The desire for assisted suicide is multi-determined, and invariably ambivalent, even in the terminally ill or geriatric population, and is motivated by conscious and unconscious thoughts and feelings. In this presentation I discuss motives and meanings of the request for assisted suicide and link this request with thoughts and feelings about palliative and end of life care, as well as fears of pain and dependency. The psychoanalytic understanding of suicide deepnes our understanding of this request and considers unconscious factors and motives that lie behind apparently rational requests for assisted death. For example, the request for assistance in dying is not only a "cry for help", to reduce suffering, but may also have relational meaning, as a way to deal with unresolved interpersonal struggles and internal conflicts. Empathic involvement with care givers can help patients clarify their current experience so that hopeless depression is not the final determinant for the desire for death. The attentive attitude of the physician or treatment team enables a therapeutic interaction that allows for internal stabilization, relational growth and enhanced functioning, as death is faced with realistic fear and support. The underlying causes for the wish to die by assisted suicide are examined with a view to how they may be addressed by the treatment team.