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Background. In Switzerland, psychiatrists sometimes assume the role of gatekeepers when patients request assisted suicide. They evaluate the patient’s capacity for decision-making and assess them for possible psychiatric disorders that could interfere with this capacity. Objectives. Our study explores the motives behind requests for assisted suicide made by patients hospitalized in a somatic care unit at Lausanne University Hospital and the challenges faced by the psychiatrist as gatekeeper. Method. We conducted a retrospective analysis of psychiatric reports concerning 18 patients aged 65 or older who had requested assisted suicide. We aimed to identify both manifest and latent motives in the patients’ accounts, drawing on attachment theory and a psychodynamic analysis based on the concepts of the ideal ego, the ego ideal, and the superego. Results. Different categories of motives for requesting assisted suicide were expressed by the patients. We also found indications of insecure and secure attachment, as well as underlying feelings of shame and abandonment and more rarely of guilt. In addition to limitations related to the patient’s condition, the gatekeeper position limits the possibility of addressing these issues or using them therapeutically with the patient. Conclusion. The psychiatrist’s role as a gatekeeper regarding assisted suicide is uncomfortable. He or she must think about how to assume this role while remaining a liaison psychiatrist.