Agenda Profile: Margit Sutrop
Draft law amending the Health Services Organisation Act (advance directive of a patient’s end-of-life will) – first reading (604 SE)
2025-04-23
15th Riigikogu, 5th session, plenary session
Political Position
The political stance is one of strong support for the draft bill concerning the patient's end-of-life declaration (604 SE), which the Reform Party backs in the patient's best interests. This position is framed on a value-based foundation, emphasizing the protection of patient autonomy and the right to self-determination in situations where they are unable to make decisions. The objective is to ensure that the declaration, which is filed through the health portal, is mandatory for doctors to adhere to.
4 Speeches Analyzed
Topic Expertise
The presenters demonstrate a profound understanding of medical ethics, palliative care, and the complexities of legislation, referencing the core principles of modern medical ethics (autonomy, beneficence, and non-maleficence). One speaker specifically highlighted their experience serving on the ethics committees of two major hospitals (Kliinikum and PERH) and cited specific legal and medical terms such as "futile treatment" and "clinical context." They also showed awareness of international precedents (Latvia, Germany) and the historical medical paradigm (the spirit of Hippocrates).
4 Speeches Analyzed
Rhetorical Style
The rhetorical style is factual, constructive, and persuasive, focusing on ethical and legal arguments. Both logical appeals (the necessity of controlling the dying process, conflicts among next of kin) and tones expressing concern (death is a taboo, frightening subject) are employed to underscore the social necessity of the draft law. The speakers maintain a formal demeanor, respectfully addressing the presiding officer and the minister, and emphasize the consensus that has been reached.
4 Speeches Analyzed
Activity Patterns
The activity patterns demonstrate long-term and systematic work on this topic, which began with a conference in September 2020 and involved 13 working group meetings. Close cooperation with the Ministry of Social Affairs, the Government Office’s InnoTeam, and the Faculty of Medicine at the University of Tartu is emphasized. The participants have been active initiators and working group members, not merely supporters.
4 Speeches Analyzed
Opposition Stance
Direct political opposition is not being criticized; the primary challenge is historical medical paternalism, where doctors have been trained to preserve life, which makes it difficult for them to discontinue futile treatment. Efforts are also being made to resolve situations where doctors struggle to make decisions due to conflicts among the patient's relatives.
4 Speeches Analyzed
Collaboration Style
The collaborative approach is broad and consensual, involving officials from the Ministry of Social Affairs, the Estonian Medical Association, the University of Tartu Centre for Ethics, and representatives of the Council of Churches. All contributors are thanked, and it is emphasized that a significant consensus has been reached regarding the current draft bill following extensive debates.
4 Speeches Analyzed
Regional Focus
The focus is at the national level (the Estonian healthcare system, the health portal) and on international models (Latvia, Germany). Specific national institutions are mentioned, such as the University of Tartu, Kliinikum, and PERH, but there is a lack of emphasis on local or regional constituency issues.
4 Speeches Analyzed
Economic Views
Economic considerations focus on the allocation of resources within healthcare, demanding greater funding to improve the accessibility of palliative care. There is also a recognized need to allocate resources for the training of physicians and for informing the public (through videos, a TV series) so that the topic is not intimidating.
4 Speeches Analyzed
Social Issues
The social issue being addressed is the taboo surrounding death and end-of-life topics in Estonian society, which hinders communication among loved ones. The goal is to increase people's autonomy, reduce suffering associated with prolonging life without the desired quality of life, and support patients and their relatives.
4 Speeches Analyzed
Legislative Focus
The legislative focus is clearly on the draft bill concerning the patient's end-of-life declaration (604 SE), which aims to legally stipulate the obligation for doctors to follow the patient's wishes and to create the possibility of formalizing this declaration within the e-Health Portal. The speakers are strong supporters of the initiative and consider it a major step forward for Estonian medicine.
4 Speeches Analyzed