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The decision making process could be abused for some cases, such as those that are comatose or elderly and confused. In the case of comatose or unresponsive cases we already have a process of letting them die by cutting off food or assistance with basic functions and then they have to suffer instead of being allowed to die peacefully like we have for pets.
Also there is some concern that normalizing it would increase the frequency with the assumption that doing so would be wrong. These are valid concerns and should be taken into account, but are massively outweighed by the benefits of less suffering.
I actually disagree with the idea that someone has to be massively suffering or in the process of dying to be able to end their life in a painless way. Having an incurable disease shouldn't mean they must live long enough to suffer before being able to make a decision. I mean we can make decisions like Do Not Resuscitate (DNR) where medical staff can let someone die, but they can't make that process quicker when it comes up because of the fear that someone might assist when they should have let the person painfully die slowly in agony instead.
There are valid concerns, but they are massively overblown compared to the amount of suffering that could be avoided if people were able to make decisions about their end of life while they were still of sound mind, like DNR but more like 'help me die painlessly if I'm going to die anyway'. Just make the decisions where the person's preference isn't known a complicated process to avoid those abuses.