Agreement: I Agree Body: Dear Editor, Blanc and colleagues identify a perceived narrowing window of opportunity among people pursuing assisted suicide in Switzerland. Participants feared losing decision-making capacity, the ability to self-administer lethal medication, or access after institutional admission. The authors interpret this mainly as urgency arising from illness progression. Their findings also raise a policy question: can safeguards intended to protect autonomy create pressure to die sooner? This possibility is supported by experience from Canada. Under the original federal framework, patients had to retain capacity immediately before medical assistance in dying (MAID). Clinicians reported expediting provision when capacity loss seemed imminent; some patients declined palliative medication because they feared it might impair their capacity.2 A separate qualitative study found that eligible patients sometimes received inadequate symptom relief or sought MAID earlier while clinicians struggled to predict capacity loss.3 Canada subsequently introduced a waiver of final consent for eligible patients whose natural death was reasonably foreseeable. Nurses described the previous requirement as creating a “race to get it done” and reported that the waiver allowed some patients to live longer without fearing that they would lose access.4 These studies are qualitative and provider-reported; they do not establish how often eligibility rules advance the timing of death. Nor can Canadian findings be assumed to apply unchanged to Swiss assisted suicide. Nevertheless, they show that the mechanism suggested by the Exit Project is plausible and observable in practice. The institutional framework may therefore do more than enable a pre-existing choice. Requirements for contemporaneous capacity, self-administration, and access in particular settings can shape when a person feels able to act. Procedural reassurance may reduce uncertainty, but a closing eligibility window may simultaneously convert an option retained for future control into an urgent present decision. Evaluation of assisted-dying safeguards should therefore ask not only whether they exclude ineligible applicants, but also whether they alter timing among eligible people. Longitudinal studies should record preferred and actual dates, reasons for advancing or postponing provision, symptom treatment withheld because of capacity concerns, and the effects of institutional restrictions. Without such evidence, the narrowing window should not be treated solely as a feature of disease progression; it may also be an unintended product of the rules designed to protect choice. References 1. Blanc S, Heistrüvers L, Savinelli S, 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. 2. Wiebe E, Kelly M, McMorrow T, Tremblay-Huet S, Hennawy M. Assessment of capacity to give informed consent for medical assistance in dying: a qualitative study of clinicians’ experience. CMAJ Open. 2021;9:E358-E363. doi:10.9778/cmajo.20200136. 3. Variath C, Peter E, Cranley L, Godkin D. Experiences of healthcare providers with eligible patients’ loss of decision-making capacity while awaiting medical assistance in dying. Palliat Care Soc Pract. 2022;16:26323524221128839. doi:10.1177/26323524221128839. 4. Pesut B, Thorne S, Chambaere K, Hall M, Schiller CJ. The evolving complexities of MAID care in Canada from a nursing perspective. Glob Qual Nurs Res. 2024;11:23333936241228233. doi:10.1177/23333936241228233. No competing Interests: Yes The following competing Interests: Electronic Publication Date: Monday, September 21, 2026 - 05:39 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: Safeguards may narrow the window for assisted suicide 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: Kong First name and middle initial: Yue Email: kongy@dmu.edu.cn Address: No. 9, West Section, Lvshun South Road, Dalian, Liaoning 116044, P.R. China Occupation: Experimentalist Other Authors: Yifan Zhao; Shao Li Affiliation: Liaoning Provincial Key Laboratory of Cerebral Diseases, Institute for Brain Disorders, Dalian Medical University. BMJ: Additional Article Info: Rapid response
Safeguards may narrow the window for assisted suicide
