End of life issues, decision-making and patient autonomy

The National Council on Medical Ethics has sent a letter to the Government accompanied by a discussion paper developed by a working group within the Council.

The paper of the working group deals with end-of-life decisions and is structured around five model cases of increasing controversy.

1) Not initiating life-sustaining treatment
2) Interrupting life-sustaining treatment
3) Palliative sedation within palliative care
4) Physician-assisted suicide and
5) Physician induced death.

The working group clearly advocates increased patient autonomy in end-of-life decision making. A patient should, under certain conditions, be able to request and receive continuous palliative sedation even if death is not imminent. Patients with certain progressive degenerative incurable diseases inducing severe pain and possibly mental impairment should be able to ask their doctor for help and the doctor should be permitted to prescribe a lethal dose of a drug that the patient can bring home and use if and when the patient chooses to end his/her life.

The Council transfers this discussion paper to Government and at the same time publishes it on its web site. The intention is primarily to promote public debate around end-of-life decision making. But the Council also discussed the paper itself and in the letter to the Government it describes the outcome (to date) of its own discussions. The Council endorses the emphasis on patient autonomy also in end-of-life decision making. It states that the conditions for when palliative sedation is applied needs to be clarified. A majority of the Council members also supported that the prerequisites for physician-assisted suicide should be further investigated.

Read the english translation of the letter and the discussion paper:

Letter: End of life issues, decision-making and patient autonomy (pdf 121 KB)

The patient’s possibility to decide about his/her own death (pdf 151 KB)

Please contact the secretariat for further information, smer@social.ministry.se