We reflect upon ethical and psychological issues of groups of patient where verbal communication is not possible due to severe physical impairment. This group of chronically ill patients is capable of emotional and cognitive processing but the patients are locked in a paralyzed body. Thinking and feeling are intact but can no longer be expressed. Brain-computer interfaces (BCI) maintain and allow communication in severely paralyzed patients. The ethical, psychological and social implications of BCIs concern mainly hasten death decisions and euthanasia.