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A further major difficulty with the discernment of genuine autonomy in those who are dying concerns the close association between the sincere wish to be dead and mental illness, present in up to 95% of those who wish to commit suicide or who request euthanasia. Numerous articles in the literature of psychiatry reveal that the great majority of patients who desire death during a terminal illness are suffering from a treatable mental illness, most commonly a depressive condition. This is not a diagnosis which can easily be made by the average doctor unless he or she has had extensive experience with depression and suicide, and it is frequently missed even in those already under medical care.

It has been suggested, therefore, that patients will be protected by having a psychiatrist see every person who requests euthanasia. But it is not so simple, since only those psychiatrists with extensive experience of terminal illness and suicide will be sufficiently qualified in this area. Frank...