In a recent editorial Kelly & McLoughlin (Reference Kelly and McLoughlin2002) highlight the fact that the uncertain prognosis of most psychiatric diseases means that the objective accuracy of decisions on ‘physician-assisted suicide’ and euthanasia in this category of patients cannot be certified.

One important psychological issue, which parallels these views but applies to all cases of physician-assisted suicide and active euthanasia, is that decisions on these issues may be influenced by unintentional and even unconscious biases. One example of this phenomenon was presented in a recent study in which Swedish jurors were presented with a case description of a severely brain-damaged patient who was taken out of a respirator in the presence of muscle-relaxing drugs. The jurors were, most likely out of concern for the patient, generally supportive of euthanasia. However, since we varied the gender of the patient, as presented in the case description, we were also able to see that both male and female jurors tended to be most supportive of this kind of euthanasia when it was administered to a patient who belonged to the opposite gender (Reference Sjöberg and LindholmSjöberg & Lindholm, 2003). Swedish jurors thus tended to be more impressed by the futility of the life of patients who were in important respects dissimilar to themselves.

Not only psychiatric, but almost all clinical decision-making is to a certain extent tentative and subject to the corrective forces of expectation and further empirical observations — but decisions that lead to the active and intentional termination of the life of a patient are not. We believe that this fact, which was also indirectly addressed by Kelly & McLoughlin, is important not only to the discussion of whether physician-assisted suicide should be administered to psychiatric patients but also to the discussion of whether physicians should engage in euthanasia and physician-assisted suicide and whether psychiatrists should take the risk of sanctioning such activities by assessing the mental status of potential subjects of such interventions.