Professor Merete Nordentoft:

I am professor of psychiatry at the University of Copenhagen and a member of the Danish Council of Ethics. The council is appointed by the Danish Parliament and consists of 17 experts from different professional backgrounds. It provides advice to the parliament on ethical questions.

I will give a little of the context in Denmark. According to Danish legislation, doctors are not obliged to give life-prolonging treatment, including nutrition, against a patient's will. There are exceptions, namely, in cases involving psychosis and severe anorexia nervosa. Apart from those exceptions, however, doctors are not obliged to give life-prolonging treatment against a patient's will. Life-shortening medication is allowed when it is used to ease pain, nausea and other unwanted consequences of illness in order to help the patient, even in cases where a side-effect of the medication is shortening of the patient's life. For instance, this could be the case with opiates. These are the elements of palliative care that can be provided, even if they are life-shortening.

The Danish Council of Ethics announced its recommendations in October 2023. First, we reviewed different models for assisted dying as implemented in Oregon and the Netherlands. We were specific about those examples. It is very important to study different models as there are huge differences in the detail of the models applied.

In the Netherlands, which allows euthanasia and has no requirement for terminal illness and where 5% of the deaths are accounted for by assisted dying, the number of people who die through assisted dying is ten times greater than in Oregon, which allows only assisted suicide and requires the presence of a terminal illness.

I shall now refer to the council's recommendations. The decision to request assisted dying is a serious one. When carried out, it is irreversible, contrary to a suicide attempt. In many cases, people regret suicide attempts and live afterwards. An important point is that the person will lose the possibility to change his or her mind. In Oregon, for instance, one third of the patients provided with medication for suicide did not use it. There are, of course, examples of patients who describe their lives as full of suffering and hopelessness, and who appear clear and well-considered, who are often discussed in the general debate. However, even in those cases, the wish to die fluctuates. On top of that, there is a large number of borderline cases where people's suffering and ability to make decisions are difficult to determine accurately and may vary over time. If assisted dying is to be allowed, it requires a regulation that can handle not only such clear and seemingly unambiguous cases but also the many more borderline cases.

As a consequence of these considerations, a majority of 16 of the council's 17 members recommend not legalising assisted dying in Denmark. As justification for this recommendation, the majority of the council has emphasised one or more of the following considerations. The members recognise that there are cases involving a death wish that is understandable but at the same time they will point out that even people with a long-term wish to die experience moments of ambivalence, and it is possible that they will change their minds.

We also argue that assisted dying may cause unacceptable changes to basic norms for society and healthcare. The very existence of an offer of assisted dying will decisively change our ideas about old age, the coming of death, living with disability, quality of life and what it means to take others into account. If assisted dying becomes an option, there is a great risk that it will become an expectation more than a right. There is a risk that it will even be experienced as a duty. That is one of our considerations. All of us agree that optimising palliative care should be an important part of what we should do in this context. We talk about assisted living instead of assisted dying. I will be happy to answer questions.