5. LEGISLATION

Suicide is seldom a rational choice. People in a suicidal crisis often experience psychological stress, i.e. an immense psychic pain, are extremely vulnerable, and ambivalent. They may require professional care to help mitigate their suicide thoughts. Legislative measures can help decrease stigma and facilitate help-seeking (World Health Organization, 2021a). The Global Mental Health Action Network initiative, an international working group, which includes the World Health Organisation, actively encourages the decriminalisation of suicide in those countries where this is still a concern (United for Global Mental Health, 2021). In the Nordic countries, suicide and suicidal behaviour is not criminalized (Mishara & Weisstub, 2016).

Palliative treatment: a holistic treatment approach aiming to improve quality of life among individuals who may suffer from a life-threatening disease, while reducing pain and other symptoms.

Ending life-prolonging treatment: withholding or withdrawing potentially life‐prolonging treatment, while taking into account that this might hasten the patient’s death.

Hastened death: administration of pain-reliving medication, such as morphine, while taking into account that this might hasten the patient’s death.

Physician-assisted suicide: when a patient’s death is facilitated by a physician who provides the necessary means to enable the patient to perform the life-ending act, i.e. the suicidal act is considered to be performed by the patient.

Euthanasia: the termination of a patient's life at their request by a physician.

Although frequently debated, physician-assisted suicide (see Box 5.1 for definition) remains not legalised in any of the Nordic countries. In fact, the Penal Code of several Nordic countries list assisted suicide as illegal (Mishara & Weisstub, 2016). Palliative care provides an important alternative for individuals with severe pain and complex disorders. The range of treatment options and availabilities have improved over recent decades, for instance in Norway where palliative care has been implemented into public health care system (Kaasa, et al., 2007). Findings from a non-representative survey of medical doctors suggest that administration of medication for alleviating pain and other symptoms with possible life-shortening effects, i.e. hastened death, may occur in 0.4-2.2% of all deaths in Denmark and Sweden (Bilsen, et al., 2006). 

Expert statements confirm the existence of palliative treatment in the Nordic countries. However, it is possible that these treatment offers might not be widely known in the general population. It is likely that individuals who may consider terminating their lives experience ambivalence. For this reason, it is important to ensure that they know about other options, for instance for securing relief of pain while remaining in control of the treatment.