of 73.5 years and an age range of 35 to 97. Eighteen participants came from the French-speaking region, seven from the German-speaking region and five from the Italian-speaking region. Cancer was the most common diagnosis, affecting 17 participants.
The team used reflexive thematic analysis within a constructivist framework. This approach examines how people make meaning from their experiences and recognises that researchers’ interpretations are part of the analytical process. It is suited to identifying shared patterns in personal accounts rather than measuring how frequently a motivation occurs across a population.
Switzerland provides a distinctive setting for this research. Euthanasia remains prohibited, while assisted suicide has been permitted since 1942 under Article 115 of the Swiss Penal Code when it is not driven by selfish motives. Swiss professional guidance states that a person must be experiencing unbearable suffering, have decision-making capacity and be able to self-administer the lethal drug. Right-to-die associations commonly help people navigate the administrative and procedural process.
Six motivations described by participants
The first theme was imagining and shaping one’s own death. Some participants said they had thought about what they considered a good or unacceptable death long before becoming seriously ill. They wanted to avoid prolonged suffering, loss of communication, severe dependence or cognitive decline, and saw preparation for death as an extension of their values and responsibility for their own lives.
The second was trust in a structured process. Participants described the Swiss model and the right-to-die associations as reliable, supportive and socially legitimate. This confidence turned assisted suicide from an abstract possibility into a practical option that they believed could be organised with predictability and dignity.
The third theme was seeking validation and common ground. Although participants considered the decision personal, many discussed it with selected relatives or healthcare professionals. Acceptance and practical support from relatives could bring relief and reinforce the decision, while opposition was often interpreted as a failure to understand the participant’s suffering.
The fourth was reclaiming authority over a medicalised dying process. Some participants described previous encounters with healthcare as dismissive, poorly communicated or excessively focused on treatment. They feared losing control over future decisions and viewed assisted suicide as one of the remaining ways to retain agency over how dying would unfold.
The fifth theme was crossing an unbearable threshold. Participants described suffering as multidimensional, involving physical symptoms such as fatigue, pain and loss of mobility alongside anxiety, loss of meaning, treatment exhaustion, social isolation and declining independence. These factors were often experienced as reinforcing one another rather than occurring separately.
The final theme was a narrowing window of opportunity. Participants feared that worsening illness could remove the capacities required to proceed, including decision-making ability or the ability to self-administer the lethal drug. Some therefore experienced urgency not as impulsiveness, but as a need to begin the process before their condition or institutional circumstances prevented it.
Implications for clinical and policy discussions
The researchers found that the six themes did not appear with equal importance in every account. Their timing and intensity varied, and one participant ultimately withdrew from assisted suicide on the scheduled day. The themes therefore describe interacting processes in participants’ narratives, not fixed or deterministic causes.
The findings suggest that discussions about assisted-suicide requests may need to consider more than symptom severity. Participants connected their decisions with personal ideas about dignity and responsibility, relationships with relatives, trust or mistrust in healthcare, and concerns about future loss of capacity. The authors argue that this broader understanding could support clinical dialogue and inform ethical and regulatory debates in places where assisted dying is permitted or under consideration.
Because the study was a small, convenience-sampled qualitative investigation within Switzerland’s specific civil model, its results describe how these participants explained their decisions rather than establishing how common each motivation is elsewhere. The study also captures participants’ meaning-making during a particular stage of the request process; it does not compare outcomes across different legal systems or assisted-dying models.