How patients explain and make sense of their decision for assisted suicide in Switzerland (the Exit Project): qualitative exploratory study.

OBJECTIVE: To explore how people actively pursuing assisted suicide in Switzerland frame and report the motivations underpinning their decision. DESIGN: Qualitative exploratory study using semistructured interviews analysed through reflexive thematic analysis within a constructivist framework. SETTING: Participants were recruited across Switzerland between October 2023 and July 2025 through three right-to-die associations and contact with healthcare professionals, including palliative care clinicians and general practitioners. Interviews were conducted in French, German, or Italian and were set in participants' homes or in hospitals. PARTICIPANTS: 30 adults with decision making capacity who were able to communicate verbally and had contacted a right-to-die association to initiate an assisted suicide request were recruited to the study. Participants were interviewed while actively engaged in the assisted suicide request process. Fourteen participants subsequently died by assisted suicide within weeks of the interview. RESULTS: Participants described the decision to request assisted suicide as the outcome of several motivational processes interacting rather than being caused by a single precipitating factor. Analysis identified six interrelated themes: imagining and shaping one's own death, considering assisted suicide as a trusted commodity, seeking validation and common ground, reclaiming personal power over the medicalisation of dying, crossing the unbearable threshold, and seizing the narrowing window of opportunity. These themes functioned as dynamic, interacting motivations that consolidated, stabilised, and reinforced the choice to pursue assisted suicide over time. CONCLUSIONS: In this study, the pursuit of assisted suicide emerged as prospective, meaning making processes embedded in personal values, relational considerations, and awareness of time, rather than solely as a reactive response to physical suffering. Recognising this complexity may support more ethical clinical dialogue and inform policy discussions in jurisdictions where assisted dying is permitted or under consideration.