Assisted dying in Norway

The text of Rikke’s Law, as proposed by Right to Die Norway:

§ 1 Definitions

In this Act, the following terms shall mean:

• a) Voluntary Assistance in Dying (VAD): assistance in dying through the administration of medication, either self-administered or provided with the assistance of a medical professional.
• b) Medical professional:
  • Physician: a person with a medical degree who has received official authorisation.
  • Nurse: a person with public authorisation pursuant to the Health Personnel Act.
  • Pharmacist: a person authorised as a prescription pharmacist or licensed pharmacist pursuant to the provisions of the Health Personnel Act.

§ 2 Conditions for the Right to Voluntary Assistance in Dying

Self-determined assisted dying may be granted to a person who:

• a) is registered in the National Population Register with the right to necessary health and care services
• b) is a Norwegian citizen or has permanent residency in Norway
• c) is over 18 years of age, legally competent, and capable of giving informed consent
• d) suffers from an incurable somatic disease (cf. § 3.1)
• e) has voluntarily requested assisted dying
• f) is not under pressure from others (family, friends, healthcare personnel, society, etc.)
• g) has been informed of all available treatment options within the healthcare system.

§ 3.1 Incurable Somatic Disease

A person has an incurable somatic disease if all the following conditions are met:

• a) A serious incurable disease and/or severe functional impairment (including neurodegenerative diseases).
• b) An advanced stage with irreversible decline, but without a required time prognosis.
• c) The stage of decline results in lasting physical and/or psychological burdens that manifest as unbearable suffering according to the applicant’s own assessment.*
• d) Documentation of the person’s medical condition under items 3.1(a) and 3.1(b) must, at the time of application, be provided in writing by the treating physician. The documentation must show that the applicant has been informed about their condition.

*The individual, not a physician, defines what constitutes unbearable suffering. See, for example, Spanish legislation.

§ 3.2 Exclusion

For § 3.1(a), mental illness alone shall not be considered an incurable disease or a severe functional impairment.

§ 4 Safeguards

• a) The applicant must meet all requirements in §§ 1 and 2.
• b) The application must be in writing and dated. It may be signed by an authorised representative if the authorisation explicitly grants permission to apply for, or maintain an application for, voluntary assisted dying.
• c) The application must confirm that the applicant has been informed that the process may be stopped at any time.
• d) The application must be co-signed by both a witness and a physician, or a nurse must confirm that the application is valid and meets all requirements, including confirming that they are assured the applicant understands all provided information. These witnesses must not be heirs or related to the applicant.
• e) Immediately before voluntary assisted dying is provided, the individual must be given the opportunity to withdraw the application, and it must be ensured that they again express consent to proceed. The question shall be: “I need you to confirm that you understand that if you take or receive this medication, you will die. Are you certain that you want this?”
• f) At least 30 calendar days must pass from submission of the application before assisted dying may be received or administered.
• g) In cases where medical personnel determine that the applicant’s decision-making capacity is rapidly diminishing, the period between the first assessment and the day the applicant may receive self-determined assisted dying may be shortened.

§ 5 External Safeguards

Involuntary expressions in the form of words, sounds, or physical gestures shall not be considered demonstrations of refusal or rejection of an approved application.

All healthcare personnel shall have the right to either assist or refuse to assist a person seeking to end their life. Pharmacists are not considered healthcare personnel in this context.

The regional healthcare service must have at least one employee who can act as a representative authorised to sign in cases where a local physician has invoked a right of reservation. This person must be able to travel within the region to perform voluntary assisted dying.

An ethics committee shall, after the fact, review each case of voluntary assisted dying to ensure that both the individual and the healthcare personnel complied with all requirements for administering voluntary assisted dying.