Agreement: I Agree Body: Dear Editor, Blanc et al’s study provides valuable insight into how people pursuing assisted suicide understand and articulate their decision and its motivations. Their findings demonstrate that these choices are multifactorial and that influencing factors range beyond physical symptoms and immediate suffering. Additionally, I feel that the social and biographical context in which these preferences develop merits further exploration. For example, several participants reported developing an interest in assisted suicide before becoming seriously unwell, with some joining right-to-die associations ‘long before’ this – something which is presented as both an expression of their values and as a safeguard for the future. Other recent studies found that between 61-63% of Swiss people would consider asking for assisted suicide in certain circumstances [1, 2]. Thus, the prevalence (up to 5% [3]), social acceptability and legality of assisted suicide in Switzerland is an important backdrop to these participant’s perception of autonomy and what constitutes a ‘good death’, ideas which are perhaps then reinforced by the development of illness. Multiple participants also described trauma related to witnessing loved ones’ end-of-life suffering. Such prior experiences may inform expectations around their own illness and potential deterioration and shape a determination to avoid similar circumstances. A 2022 study showed that 88% of individuals in the U.S. with a family history of dementia supported legalising assisted suicide – this compared to around 66% of the general population [4] – potentially illustrating a similar association. Conversely, other participants in the study spoke of positive experiences of assisted suicide in those close to them, which may also have influenced their subsequent opinion of assisted suicide as a familiar, reassuring model of dying. There is scope for future qualitative and longitudinal research to further explore these societal and biographical contexts, building on the insights provided by Blanc et al. in this study. References: [1] Vilpert S, Bolliger E, Borrat-Besson C, Borasio GD, Maurer J. Social, cultural and experiential patterning of attitudes and behaviour towards assisted suicide in Switzerland: evidence from a national population-based study. Swiss Med Wkly. 2020;150:w20275. doi:10.4414/smw.2020.20275. [2] Blanc S, Meier C, Gamondi C, Maurer J, Jox RJ. Preparing for the end-of-life: public attitudes towards advance directives and assisted suicide in Switzerland. BMC Palliat Care. 2025;24:118. doi:10.1186/s12904-025-01758-7. [3] Blanc S, Heistrüvers L, Savinelli S, Bernard M, Borasio GD, Jox RJ, et al. How patients explain and make sense of their decision for assisted suicide in Switzerland (the Exit Project): qualitative exploratory study. BMJ. 2026;394:e100610. doi:10.1136/bmj-2026-100610. [4] Yi R. Most Americans favor legal euthanasia. Gallup [Internet]. 2024 Aug 8 [cited 2026 Sep 21]. No competing Interests: Yes The following competing Interests: Electronic Publication Date: Tuesday, September 22, 2026 - 07:29 AI use: No, I have not used AI Highwire Comment Subject: How patients explain and make sense of their decision for assisted suicide in Switzerland (the Exit Project): qualitative exploratory study Workflow State: Released Full Title: The social and biographical context of assisted-suicide requests Highwire Comment Response to: How patients explain and make sense of their decision for assisted suicide in Switzerland (the Exit Project): qualitative exploratory study Check this box if you would like your letter to appear anonymously:: Last Name: Munro First name and middle initial: Isabelle Email: isabelle.munro1@nhs.net Address: Westminster Bridge Road, SE1 7EH Occupation: Resident Doctor Affiliation: Guy's and St Thomas' NHS Trust BMJ: Additional Article Info: Rapid response