End-of-life medical treatment plans to be introduced in coming years

Discussions about end-of-life care – such as do-not-resuscitate orders – are continuing in the Ministry of Social Affairs. Doctors believe patients should have the right to determine their course of treatment, but a draft law is currently in conflict with people's fundamental rights.
Doctors have been working for several years to ensure patients can make decisions about when they want to stop treatment in cases where they can no longer decide for themselves. For example, if they are brain dead and on life support.
However, a draft law drawn up by the Ministry of Social Affairs surprised medical professionals at the end of last year. The legislation included a clause saying a declaration would only be considered if doctors deemed a medical condition irreversible.
"According to this draft, it was literally not possible to unconditionally refuse life-saving treatment. It always had to be accompanied by a doctor's assessment of the patient's condition and prognosis," said Katrin Elmet, an anesthesiologist at Tartu University Hospital.
Elmet said this would require doctors to do something that is usually impossible in the situations described in an end-of-life declaration — predict the future.
Additionally, the regulation would limit a person's freedom of choice, as they would only be able to refuse treatment under certain conditions.
"If the situation arises where an end-of-life declaration can only be written in such a way that a do-not-resuscitate order must be accompanied by a doctor's assessment of the irreversibility of the condition, then imagine how doctors would evaluate that. Resuscitation can often be reversible, which means that all elderly people who do not wish to be resuscitated would still be resuscitated. Moreover, the first responders arriving with an ambulance are a nurse team, who must start performing chest compressions because they are not allowed to assess prognosis," Elmet explained.
Katri Aaslav-Tepandi, an advisor and chief chaplain at the Ministry of Social Affairs, said there was a long debate over this clause to determine whether preserving life or respecting a person's autonomy in decision-making was more important.
"We have been debating this in the working group for a whole year, and there is still no consensus. I can say that we have made progress, and the irreversibility clause will be removed," Aaslav-Tepandi told Sunday's "Aktuaalne kaamera."
If everything goes according to plan the new law will come into force in 2027. It will give people the right to document in the Health Portal (Terviseportaal) what treatments they do not wish to receive, after consulting with a doctor.
Medical professionals will consider these wishes only if the person is no longer able to express them themselves.
"We are mortals, and society needs to be made aware of this, that death is not a medical mistake," said Aaslav-Tepandi.
Both the doctor and the chaplain emphasized that simply legalizing end-of-life declarations is not enough. Ensuring the availability of palliative care across Estonia is crucial so that patients who refuse treatment do not have to spend their final days suffering in pain.
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Editor: Marko Tooming, Helen Wright
Source: Aktuaalne kaamera