Euthanasia or assisted suicide are now legal in several European countries. Spain has approved related legislation in 2022, and in Portugal the subject is currently under debate after preliminary ratification. This remains a controversial topic, raising passionate discussions that sometimes hamper the need to consider, in depth, the ethical, clinical, and operational difficulties of processes of this type. Older age people do not necessarily lose their autonomy with age, nor should they lose their right to decide on euthanasia or assisted suicide whenever the jurisdiction allows it. However, there is a growing concern of older people being coerced into decisions about ending their lives, not least due to their own fears of becoming a burden both for their families and the society. Manuel Martín-Carrasco will analyze how ageism can influence or model a wish to die in elderly people, especially those living with greater physical and/or mental disability. The so-called rational suicide focuses on the possibility that a healthy subject eventually decides to end his own life as a reflex of a free decision, and not within the context of a mental illness. Manuel Sánchez-Perez will discuss how difficulties in assessing the rationality of suicidal ideation include its dimensional character, together with the evidence that rationality is not always absent in depression and that the absence of depression does not imply rationality. Next, Lia Fernandes will provide an overview of years of public and parliamentary debates on euthanasia and physician-assisted suicide in Portugal. She will focus on issues regarding the exact role of psychiatrists (old age psychiatrists in particular) in the decision process, as proposed by the recently approved legislation. Finally, Javier Olivera will provide a brief overview of the recent implementation of legal access to euthanasia in Spain. A discussion of several controversial aspects of the operationalization of such a complex process will follow, including those related with conscientious objection.