While medical assistance in dying is not available in Sweden, it is currently a topic of debate among physicians and lay persons alike. As a researcher with a special focus on late-life suicide, I will share some reflections related to the role of physical illness, pain, and existential issues in older adult suicidality. Further, I will briefly present some preliminary data from a nationwide study on physical pain issues in persons of all ages who died by suicide in Sweden. Even though half were on antidepressants, the topic of suicidal ideation was seldom brought up by doctors during consultations in the weeks and months that preceded suicide, precluding any chance for suicide prevention. Based on the narratives of older patients who tried to take their lives, as well as consultations with somatic patients with death wishes in my role as a consultation liaison psychiatrist at a large urban hospital, I will address the fluctuating nature of suicidal ideation over time, and its implications for both suicide and assisted suicide.