In 2022, the Health Care Accountability Board (HSAN) informed Staffan Bergström, a doctor and professor emeritus, that they deemed him “obviously unfit to practice the medical profession” and would be revoking his medical license. This decision came as a surprise to those who were familiar with Bergström’s outstanding medical career. Bergström had been a registered doctor since 1969 and had supervised 35 doctoral students, written nearly 400 scientific works, and taught medicine as a professor in Oslo and Stockholm. He had also received various awards for his contributions to the medical field. Despite this, Bergström had been under scrutiny throughout his career, including when appointing chief medical officers and professorships.
The decision to revoke Bergström’s license came after he helped a man with severe ALS to sleep into death after being denied entry to the Dignitas organization in Switzerland due to the pandemic. Bergström attempted to provide similar care to what the man would have received at Dignitas, but the authorities deemed his actions unsuitable and reported him to the Inspectorate for Care and Care (IVO) and the Public Prosecutor’s Office. Although the case was dropped, IVO reported it to HSAN, requesting that Bergström be delegitimized.
After nearly a year of proceedings, HSAN revoked Bergström’s license, citing his actions as damaging to public trust. However, Bergström argued that his actions were guided by respect for the patient’s self-determination and integrity, and several polls have shown that the public largely supports voluntary euthanasia. Furthermore, Bergström’s actions did not cause harm to the patient or their relatives.
Bergström plans to appeal the decision, and it is hoped that the Administrative Court will take a less prejudiced approach to the case. It is essential to remain vigilant and protest when authorities begin to speak new languages, and the Medical Association should strongly react when doctors are bullied by the authorities.
In the fall of 2022, Staffan Bergström, doctor and professor emeritus, was told by the Health Care Accountability Board (HSAN) that he was “obviously unfit to practice the medical profession” and would therefore be stripped of his medical license.
Those who know Bergström’s extraordinary medical work were very surprised. When did his unsuitability begin to show? He has been a registered doctor since 1969 and has had a strong research career, supervising 35 doctoral students for their dissertation. In addition, he is the author and co-author of nearly 400 scientific works and has for many years taught U-country medicine and International Health in Oslo and Stockholm (KI) as a professor.
Is Bergström one Rotten eggs in the medical profession, which all these years went under the radar? Hardly. On countless occasions he has been subjected to scrutiny, not least when appointing chief medical officers and professorships. During five years of operation in Mozambique, he succeeded in significantly lowering maternal and child mortality at the largest maternity clinic there. In 2009, he received the Distinguished Service Award, which the Karolinska Institute describes as “the world’s most prestigious award for gynaecologists”.
The fact that Bergström attracted the authorities’ interest as a pensioner has its background in the fact that in 2020 he helped a man with severe ALS to sleep into death, after he was denied entry to the Dignitas organization in Switzerland, where he would otherwise have received that help, due to the pandemic. Bergström tried to follow in the patient’s home environment the approach that would have been applied at Dignitas, as the patient refused any form of hospital or hospice care. The case received a lot of attention in the daily press, not least in Dagens Nyheter, which did a report in connection with the man’s death (15/7 2020).
Bergström reported himself to the police, after which the Inspectorate for Care and Care (IVO) also initiated a case and reported the incident to the Public Prosecutor’s Office. The case was dropped, as suicide and aiding and abetting suicide are not criminal acts.
The inspection for vård och sorgh (IVO), however, reported the case to HSAN with the request that Bergström should be delegitimized, as he did not act according to science and proven experience and proved “obviously unsuitable” to practice the medical profession. His clinical and research merits are not mentioned in the report, however, that he is an “experienced euthanasia debater”.
After nearly a year of proceedings, the result is this: Bergström loses his medical license. When HSAN reports its decision, it dutifully mentions the many points of view found in Bergström’s answer and opinions from various experts after IVO’s notification, but without discussing their impact on the decision at all. Among other things, they concern the objection that the concept of science and proven experience must be seen in an international and global perspective.
Several European countries and about 10 states in the USA apply physician-assisted dying in a similar way to what Bergström used. Furthermore, the European Convention on Human Rights is highlighted. In several rulings, the European Court has interpreted the convention so that an individual has the right to decide for himself when he wants to end his life and also has the right to have access to the means to do this.
The European Convention has legal status in Sweden. Judging from IVO’s notification and Bergström’s response, different legal principles seem to exist depending on the degree to which one has a strictly Swedish administrative perspective or a more international perspective. One would expect this to be discussed in HSAN’s deliberations.
It is not done at all. Since a sanction must nevertheless be justified and it cannot be demonstrated that the patient or relatives have suffered any harm, HSAN’s decision is justified by the fact that Bergström’s actions are considered to damage public trust. Bergström responded to the claim that the public’s trust would be damaged already after IVO’s report.
According to the Health Care Act, the public’s trust in a registered doctor is “based on the doctor’s respect for the patient’s self-determination and integrity”. Bergström’s actions were guided by such respect. As for the public’s attitudes towards voluntary euthanasia, these are largely positive according to several large opinion polls, which is why it is unlikely that trust would be damaged for that reason.
While IVO at least referenced the section of the Patient Safety Act, which prescribes that care should be given as far as possible in consultation with the patient, this reference has been omitted by HSAN. Without showing how, it is thus sweepingly claimed that the action led to damage to the public’s trust. The responsibility committee does not at all discuss the many objections that Bergström presented after IVO’s notification, but only repeats what IVO claimed. It is written with authoritative arrogance that Bergström’s ID card is to be revoked “regardless of the motivations he had and what he otherwise stated”.
That Bergström “is clearly unfit” to practice the medical profession is an unreasonable claim. The suspicion then becomes that it is rather his views as an “experienced euthanasia debater” that are considered reprehensible.
When authorities begins to speak new languages, we should be vigilant and protest. Above all, the Medical Association should react strongly when a doctor is subjected to bullying by the authorities.
The case will shortly be brought up to date in an appeals process. Let’s hope that the Administrative Court shows a less prejudiced attitude. It deserves an all-round illumination, where the words have not lost their meaning.
Chief physician in psychiatry, active within the Academy for Trauma and Culture, former head of research and development units within Stockholm County Council, and researcher at Karolinska Institutet.
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