Reading Swiss first-person accounts from an Indian psychiatric setting

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Blanc and colleagues show that people pursuing assisted suicide in Switzerland describe more than a response to pain or disability. Their accounts involve control over dying, trust in a civil society model, affirmation by family members, a threshold beyond which life feels unbearable, and anxiety that the opportunity to act may be lost.¹ These accounts deserve to be heard. Their meaning, however, cannot be separated from the setting in which they arise.

The participants had already entered an established Swiss pathway for assisted suicide. In India, a person who says that life is no longer worth living is more likely to enter a psychiatric ward, a medical emergency, or a family crisis. Active euthanasia and assisted suicide remain unlawful. The Supreme Court has instead developed safeguards for withholding or withdrawing life-sustaining treatment, including clinically assisted nutrition and hydration, and has simplified the procedure for advance directives.² ³ Section 115 of the Mental Healthcare Act 2017 presumes severe stress following a suicide attempt and places a duty on the government to provide care, treatment, and rehabilitation.⁴ The clinician’s immediate responsibilities remain the assessment of capacity and mental disorder, treatment of depression and demoralisation, relief of suffering, and support for the family.

The themes identified in Switzerland also acquire a different meaning where palliative care remains difficult to obtain. An estimated seven to ten million people in India require palliative care each year, yet fewer than 4% have access to it.⁶ Government figures show that services under the National Programme for Palliative Care are functional in around 600 districts. During 2024–25, 6 082 069 outpatient, 2 517 663 inpatient, and 550 056 home-based palliative-care contacts were reported.⁵ Yet geographical access remains poor: only 23.6% of the population lived within 30 minutes of a listed palliative-care centre in 2022, with substantially poorer access in rural areas.⁶ Oral morphine was absent from one national scheme list and 17 state or union-territory essential medicines lists.⁷

In such circumstances, statements about being a burden, family agreement, or an urgency to die cannot automatically be read as expressions of settled personal autonomy. They may also carry the weight of untreated pain, unaffordable care, exhausted caregivers, inadequate social protection, and fear of abandonment.

The study is a valuable invitation to listen more closely. It should not, however, be taken to mean that an Exit-type pathway is the logical next step wherever similar themes are heard. In India, the more urgent task is to ensure access to palliative care, pain relief, psychiatric treatment, and practical support for families. Debate about assisted dying will remain ethically incomplete while choices at the end of life are still shaped by neglected suffering.

Competing interests: None declared.

References

1. Blanc S, Heistrüvers L, 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. Common Cause (A Registered Society) v Union of India and Another. (2018) 5 SCC 1; Common Cause (A Registered Society) v Union of India. 2023 SCC OnLine SC 99, order dated 24 January 2023.

3. Harish Rana v Union of India and Others. 2026 INSC 222; 2026 SCC OnLine SC 358, judgment dated 11 March 2026.

4. Government of India. Mental Healthcare Act 2017, section 115.

5. Ministry of Health and Family Welfare, Government of India. Palliative care services. Lok Sabha Unstarred Question No 967, answered 16 December 2025.

6. Sharma P, Thakkar H, Patil A, et al. Access to palliative care in India: situational analysis and modeling of access from public healthcare centers. ecancermedicalscience 2025;19:2038. doi:10.3332/ecancer.2025.2038.

7. Agrawal D, Shrinivas D, Sharma P, Rajagopal MR, Ghoshal A, Zadey S. An evaluation of the adequacy of Indian national and state essential medicines lists for palliative care medical needs—a comparative analysis. ecancermedicalscience 2025;19:1837. doi:10.3332/ecancer.2025.1837.

No competing Interests: YesThe following competing Interests: Electronic Publication Date: Thursday, September 17, 2026 - 14:45AI use: Yes I have used AIHighwire Comment Subject:

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

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Reading Swiss first-person accounts from an Indian psychiatric setting

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

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Address: Department of Geriatric Mental Health, Institute of Human Behaviour and Allied Sciences (IHBAS), New Delhi, IndiaOccupation: Professor of Psychiatry & Head, Department of Geriatric Mental Health Affiliation: Institute of Human Behaviour and Allied Sciences (IHBAS)BMJ: Additional Article Info: Rapid responseTwitter: @ompsychiatrist