Second reading of the draft law amending the Health Services Organisation Act, the Unemployment Insurance Act, and other related acts, as well as amending the Act on Support for Working Capacity (604 SE)
Session: 15th Riigikogu, 5th session, plenary sitting
Date: 2025-06-12 01:37
Participating Politicians:
Total Speeches: 52
Membership: 15
Agenda Duration: 1h 0m
AI Summaries: 52/52 Speeches (100.0%)
Analysis: Structured Analysis
Politicians Speaking Time
Politicians
Analysis
Summary
The present minutes of the agenda contained information regarding draft bill 604, which includes amendments to the law on the organization of healthcare services initiated by the Republic's Government, and the unemployment insurance law and related laws, as well as the law amending the law on disability support. The main objective is to increase patient autonomy and to make advance directives for end-of-life care more accessible through both medical assistance and the health information system, also adding a requirement for medical consultation. A recurring theme was the connections between patient wishes clarity, inclusive consultation, and the use of digital registries, as well as the inclusion of the viewpoints of various parties (Health Insurance Fund, the Chamber of Disabled People, the Association of Primary Health Care Centers, ministries, etc.).
Secondly, other important discussions were also thoroughly reflected upon: whether to include nurses or other specialists in the consultation process, how to account for a patient’s decision-making ability in situations involving varying disease and treatment interactions, and what role separate funding plays in the advance directive consultation process; discussions also covered the implementation of digital solutions, age limits (18 versus 21 years), and the development of national guidelines and action plans for palliative care. A common thread was promoting a caring and people-centered approach, and the need to promote the accessibility of palliative care throughout Estonia. Summaries were formalized in the form of agreements, and procedural documents were approved unanimously; the final outcome was that preparations for the third reading of the bill were continued, suspending it for the second reading.
Decisions Made 1
The Riigikogu passed a decision to conclude the second reading and to put the bill on the Riigikogu plenary session agenda for the third reading. The procedural documents for the second reading were also unanimously approved, and procedural actions concerning several amendments (not all received support) were postponed, directing the process back to discussions between parliamentary factions and the committee to prepare the final form.
Most Active Speaker
The most active speaker was emSc80KD_vw (Signe Riisalo), who is the chair of the social affairs committee. Her role as speaker and committee chair appears to be that of a leading discussion facilitator and coordinator of colleague involvement; her position within the Riigikogu is a “sideline-left”/“operative” role – in other words, a leading committee chair (who holds a position of representative stature across borders).
Aseesimees Toomas Kivimägi
AI Summary
We have reached the tenth item on the agenda, where we will consider the second reading of Bill 604, initiated by the Government of the Republic. This bill concerns the amendment of the Health Services Organisation Act, related acts, and the Work Ability Allowance Act. The Chairman of the Social Affairs Committee, Signe Riisalo, will now come forward to present the report.
Signe Riisalo
Profiling Eesti Reformierakonna fraktsioonAI Summary
Riisalo detailed the procedure for the draft bill on end-of-life declarations of intent and its main amendments, including expanding access to counseling options, addressing issues of legal capacity, raising the age limit from 18 to 21, organizing financing through the Health Insurance Fund (Tervisekassa), and a shared consensus plan to place the draft bill on the Riigikogu agenda for the second and later the third reading.
Aseesimees Arvo Aller
AI Summary
Deputy Chairman Arvo Aller thanked them and said that it was probably June 18th.
Signe Riisalo
Profiling Eesti Reformierakonna fraktsioonAI Summary
He apologizes and asks if he said anything wrong.
Aseesimees Arvo Aller
AI Summary
The speech refers to what you said on May 18th.
Signe Riisalo
Profiling Eesti Reformierakonna fraktsioonAI Summary
At the heart of the speech is a brief, sincere apology.
Aseesimees Arvo Aller
AI Summary
Vice-Chairman Arvo Aller announces that there are questions and asks Lauri Laats to ask the question.
Lauri Laats
Profiling Eesti Keskerakonna fraktsioonAI Summary
Lauri Laats asks about the admissibility of an end-of-life declaration of intent made by a person with limited legal capacity, including its pros and cons, and whether these issues have been discussed in the committee.
Signe Riisalo
Profiling Eesti Reformierakonna fraktsioonAI Summary
Riisalo said that there are two situations concerning limited legal capacity: minors, who are unable to make an end-of-life declaration of will, and adults with special needs whose decision-making ability is restricted. These individuals are assessed by doctors who have specific training for this purpose and who adhere to a special guideline that follows the established practice since the adoption of the Law of Obligations Act.
Aseesimees Arvo Aller
AI Summary
Deputy Speaker Arvo Aller invites Riina Solman to speak.
Riina Solman
Profiling Fraktsiooni mittekuuluvad Riigikogu liikmedAI Summary
Riina Solman is asking how far along the national guidelines and action plan for palliative care are, and why they have not yet been finalized concurrently with the draft bill concerning end-of-life declarations, noting that palliative care could improve the quality of life and that the draft bill reached the chamber before the guidelines did.
Signe Riisalo
Profiling Eesti Reformierakonna fraktsioonAI Summary
Riisalo stated that end-of-life services encompass nursing care, home care, and spiritual support, noting that the development of palliative care is currently underway. Services across both the healthcare and social sectors must be coordinated around this initiative so that individuals can pass away with dignity in their final days, and their loved ones receive the necessary support.
Aseesimees Arvo Aller
AI Summary
Deputy Chairman Arvo Aller offered his thanks, stated that there were no further questions, opened the floor for debate, and requested that Priit Sibul proceed.
Priit Sibul
Profiling Isamaa fraktsioonAI Summary
Priit Sibul said that although the draft bill is concise, it communicates a person's wishes to the medical system and increases the chance that end-of-life wishes will be fulfilled, but there is no unified standard, and solutions must take into account differences in digital access and people's capabilities.
Aseesimees Arvo Aller
AI Summary
Deputy Chairman Arvo Aller requests three more minutes.
Priit Sibul
Profiling Isamaa fraktsioonAI Summary
Priit Sibul emphasizes that while he generally supports the bill, Chapter 52 is misleading because it includes non-medical wishes and claims that healthcare professionals are not responsible for fulfilling them, which creates an expectation regarding assisted suicide. He therefore recommends revising the wording and the title, stressing that it should instead read "declaration of intent to forgo treatment."
Aseesimees Arvo Aller
AI Summary
The Deputy Chairman thanked Riina Solman and called upon her.
Riina Solman
Profiling Fraktsiooni mittekuuluvad Riigikogu liikmedAI Summary
Riina Solman emphasizes that an advance directive must not signify the termination of treatment or lead to euthanasia or assisted suicide, and before such a directive is adopted, universally accessible palliative care must be guaranteed and national guidelines must be established.
Aseesimees Arvo Aller
AI Summary
Vice-Chair Arvo Aller announces that three extra minutes will be added.
Riina Solman
Profiling Fraktsiooni mittekuuluvad Riigikogu liikmedAI Summary
Riina Solman briefly summarized the debate surrounding end-of-life declarations of intent, noting that while some segments of society are awaiting the draft legislation, others are concerned about the burden placed on the elderly. She emphasized that the financial needs of the healthcare sector are increasing and that any money saved could be channeled into developing better treatment options. She also mentioned Jourdan's position and confirmed that she has listened to expert opinions, expressing a desire for a swift resolution to improve palliative care and overall quality of life.
Aseesimees Arvo Aller
AI Summary
The speech is a vote of thanks, and Margit Sutrop is invited to take the floor.
Margit Sutrop
Profiling Eesti Reformierakonna fraktsioonAI Summary
This bill strengthens patient autonomy and the person-centered approach by making their will available in the health information system, adding mandatory counseling for the physician, and providing the opportunity to clarify their will through a trusted person, emphasizing the importance of the principles of biomedical ethics—autonomy, beneficence, and non-maleficence—as well as the importance of discussing end-of-life issues.
Aseesimees Arvo Aller
AI Summary
The speech focuses on the request for three additional minutes of time.
Margit Sutrop
Profiling Eesti Reformierakonna fraktsioonAI Summary
Margit Sutrop emphasizes that an end-of-life advance directive is the expression of the patient's personal wishes and values until the end of life, and that this is not a refusal of treatment, but rather a request for palliative care. Furthermore, implementing this requires developing and funding palliative care and finding an appropriate funding model so that everyone can receive care aligned with their values.
Aseesimees Arvo Aller
AI Summary
Deputy Chairman Arvo Aller thanks [the previous speaker/body] and addresses Riina Sikkut.
Riina Sikkut
Profiling Sotsiaaldemokraatliku Erakonna fraktsioonAI Summary
Riina Sikkut confirms that the draft bill makes end-of-life declarations of intent enforceable by offering advice from a trained specialist, providing the option to use the patient portal, and allowing users to fill in a free-text field. Furthermore, it increases the availability of palliative care and stresses that euthanasia is not permitted, all with the aim of improving the quality of life at the end of life and ensuring people's wishes are followed.
Aseesimees Arvo Aller
AI Summary
The Deputy Chairman thanks the previous speaker and invites Diana Ingerainen to take the floor.
Diana Ingerainen
Profiling Fraktsiooni mittekuuluvad Riigikogu liikmedAI Summary
This draft bill provides doctors with a clear tool for conducting consultations and transmitting the patient's wishes to the health information system, which doctors are eagerly awaiting. However, I am sad that other topics are being expanded upon with it; at the same time, palliative care is available, and general practitioners can consult with anesthesiologists and palliative care specialists to alleviate suffering.
Aseesimees Arvo Aller
AI Summary
The Deputy Chairman gives thanks, calls upon Lauri Laats, and requests three additional minutes.
Lauri Laats
Profiling Eesti Keskerakonna fraktsioonAI Summary
Lauri Laats pointed out that in Estonia, palliative care is predominantly available in large cities, and the lack of resources and training makes quality care inaccessible. Therefore, merely a law on end-of-life declarations does not solve the system's fundamental issues and requires additional amendments, which were submitted by the Centre Party faction.
Aseesimees Arvo Aller
AI Summary
There are no further requests for speeches, and I hereby close the debate. Thirteen amendments have been submitted regarding the draft bill, and we will now commence their review. The first was submitted by the Social Affairs Committee; the lead committee recommends taking it fully into account. The second was submitted by Priit Sibul; the lead committee recommends rejecting it (this proposal is not subject to a vote pursuant to § 106, subsection 2 of the Riigikogu Rules of Procedure and Internal Rules Act). And the third was submitted by the Estonian Centre Party faction; the lead committee recommends rejecting it. Lauri Laats, please proceed!
Aseesimees Arvo Aller
AI Summary
Deputy Speaker Arvo Aller put to a vote the third amendment proposal submitted by the Estonian Centre Party faction, which the leading committee had recommended disregarding.
Aseesimees Arvo Aller
AI Summary
The motion received 7 votes in favor, 50 against, and 0 abstentions, and consequently failed to gain support. The fourth amendment was submitted by the Estonian Centre Party faction to the lead committee, and it was requested that it be disregarded.
Lauri Laats
Profiling Eesti Keskerakonna fraktsioonAI Summary
Lauri Laats thanks the audience and asks them to vote.
Aseesimees Arvo Aller
AI Summary
Arvo Aller put the fourth amendment proposal, which was submitted by the steering committee of the Estonian Centre Party faction, to a vote, with the aim of having it disregarded, and requested that members take a position and vote.
Aseesimees Arvo Aller
AI Summary
The Riigikogu voted 7 in favor, 49 against, with 0 abstentions, and consequently, the proposal failed to gain support. The fifth amendment was submitted by the Estonian Centre Party faction, and the lead committee recommended rejecting it.
Lauri Laats
Profiling Eesti Keskerakonna fraktsioonAI Summary
Lauri Laats thanks the audience and asks listeners to vote.
Aseesimees Arvo Aller
AI Summary
Vice-Chairman Arvo Aller opens the voting process and submits the fifth amendment proposal from the Estonian Centre Party faction's lead committee, the substance of which is to reject it, and asks members to take a position and vote.
Aseesimees Arvo Aller
AI Summary
The proposal received 7 votes in favor, 50 against, and 0 abstentions, and consequently failed to gain support; the sixth amendment was submitted by the Social Affairs Committee, with the lead committee recommending full adoption; the seventh amendment was submitted by the Estonian Centre Party Faction, with the lead committee recommending rejection; Lauri Laats, please!
Lauri Laats
Profiling Eesti Keskerakonna fraktsioonAI Summary
Lauri Laats thanks everyone and invites them all to vote.
Aseesimees Arvo Aller
AI Summary
Deputy Chairman Arvo Aller announced the start of the vote and presented the seventh amendment, which the steering committee of the Estonian Centre Party faction wishes to disregard.
Aseesimees Arvo Aller
AI Summary
The proposal received 7 votes in favor, 50 against, and 0 abstentions, and therefore failed to gain support; the lead committee decided to disregard the eighth amendment proposal, which had been submitted by the Estonian Centre Party faction.
Lauri Laats
Profiling Eesti Keskerakonna fraktsioonAI Summary
Lauri Laats thanks the listeners and asks them to vote.
Aseesimees Arvo Aller
AI Summary
Deputy Chairman Arvo Aller announced the commencement of the vote and put the eighth amendment proposal to a vote. This proposal was submitted by the steering committee of the Estonian Centre Party faction, and its objective is to dismiss it from consideration.
Aseesimees Arvo Aller
AI Summary
Seven members of the Riigikogu voted in favor of the amendment proposal, 50 were against, and there were no abstentions, meaning the proposal failed to gain support; the ninth amendment proposal was submitted by the Estonian Centre Party faction, and the lead committee recommends rejecting it.
Lauri Laats
Profiling Eesti Keskerakonna fraktsioonAI Summary
He thanks the listeners and asks them to vote.
Aseesimees Arvo Aller
AI Summary
Deputy Chairman Arvo Aller called the ninth amendment proposal to a vote. The proposal, submitted by the steering committee of the Estonian Centre Party faction, sought to reject [the motion/provision]. He then requested that members take a position and vote.
Aseesimees Arvo Aller
AI Summary
For the ninth amendment proposal, there were 7 votes in favor, 51 against, with 0 abstentions, and thus it did not receive support; the tenth, eleventh, and twelfth amendments were submitted by the Social Affairs Committee as the leading committee, and their full adoption was requested, while the thirteenth amendment was submitted by the Estonian Centre Party faction and was rejected; Lauri Laats, please!
Lauri Laats
Profiling Eesti Keskerakonna fraktsioonAI Summary
Lauri Laats thanks you and asks you to vote.
Aseesimees Arvo Aller
AI Summary
The Deputy Speaker announces the commencement of the vote and introduces the 13th amendment proposal from the Centre Party Faction to the Steering Committee, the purpose of which is to disregard it.
Aseesimees Arvo Aller
AI Summary
The 13th amendment received 7 votes in favor, 49 against, and 1 abstention; consequently, the proposal was rejected. All amendments have now been reviewed, and the leading committee’s motion to conclude the second reading of Draft Act 604 was adopted, thereby concluding the second reading.