Patients' experiences of unbearable suffering in assisted dying requests in Spain and Switzerland: A qualitative study of common patterns of expressions.

In most countries where assisted dying is regulated, unbearable suffering is a key eligibility criterion. Yet, due to its deeply subjective nature, the assessment of suffering by third parties remains a challenge. Few studies have examined how patients themselves describe this experience. This cross-national qualitative study explores how individuals requesting assisted dying express and describe their experiences of unbearable suffering in Spain and Switzerland. Two parallel projects conducted between 2022 and 2025 used in-depth, semi-structured interviews with people seeking assisted dying. Combined datasets from 46 participants were analyzed using secondary data analysis, to identify common patterns of expressions using metatheme analysis. Five patterns of expression of unbearable suffering emerged. Listening to patients' own accounts offers a clearer understanding of the complexity of unbearable suffering. These findings may support more nuanced assessments, guide healthcare professionals and families, and inform public debate on assisted dying.