(cont. from § 4) Priorities within health and medical care (cont. SoU17)

Karin Rågsjö (V)

Mr. Speaker! Member Hultberg brought up Malmö, or rather the Skåne region, and the personnel costs within healthcare in Skåne. They are to be reduced by 1 billion, I must say. It will involve some layoffs in different ways, I believe. I just want to say that. There, the Tidö parties rule more or less.

I also have a question regarding a study on inequality that passed by briefly yesterday. Class-based inequality is something we talk about sometimes. It is researchers at Högskolan i Jönköping and Stockholm University who have looked at this regarding life expectancy. It has been measured during the period 1962–2021. The difference in life expectancy between men with the lowest and highest income has increased from 3.5 years in the 60s to almost 11 years now. That is quite remarkable. For women, it has increased from 3.8 to 8.6 years.

During this period, a number of governments have been in power – not to mention that. But this should, I think, still have been included in the considerations before the budget that the Tidö parties presented. What I lack in your announcements, in your budget and so on, is a thought about class-based inequality in health. Is this something the member has considered?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Johan Hultberg (M)

Mr. Speaker! Let us begin in Skåne. I think it is important to try to clear up some of the truly false claims that have come from leading representatives of the opposition, actually even from the opposition leader Magdalena Andersson, who claims to be the Prime Minister of Sweden. She has lied on live national television about the situation in Skåne and claimed that 1,000 people would be laid off. The fact is that the number of healthcare workers in Skåne has increased.

What has been achieved in Skåne includes, among other things, that the dependency on leasing has been broken. Care has been taken to ensure that more people are employed directly by Region Skåne, which has contributed to a strengthened continuity. I and member Rågsjö have many times discussed the value of having a fixed point of contact in healthcare and meeting the same staff at the health center or as a chronic patient in specialized healthcare. I think Skåne deserves praise for having succeeded well with that transition.

When it comes to the question of inequality, it is not entirely simple for me to comment on it. I have not received the investigation that Member Rågsjö refers to, Mr. Speaker. I can, however, comment on the issue in a somewhat general sense.

Mr. Speaker! Where is the greatest difference in income between people? It is between those who work and those who do not work. That is why it is so incredibly important for us Moderates that we now re-establish the work principle and make it more profitable to work.

We are lowering thresholds in the labor market and strengthening educational initiatives that enable people to become employable. We are also making reforms to create a better business climate in Sweden in various ways, both small and large.

Yesterday, I and MP Rågsjö discussed a small but still important reform to create a better business climate, namely the introduction of farm sales. On this, the Moderaterna are in favor and Vänsterpartiet is against. It is yet another example of the difference in politics between right and left in Swedish politics.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Mr. Speaker! Where the alcohol goes in, the senses flow out.

Back to Skåne. There was a small break in the debate here before. Then I went and checked once more if 1 billion is to be removed. It is then not about locum doctors but that cuts will be made.

Cuts will be made in Helsingborg. Cuts will be made in Lund. Cuts will be made in Malmö and everywhere in Skåne. It is not fine clouds and constant sunshine down there. It is a serious crisis in Region Skåne. That is my opinion.

I will not fight any more for Skåne. But I still think it is remarkable. If you remove 1 billion from the budget in a region, it does not mean that it is only temporary staff, it means that you will be making cuts.

I was in Helsingborg myself a few months ago. It is obvious that there is a major crisis in Skåne. There is no doubt about that.

Now to something completely different, which I hardly have time to get to. We often talk about the cost of administration. One issue that will increase the administration enormously is welfare crime.

Good God! Every region will have to employ more and more people to keep track of the welfare crimes. The welfare crimes can primarily occur thanks to the revolving doors that specifically the right wing has opened when it comes to the freedom of establishment.

I wonder, Member Hultberg: Have you considered all the specific measures that must be taken precisely because of the welfare crimes and what that will mean for the regions in increased costs in administration?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Johan Hultberg (M)

Mr. Speaker! We should probably have the debate on regional healthcare in the respective regional councils.

Again: The number of healthcare workers in Skåne has increased. From 2021 to 2023, the number of healthcare workers increased by a full 6.1 percent. It is a quite substantial increase.

That is not to say that there are no challenges and problems in Skåne's healthcare. The queues in Skåne are too long. The economy is absolutely strained. Therefore, it is good that positions are left vacant if someone leaves the region for natural reasons and that one evaluates whether each position should be refilled or not.

What I am more concerned about is the incredibly rapid deterioration in healthcare that we see in Region Stockholm, in the region of member Karin Rågsjö where Vänsterpartiet is included. There we now see dramatic deteriorations of both accessibility and the economy. Taxes are becoming higher, buses fewer, care beds fewer, and care queues longer. That is the result that the red-green government in Region Stockholm has after two years.

Mr. Speaker! We need to cut the administration. It is one of the most important issues for creating more time for the healthcare staff to devote to patients and thus be able to achieve what I spoke about in my speech, namely more care for the money.

There, I believe it is important with the digital infrastructure to ensure that healthcare workers do not need to register the same information in journal systems and national registers without being able to do it in one place.

When it comes to welfare crime, it is a huge problem that the government is taking very seriously. We are taking a long series of different initiatives to address it.

Mr. Speaker! Let me finally, before time runs out, point out the fact that welfare crime exists everywhere. It exists in municipal administrations, in regions and in private companies. We shall fight the ugly face wherever it appears. But it is everywhere in welfare.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Christian Carlsson (KD)

Mr. Speaker! The Christian Democrats' primary priority regarding health and medical care is that those who are ill should be able to receive care in a timely manner and that people should be able to receive the best care regardless of where in the country they come from. We want to abolish the regions' responsibility and let the state take over the full responsibility for Swedish healthcare so that we can offer people equal care.

Today's motion report concerns many different types of proposals, but several of the motions point out exactly the inequality within healthcare. More is requested of national guidelines and more of state governance. It concerns everything from demands for a national strategy for diabetes care to the Christian Democrats' demands for equal rules for the number of IVF attempts in cases of involuntary infertility and national plans for maternity care. I welcome this, of course. Sweden needs increased state governance of healthcare.

For me as a Christian Democrat, it is also evident that national guidelines are not always sufficient, and that the state actually needs to be given the full mandate to be able to step in and ensure that we have equal healthcare for people in Sweden.

Take cancer care as an example. Socialstyrelsen already has a mandate today to produce recommendations on national screening programs, and we have regional cancer centers. But at the same time, it is up to the 21 self-governing regions to decide if and when a screening program should be started.

It has led to the unreasonable and unjust fact that there is a difference of more than ten years when it concerns, for example, the introduction of screening programs against colorectal cancer. It is more than a decade between the first region that introduced this program fully developed in 2014, Region Stockholm, and Västra Götalandsregionen, which is the last region to fully implement the program.

This is an unacceptable inequality. It severely affects seriously ill people who are in need of early detection in order to be cured of their disease.

When it comes to lung cancer, the waiting time between referral and drug treatment was 23 days in Uppsala in January this year. In Gävleborg and Västmanland, the waiting time was more than twice as long. There are still many regions that have even longer waiting times.

To take a third example, the report mentions the screening for cervical cancer. In December last year, Dagens Nyheter was able to reveal that the regions, contrary to the national guidelines, had opted out of HPV testing for 155,000 women who should have been tested before they were removed from the national screening program for cervical cancer.

Of these women, 117 were diagnosed with cervical cancer in the years 2021–2023. In 76 percent of the cases, the cancer was detected at such a late stage that it had already spread and become difficult or impossible to cure. It would not have had to happen if the regions had followed the national guidelines.

In the case of cervical cancer detected through screening, the proportion of cancer at a late stage is only 3 percent. In Sweden, women have therefore become seriously ill with cancer completely unnecessarily because individual regions have chosen to opt out of them.

That there are 21 self-governing regions leads to unequal care, and the inequality can literally be the difference between life and death.

We Christian Democrats will therefore continue to work to let the state take responsibility for Swedish healthcare. We do this within the framework of the ongoing Healthcare Responsibility Committee and within the framework of our government cooperation.

Mr. Speaker! The Christian Democrats largely support the committee's report, but I would, in addition, like to move for approval of reservation 12, which concerns the issue of the new gender identity law.

In the spring of 2024, the Riksdag decided on a new gender identity law, which is to enter into force on July 1, 2025. Only two parties reserved themselves: Kristdemokraterna and Sverigedemokraterna.

We Christian Democrats still believe that the new legislation risks having serious consequences for the children and young people affected. We are still opposed to the introduction.

We say, first of all, no to lowering the age limit for legal gender reassignment to 16 years so that the possibility in the future will also include children upon the parents' application. We know that more and more children in Sweden have sought care in recent years due to gender dysphoria. The number of cases of gender dysphoria really skyrocketed during the 2010s, and we do not fully know what this is due to.

We know, however, that professors and specialist physicians in psychiatry have warned us that the possibility of more easily changing legal gender at a young age could lead to the gender dysphoria being exacerbated and that this therefore becomes a first step towards hormone treatments and gender reassignment at a later stage. These are treatments with irreversible biological consequences, which perhaps would not have been needed because there are studies showing that gender dysphoria can subside or disappear after puberty. In this case, we therefore mean that it is necessary to exercise caution.

Mr. Speaker! We Christian Democrats turn for the second time to the principled view that legal gender reassignment is something that one should be able to do freely even though there is no underlying diagnosis of gender dysphoria. Sweden should not have legislation that implies that gender identity is reduced to something arbitrary.

The Christian Democrats' starting point is that legal gender shall correspond with biological gender. It shall, of course, continue to be possible to change legal gender, but only after a medical investigation where one has been diagnosed with gender dysphoria and after approval from Socialstyrelsen. For that reason, we say no to the simplified review for a legal gender change proposed in the new gender identity law.

The problem with the simplified assessment is that when the doctors' ability to set requirements for a diagnosis of gender dysphoria before a legal gender reassignment disappears, and when the doctors' ability to attach weight to how long a person has had this self-perception also disappears, the healthcare staff's ability to conduct a proper medical investigation is also affected.

If the healthcare staff is bound in that way, there is a risk that other explanations for the person's self-perception and well-being are missed and that the children and adolescents do not receive the support they need. We know that mental ill-health, for example anxiety and autism, is more common among people who suffer from gender dysphoria. It is common among people with autism to not be able to fully relate to their body, especially during adolescence.

To confirm children and young people in their perceived gender identity through a legal gender change at a young age, without proper investigation, is therefore not responsible.

Mental illness among trans people is widespread, and many today have to wait far too long before they receive the support they need. The Christian Democrats want to improve care and shorten waiting times for support for people suffering from gender dysphoria so that more receive care in time.

The government is now working intensively to shorten waiting times for healthcare, including child and adolescent psychiatry. Recently, an intensified initiative on psychiatry for 2025 was presented. All of these are initiatives that we Christian Democrats have pushed for.

The new gender identity law should, however, be torn up. The Christian Democrats will therefore join forces with the Sweden Democrats, and we will vote to repeal the new gender identity law before it enters into force.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Mr. Speaker! I will not speak about gender identity. I will not speak about trans care. We did that a year ago in here in what felt like a day. And you lost.

Mr. Speaker! I have a few other questions concerning healthcare. Everything sounds so rosy when you on the right side talk about Swedish healthcare, but that is not really the case. Now there is a lot of talk about defense and preparedness, and at the same time, we can see that intensive care beds have decreased by 5 percent after the pandemic. It is that bad, and one can wonder about that.

Mr. Speaker! In order for someone, for example, to have the opportunity for a mammogram if they feel their breasts and become worried, a decent primary care is required. Various investigations have been conducted, including one from Vårdanalys, which states that after the investments that we have made for several years on transition – a good and close care, as it is called – new measures are now required. One can indeed see that very little has happened. When it comes to the number of patients per doctor, for example, we simply have not achieved the goals. It is also about the accessibility altogether, about participation and about continuity. Almost everything has regressed.

That is why one becomes a bit worried. If we have no primary care that works out in the country, it will become very difficult to get momentum in the other part of the care. Then it will be difficult as a patient to get help and, for example, get a referral to a specialist.

I wonder if the government has any incredibly good ideas regarding primary care, because it takes quite a lot to restructure it.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Christian Carlsson (KD)

Mr. Speaker! Everything concerning Swedish healthcare is certainly not rosy, and the inequality is great and the healthcare queues are far too long. But perhaps in that case it is precisely the healthcare queues that are rosy. Let me remind you of the situation we were in when we took over power in Sweden. After eight years of Social Democratic rule in Sweden, the healthcare queues had doubled, and for child and adolescent psychiatry, they had tripled. And the queues were record-long even before the pandemic.

But the fact is that the healthcare queues have become entrenched, and the government is doing a lot to shorten them. We are injecting special funds to shorten the healthcare queues and increase healthcare capacity.

An important part is also to strengthen primary care. It is incredibly frustrating to see that nothing has come of the funds that the state has provided, over 16 billion over a period of four years, for the regions to increase budgeting for primary care and strengthen it. The regions have thus not kept what they promised. They have not provided more money to primary care.

This means 16 billion in the sink of the state's money. It points out how dysfunctional the Swedish healthcare organization is and how inefficient it is.

We would have liked to see the state take a greater responsibility and take full responsibility. We can state that it would have facilitated the transition because the state has been prepared to budget more for primary care, which the regions have not been.

Our ambition is that one should have a fixed doctor contact. That is what truly ensures that one gets continuity in care, which leads to good quality and security for the patients.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Mr. Speaker! When KD speaks, it always sounds as if one were at a promotion meeting, a marketing meeting, about state healthcare. It is interesting.

You have fantastic opportunities to do something and not just shift the responsibility onto the regions, as you do in every debate. When one listens to you, one hears that your own responsibility is far away, while the regions' responsibility is total when it comes to primary care and so on.

If one reads Vårdanalys' various reports, which I recommend, one can see that it is about the state not having provided the prerequisites. It is the long-term prerequisites that are missing when it comes to building up primary care. This is what I lack, and it is also what the patients lack. One cannot constantly say that the regions have not done what they are supposed to do. Good heavens! One has lived under an extreme economic crisis in recent years, both in 2023 and 2024.

It sounds like there were fantastic investments in healthcare, but I cannot really see them. If there had been such fantastic investments in healthcare, everything would be running like clockwork – now the train is no longer running either, but at least it would be moving forward.

How can it be that KD and the other parties constantly pass all responsibility over to the regions, even though the state has the possibility to work long-term, for example with resources? That question, I think, is interesting, Mr. Speaker.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Christian Carlsson (KD)

Mr. Speaker! The state takes its responsibility. We are happy to take an even greater responsibility in order to, among other things, strengthen primary care. The Christian Democrats would like the state to take full funding responsibility for healthcare. We would also like to have full responsibility for the supply of competence. These are two problems that Karin Rågsjö also raises. If we are to be able to achieve good primary care, we need to handle this. Until we have the full mandate to do this, we must take it as it comes.

What do we do then? Yes, 16 billion to the regions to strengthen primary care is an attempt on our part to get them to do it. But we have no mandate to actually direct them to do it. We are going to settle with SKR in agreements, but what will the state do when SKR does not keep its word and no money is released? Here we have a problem: The state's governance does not reach all the way through.

Regarding the staffing, we know that there are too few general practitioners to staff our health centers. It was only this government that ensured we received a national plan for competence supply so that we get a collective grip on what competence needs we have and what should actually be done to meet them.

So this is what we do. But at the same time, it is a problem that not all regions see it as their core task to provide a sufficient number of training places. If one does not prioritize it and also does not know what the needs look like, and if the state cannot point with a firm hand and tell the regions that they have a certain training need and must take their responsibility, yes, then we get the problems within Swedish healthcare that we see.

The State is prepared to take responsibility. We are happy to take a greater responsibility. But the Christian Democrats' conclusion is that we then also need to receive the full mandate.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Westerlund (MP)

Mr. Speaker! I actually agree with Karin Rågsjö that this is finished being discussed, but now that the Kristdemokraterna want to bring it up again, I must nevertheless respond.

I want to begin with a brief piece of history. In 1972 – the same year I was born, so quite a long time ago – Sweden introduced the world's first gender identity law. At that time, we made this break between biological sex and legal gender.

In the reservation, it is now expressed that KD's and SD's position is that one actually thinks that the two things should correspond. Then I become curious about what is meant. Do we want to back out to the situation that was before 1972?

The next year I want to bring up is 2013. That was when Sweden finally abolished the forced sterilizations of persons who change their legal gender. The Christian Democrats were to the highest degree instrumental in making that process very protracted. Because of the Christian Democrats, we today have more people in Sweden who are forcibly sterilized than we otherwise would have had. There, one can talk about an irreversible procedure that people regret.

This was due, among other things, to the fact that there was a very strict set of regulations regarding what type of care one had to undergo in order to change legal gender. Consequently, people have been forced into procedures that they perhaps did not actually feel any need for.

A major victory with the reforms that have been implemented since then is that we have separated the legal and the biological, and that it has become possible to change legal gender without performing any interventions that the person is not in need of – which doctors do not judge that the person needs and which the person themselves does not desire. In that case, there is less risk of regretting something than if there is a mandatory legislation or a mandatory practice that forces more interventions on a body that is not in need of those interventions.

It is this that we must take with us when we discuss the issue here today again.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Christian Carlsson (KD)

Mr. Speaker! I thank Ulrika Westerlund for the questions.

The Christian Democrats argue that the starting point must naturally be that legal gender corresponds with biological sex. If it is not to do so, there must also be some basis for it. That is what we mean: We do not think that one should simply be allowed to choose. If one has gender dysphoria, one should be allowed to change legal gender, but it is precisely that one is abolishing the diagnosis requirement of gender dysphoria in order to carry out a legal gender change that we have objections to.

We believe that one should be able to change legal gender even as an adult. The requirement is then also that one must be of legal age. One must be an adult person to be able to do this. We oppose the lowered age limit which means that even children are included in the possibility to change legal gender. That was also why we chose to say no to the new legislation.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Westerlund (MP)

Mr. Speaker! I thank you very much for the answer.

The very basis for and the reason why the gender identity law exists is not the view on diagnoses and which conditions can exist without us considering that gender identity exists. There are quite a few countries in the world that do not think so but think that you are born with a certain biological sex – end of discussion; you get a legal gender that matches. In our part of the world, however, it is quite common that one recognizes that there is something called gender identity. That is the entire reason why there is a gender identity law, not the discussion about which medical diagnoses should exist and how care should then be provided. It is precisely this, that one respects gender identity, which is the very reason for the law's existence. This must also be kept in mind when one expresses oneself as Christian Carlsson just did.

All our Nordic neighboring countries have also introduced gender identity laws with self-determination. We have not done so. What was introduced here in Sweden was a compromise – as everyone here remembers, I believe. Different parties, for example my own, which wanted self-determination, agreed to the compromise in order to move forward and get something that was still better than what existed before.

It is not only the Nordic countries that think it can be done in this way, but so do heavy actors within the human rights field. As an example, it can be mentioned that both the Council of Europe's Commissioner for Human Rights and the UN High Commissioner for Human Rights believe that it is self-determination that should form the basis for changing legal gender.

So, this is not about healthcare. It is perhaps also worth repeating that those in the healthcare staff who decide who should receive which type of healthcare intervention are not guided by what legal gender the person has or what has been changed in the Swedish Tax Agency's registers. They make an assessment: Do we believe that a healthcare intervention will make this person feel better? It is, therefore, up to the doctors.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Christian Carlsson (KD)

Mr. Speaker! Yes, there is biological sex, and there is gender identity. We naturally agree to that. That is why we have a gender identity law in the first place. There is nothing strange about that.

The problem is just that when the requirement for a gender dysphoria diagnosis to change legal gender is abolished, it becomes very much more difficult for doctors to make an assessment and a proper medical investigation. With the new proposal, doctors are also not allowed to attach any weight to how long someone has experienced belonging to the wrong gender. Nevertheless, the healthcare staff are expected to write a certificate stating that one should be allowed to change legal gender.

It would have been very interesting to know what the healthcare workers themselves think about it. The Christian Democrats and the Sweden Democrats also wanted the proposal to be sent for consultation so that we could find out how they assessed it affected the possibilities of making a medical assessment and investigation, but unfortunately, we did not get that opportunity. It would have been very good. The limitations on how the healthcare staff should make their assessments were not included in the proposal that was sent out for consultation from the beginning.

We do not think it is a well-considered proposal. We note that the specialists in child and adolescent psychiatry warn that the lowered age limit for legal gender reassignment could mean that gender dysphoria is reinforced and that, at a later stage, one is led into hormone treatments and physical interventions that would not have been necessary. Therefore, the law should be repealed before it enters into force.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Lina Nordquist (L)

Mr. Speaker! There are many good things proposed in today's report. A good deal is such that has already been started. Much has been done by this government, and some things have been done by previous governments. The National Board of Health and Welfare, for example, has received two assignments from the government to pay out funds for safer screening of blood donors, just as the proposers want. There are currently ongoing initiatives for safer, better, and more knowledge-based care when it comes to diseases that most often affect women. It can be menopausal issues, endometriosis, aftercare after difficult births, and so on. The government has also invested heavily in competence when it comes to the care of people who have been subjected to violence, specifically honor-related violence.

There are many areas that are important but which are not really the Riksdag's task to make decisions on. What strikes me when I read the motions in the report is that much is laudable, but every line is about investments. Everything is to be added but nothing is to be deducted. I do not really know how this is to be resolved in the long run.

Two things become clear to me. The first is that we must introduce a right to continuing education for all healthcare employees. All these requests always land on the fact that more competence, more knowledge is required in the encounter with patients with different diagnoses. The right to continuing education is the only way to solve this problem in a safe way without focusing on individual diagnoses and risking forgetting others.

The second thing is that we forget certain diagnoses but remember others. It is completely obvious that Swedish healthcare needs an in-depth and responsible investigation regarding the prioritization platform. It is nearly 30 years since the Riksdag stood behind today's guidelines – and they are good. They are based on three fundamental principles. We Liberals fully support that care should be prioritized – in order – according to the human dignity principle, the need and solidarity principle, and the cost-effectiveness principle.

But we see many ambiguities in how these principles are applied. How sure can we be that the principles are followed? We think, for example, that the cost-effectiveness principle is relevant when it concerns the organization of care or when it concerns the choice between different treatment methods for the same patient group, but we do not think that principle is relevant when it concerns pitting patient groups against each other. That must not happen. We are not convinced that it is not the case today.

Furthermore, we believe that it is currently unclear how preventive care should be prioritized. Preventive work is clearly included in the priority groups, but we do not perceive that this is always how care is de facto financed and performed. An in-depth prioritization study is needed, that is to say, an in-depth discussion on which care needs to be prioritized higher and which interventions should not be prioritized as highly or which sometimes, somewhat corresponding to nearsightedness operations and certain hernia repairs, need to be performed by healthcare-skilled employees but which we perhaps should not use the healthcare's common resources for. All of this is absolutely necessary, but equally necessary is that we do not dither over individual matters here in this chamber.

I am proud that the government and many agencies, with the mandates they have received from the government, are making significant efforts today. I am grateful that the healthcare professionals are making the truly significant efforts. I personally promise to do everything I can so that continuing education and well-considered priorities become a reality in healthcare moving forward.

I vote in favor of the committee's proposal.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Sundin (S)

Mr. Speaker! We are talking about priorities within health and medical care. This report is based on previous parliamentary decisions regarding which guidelines shall apply for priorities within health and medical care. The starting point is important fundamental principles that all people are equally worthy and have the same right to health and medical care, regardless of personal characteristics and functions in society. Resources shall be distributed according to need, and there should be a reasonable relationship between costs and effect measured in improved health and increased quality of life.

This is a good starting point for debating these issues. It concerns 140 proposals – what we call motions – from the general motion period. There is a great breadth of issues; we have already heard that in the chamber today. But before I go into the issues and what the Social Democrats have chosen to particularly highlight this year, I want to pause for a moment at the overarching principles of how one should prioritize within healthcare. Previously decided principles are one thing, and it is another thing to live up to them. I intended to give three examples of how difficult that can be.

My first example is that a functioning healthcare system is one of the political issues that citizens consider most important. It is with all right. A functioning healthcare system is vital in the true sense of the word. We know that there are great concerns in healthcare today. Primary care does not have the right conditions to fulfill its mission to be the hub for the patient. The queues are long in many areas, and when there is a lack of care beds, the priorities sometimes become so harsh that they come at the expense of the patients.

But when the Tidö government judged that there was a large reform space, 60 billion kronor, in the budget for 2025, they chose to prioritize lowering taxes for those who earn the most over providing more resources to health and medical care. Instead, they reduced the state grants for municipalities and regions. That does not make it easier when one has to prioritize within health and medical care.

My second example of how difficult it can be to prioritize is when the government says that one should take action to reduce waiting times in healthcare. This is done with a one-time investment of 497 million kronor in performance-based funds to shorten the healthcare queues. It is good that the government is investing the money because every single krona is needed in Swedish healthcare. But one limits the investment to three clearly defined areas, in the sense of not "duttaing" [spreading resources too thin], namely operations of hip replacements, fractures, and cataracts.

It is undoubtedly true that it is important for healthcare to function in these areas. Many patients suffer and experience great discomfort. Some are in a lot of pain, and it can understandably be both frustrating and difficult to live while waiting for surgery. But is it within these areas that the needs are greatest within Swedish healthcare today? Is it really the right prioritization that the country's regions should compete to perform as many operations as possible in just these three areas? Are there not other, perhaps even life-threatening conditions, that should be prioritized higher than, for example, cataracts?

Furthermore, it looks very different across the country. Wouldn't it be wiser if the regions were allowed to decide which queues are too long for them specifically?

My third example of how difficult it is to prioritize is pharmaceutical treatment, which is a central part of healthcare.

With new medicines, miracles are happening in healthcare today, but the costs are increasing. The government chooses to pass on a large part of the cost increase for medicines to the sick themselves by shock-raising the co-payment in the high-cost protection by 34 percent, from 2,900 kronor to 3,800 kronor. This is an increase that, by definition, affects sick people. All over the country, patient organizations and pensioner organizations, doctors and pharmacists are now warning that it will lead to many not being able to afford to pick up their medicines.

In my opinion, this is a completely crazy prioritization. It is unreasonable, unfair, and unworthy. I and the Social Democrats believe that health and medical care should be prioritized much higher than the government does, and in our proposal for the state budget for this year, we included 10 billion more than the government for welfare, healthcare, and dental care.

Mr. Speaker! In the report that is on the table today, I would like to specifically highlight three areas.

The first is menopause care. A large proportion of all women, 70 percent, are affected during a period in life by menopausal symptoms that affect their quality of life in different ways. But many do not know what help they can get or where they can get it.

The previous, Social Democratic-led government tasked Socialstyrelsen with describing what measures are being taken in care to meet the difficulties, and that investigation showed a great need for improved information and guidance. It also showed large regional variations regarding advice, support, and treatment.

Socialstyrelsen proposed that a national knowledge support regarding advice, support, and treatment for menopausal symptoms should be developed. It is a proposal that we have advocated for, and we note with great satisfaction that Socialstyrelsen is now working on national guidelines for care for menopausal symptoms which are to be presented this autumn.

The second area I want to highlight is the work to eradicate cervical cancer. In Sweden, approximately 500 women are affected by this every year, and approximately 150 women die. That is 150 women too many.

We can protect ourselves through vaccination against the HPV virus, but that depends on as many people as possible getting vaccinated. That work is ongoing, both by offering the vaccine to all schoolchildren – both girls and boys – and through a special vaccination effort for all women born between 1994 and 1999. That initiative has been extended, which is good.

However, it is not enough. If we are to succeed in eradicating cervical cancer, as many adult women as possible must also participate in the cervical cancer screening. There are groups that have a significantly lower participation than others, for example, women who suffer from mental illness or substance abuse. Therefore, we Social Democrats want to see a special coordinated information effort to reach the women who do not participate in the screening today.

The third and final area I want to highlight is blood donation. Access to blood is crucial in, among other things, cancer care and for various blood diseases, surgeries, childbirths, and serious accidents. Blood is a constant shortage, and Sweden needs every single person who can and wants to give blood.

Today, however, we have an outdated view on who can donate blood, which means different rules depending on people's sexual orientation. Men who have sex with men are not allowed to donate blood today if they have had sex within the last six months, regardless of whether they have had sex within the framework of a long-term, monogamous relationship or not. Today we know enough about the spread of infections to know that it is completely unreasonable to view an entire population group as potential carriers of infection in that way. An individual-based risk assessment needs to be made.

As we have heard here today, it is also in progress; the Public Health Agency has mapped out how it has been done in other countries and notes that there has been no clear increase in transfusion-transmitted infections in countries that have switched to an individual-based risk assessment. It is time that Sweden treats all people equally also when it comes to blood donation. Of course, homosexuals who do not risk spreading any infection should be able to give blood like others.

Mr. Speaker! With this said about the Social Democrats' priorities within healthcare, I would like to move for approval of reservation 5.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Johan Hultberg (M)

Mr. Speaker! In my speech, I went a little bit on the attack against the Social Democrats for the fact that Magdalena Andersson, party chairperson for the Social Democrats, lies about the Swedish healthcare. On a similar theme, Karin Sundin spoke about the issues regarding pharmaceuticals in her speech and criticized the Moderate-led government in harsh words for the change of the high-cost protection.

I am the first to agree that it is a change that will naturally affect many people. It is absolutely a tough change. But I also want to remind that the Social Democrats, in their budget, do not add a single penny more to the pharmaceutical benefit than the government does in its budget. The criticism that the Social Democrats direct at the government, I think, therefore clashes very poorly with reality and what one prioritizes in their budget, Mr. Speaker.

Since, it is good that Member Sundin highlights women's health. I also did so in my speech, and I think it is fantastically good that so much is now happening in that area. It is happening thanks to the Moderate-led government and thanks to the fact that it is a specific point in the Tidö Agreement.

It is also happening because Moderates across Sweden are driving these issues locally. In Västra Götaland, where I come from, a party colleague of mine in Partille – Marith Hesse – has taken the lead and shown how, as an employer, by offering training to managers and employees, one can provide women who are in menopause with better care and better support and in that way actually lower the sickness absence rates and the costs. It is a good example of something that can be done locally and which reinforces the important work that the Moderate-led government is doing nationally.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Sundin (S)

Mr. Speaker! I do not know if I perceived that I received any question, but I note that Member Hultberg is correct regarding the budgeting for pharmaceutical costs.

The savings that the government is making correspond to half a billion in a budget that covers 40 billion for pharmaceuticals. In the Social Democrats' budget, a corresponding saving is included, but one can make a saving in different ways. We believe that there are conditions to make significantly smarter procurements. There is significantly more to be done regarding cooperation within the European Union to press down the costs for pharmaceuticals.

What the government chooses to do is to place the entire saving on those who are ill. And people who need medicines – who are dependent on medicines – are generally seen as people who have worse economic conditions than others. It is connected to being on sick leave or living on sickness or activity compensation. If you live on sickness or activity compensation in Sweden today, you are also taxed higher than those who have wage employment. Those who have the lowest incomes today have the highest tax and now receive a radically much higher cost for their medicines.

It is a precision hunt on sick people that is taking place in this country, and so we in the Social Democrats would not have chosen to prioritize if we had had the opportunity to prioritize in the country's budget.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Johan Hultberg (M)

Mr. Speaker! If one reads the Social Democrats' budget, one sees that there is not a single penny more for the medicine benefit.

I agree with Member Sundin that in the long term there are other measures that we can also take to push down pharmaceutical costs. But making better procurements and working at the EU level are long-term changes. There are no sharp proposals from the Social Democrats on how we should reduce the state's costs for pharmaceuticals here and now – or rather, Mr. Speaker, halt the cost development. For this is fundamentally not about a saving. It is about the fact that the state's share and the state's costs for pharmaceuticals have increased dramatically in recent years.

This, Mr. Speaker, is fundamentally an expression of a fantastically positive development. We have a medical development here in the country and globally that is fantastic. New medicines and new treatments are being developed, but this also drives up costs. The state has borne those costs to a very large extent. The costs for individual patients have not developed at all to the same extent as the costs for the state. This development is completely unsustainable. The Social Democrats also state this in their budget proposal because they are settling on exactly the same level as the government.

My criticism and my question to Member Sundin was: How are you, truly, going to finance this when the fact is that on the one hand you do not lay down another penny, but on the other hand, with conviction, you say no to the change we are making to the high-cost protection? We believe that it is important that we have a sustainable system that allows us to offer new medicines even tomorrow. We see the development with costs that will increase radically. If, for example, the new effective medicines against overweight, obesity, get changed indications for prescription, the medicine costs can, solely because of this, simply double.

We need to have a responsible policy, but the Social Democrats are actually acting purely populistically here, when one says things that one does not have coverage for in the budget.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Sundin (S)

Mr. Speaker! It must be acknowledged that the Social Democratic parliamentary office does not have the same investigative resources as the officials at the Ministry of Finance, who prepare the basis for the state budget. But in a budget for pharmaceuticals that amounts to 40 billion, there are other conditions for making savings than to place the entire cost directly on the patients. The government is unable in any way to explain how they will work long-term to reduce these costs, but instead chooses to place the entire cost directly on those who need pharmaceuticals. It is not reasonable, and perhaps this is what distinguishes the current government from the previous one.

One needs to manage to attack the issues from both a short-term and a long-term perspective. I mean that what this government does when it places the entire responsibility on the patients is to think long-term, and that is to conduct a witch hunt on a vulnerable group.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Carita Boulwén (SD)

Mr. Speaker! Thank you, Karin Sundin, for your speech!

The Social Democrats usually take every opportunity to blame the healthcare crisis, as they call it, on the current government and not least on the Sweden Democrats. If one looks back historically, one sees that the Social Democrats previously held power for eight years. During that time, the healthcare bed crisis increased – 160,000 patients were waiting for care when the Social Democrats left government power in 2022, despite promises of shorter queues. Despite high taxes, healthcare has been underfunded. The number of administrators in healthcare increased by 36 percent between 2010 and 2020.

Under the previous government, the dependence on expensive hired personnel increased exponentially. Between 2014 and 2022, the costs for hired locum doctors and nurses more than doubled. This led to impaired continuity, pressured work environments for permanent staff, and billion-kronor costs – money that could have gone to permanent staff.

The Social Democrats did not present any action program. Instead, they kicked the problems down the road. The healthcare queues doubled, and the queues for BUP tripled.

I wonder now: What do the Social Democrats intend to do differently if they come to power again? What new proposals do you have? It obviously does not help with the proposals that you have praised and that you have claimed to have implemented yourselves. Where is the shortcoming? Have you examined yourselves to see what you can do differently?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Sundin (S)

Mr. Speaker! It was a broad and difficult question with very many figures as a starting point. I can state that there are many starting points when we talk about waiting times in healthcare and about hired staff and the costs for them, and it looks very different across the country.

In my previous life as a regional councilor in Örebro County, I closely followed how we worked in the region with both waiting times and, not least, the issue the member raises regarding hired personnel. I am the first to say that I am deeply impressed and very happy that the multi-year work that has been carried out to break the dependence on hired personnel across the country has actually yielded results. It has required an enormous effort from all regions to achieve this.

I come from a region where we managed to never let in agency nurses on any significant scale. We have benefited greatly from that. We see, in fact, that the costs increase dramatically as soon as we let in the staffing companies.

It has cost to hold back. It is the result of a long-term effort that has been driven by the regions jointly, with the support of not least Sveriges Kommuner och Regioner, and which makes a difference.

When it comes to the investigation and how we should proceed, perhaps we should look at the opposite – what is now happening in Region Stockholm, where the Social Democrats have been able to take over the regional leadership after 16 years, which I believe was, of moderately-led rule. There we now see how the queues are actually decreasing. When you tackle the market failures, settle with private companies that have not succeeded in delivering, and take back care home stays, you also shorten the queues. This I think we Social Democrats will continue to follow, with great interest.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Carita Boulwén (SD)

Mr. Speaker! Member Sundin raises the situation in Region Stockholm. They have been the subject of quite harsh criticism, because care choices and clinics have been shut down and the queues have actually increased by 2,700 people since March 2023. I do not know which figures are correct. I receive a figure from one side and quite often a completely different one from the Social Democrats.

Child and adolescent psychiatry has been worsened, and cuts are being made in women's healthcare. There are a number of concerns regarding how care should be provided to the residents of Stockholm.

In addition to this, we see that hospitals are being closed around the country. Now it is Sollefteå that risks being affected by large closures, and we also see it in other parts of the country. There, the Social Democrats are involved in governing. I wonder how that squares with how you emphasize that you want to see equal healthcare throughout the country.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Sundin (S)

Mr. Speaker! I note that the Social Democrats in Stockholm took over a budget deficit of 3.5 billion kronor when they took power. I understand that it is galling to see how they are now working long-term to rectify that deficit. And I understand that it is even more galling when the independent credit rating agency Standard & Poor now very recently, in March, raised Region Stockholm's credit rating from AA+ to AAA, which is the highest level. I understand that it is galling.

But I think it might grate even more that Region Stockholm, which had the longest waiting times at the emergency room, has shortened that time by an average of half an hour since Iréne Svenonius's time. And I understand that it grates that today a higher percentage of all operations are carried out within the healthcare guarantee than during the bourgeois period in Region Stockholm.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Carita Boulwén (SD)

Mr. Speaker! Today we are debating the Social Affairs Committee's report number 17, Priorities within health and medical care. We in the Sweden Democrats stand behind all of our reservations, but I move here for special approval of reservation 12, which we share with the Christian Democrats.

Mr. Speaker! Sweden is one of the countries in the world that invests the most money per inhabitant on healthcare. Yet, we have some of Europe's longest care queues, and we have fewer care beds per capita than many comparable countries. We have a staff shortage that means the care capacity cannot be fully utilized.

This is not about a lack of resources, but about a lack of prioritization, weak national governance, and a fragmented system where 21 regions are pulling in slightly different directions. The previous government had year after year of opportunity to address the problems, but they chose not to do so. The problems were allowed to grow.

Mr. Speaker! The Sweden Democrats are today part of a cooperation that is seriously addressing the challenges in healthcare. Through the Tidö Agreement, we are now pushing through necessary reforms to rectify the serious deficiencies that have grown for decades despite the problems having been known. It is about reforms that shall, among other things, cut healthcare queues, increase accessibility, improve efficiency and equality in healthcare, as well as improve the working environment and competence supply for employees within healthcare.

We have also initiated several measures to combat welfare crime, strengthen legal certainty, increase efficiency in the welfare system, and prevent the misuse of public funds. Nor here has the previous government taken responsibility and shown decisiveness. This is the result of a naive and irresponsible policy that has been allowed to continue for far too long.

For the year 2025, 18.4 billion is invested in healthcare, including 7.5 billion to the regions to strengthen healthcare capacity and shorten the queues. We are establishing a new national healthcare brokerage, so that patients shall receive care where the capacity exists. We allocate 500 million kronor to several operations involving hip joints, cataracts, and hernia. We establish a national plan for competence supply with 25 concrete proposals from Socialstyrelsen and the healthcare competence council.

Mr. Speaker! The Government, together with the Sweden Democrats, is carrying out, as I just mentioned, a number of concrete and decisive initiatives within health and medical care, for example when it comes to cancer care. These are initiatives for a more equal and efficient cancer care with a focus on shorter waiting times, early detection, and access to advanced diagnostics.

We are making an intensified effort on women's health and maternity care, including aftercare and treatment. A national maternity plan has been developed to strengthen maternity care and reduce regional differences. A national strategy for mental health and suicide prevention has been decided, with a particular focus on children and young people. These are examples of how we work broadly, purposefully, and responsibly – not with empty promises but with concrete reforms.

Mr. Speaker! Despite the important investments being made, we still see a need for additional measures that we raise in this report. We in the Sverigedemokraterna propose, among other things, a national strategy for diabetes care to reduce unjust differences between the regions regarding treatment, aids, and follow-up. We propose expanded screening for early detection of type 2 diabetes and that Sweden should promptly implement the EU's screening recommendations within the cancer strategy.

We also want the National Board of Health and Welfare to once again investigate a national screening program for prostate cancer and that the national care program for palliative care of children be implemented throughout the country. Today, the program is not yet fully implemented, which means that children at the end of life receive different care depending on where in the country they live. It is unacceptable. All children and their families have the right to the same support, security, and dignity.

Mr. Speaker! There is much of importance in this report. I could stand here for quite a long time and list all the proposals that I and we in the Sweden Democrats think are good and advocate for. But I will go into a little bit regarding the reservation that we move for approval of. It is the reservation concerning gender identity.

After a long debate in the chamber last year, new legislation regarding gender identity was passed. It is expected to enter into force on July 1 this year. In our opinion, the Riksdag's decision in this matter should be overturned, except where it concerns the proposed amendments to the Prison Act and the Detention Act.

I want to be clear that I have great respect for the seriousness and suffering that gender dysphoria can entail. It often concerns young people in a very vulnerable situation who are struggling with mental ill-health and seeking safety and identity. But precisely because of that, we must act with deliberation. The new law risks worsening the situation, not improving it.

We are facing a legislative change that fundamentally alters the view on gender, identity, and society's responsibility towards children and young people. From July 1 of this year, a 16-year-old will be able to change their legal gender without a diagnosis, without a proper medical investigation, and without requirements for maturity and understanding. This is occurring at a time when young people's mental ill-health is increasing and identity confusion is often linked to trauma, bullying, or neuropsychiatric issues.

Mr. Speaker! Instead of giving young people security, predictability, and help, the state gives them a legal identity on the fly. It is a political concession to an ideologically driven movement that puts emotions before facts and symbolic actions before responsibility. This is not just a change of the population register, but it is a change of the foundations of our legislation.

The previous connection between body, biology, and law is now being dismantled. Legal gender becomes a kind of self-chosen expression of identity that society is forced to adapt to.

We therefore say no to lowering the age limit to 16 years. We say no to legal gender being able to be changed without a medical diagnosis and assessment. We say no to simplified assessment of gender identity, as well as to abolishing the Socialstyrelsen's permit review for surgical interventions on the genitals.

Mr. Speaker! We and many others, not least the women's movement which for so long has fought for women's rights, are quite pleased with the ruling from the Supreme Court in England which established that the term "woman" in legal text refers to biological sex and not to gender identity.

Mr. Speaker! Lastly, I want to highlight the importance of preventive measures. If we are to manage the future's healthcare challenges, we cannot only treat – we must prevent. Healthcare must identify risks early, reduce lifestyle-related ill health, and work long-term, not just acutely. It is a matter of both responsibility and long-term sustainability.

We must also see the whole person, not just a diagnosis. The causes of ill health must be taken seriously. We see how many patients with chronic pain, menopausal issues, or autoimmune conditions today experience that the care lacks a holistic view and are forced to seek out costly private treatments because knowledge and opportunities are increasingly lacking within publicly funded care.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Westerlund (MP)

Mr. Speaker! I have many questions for Member Boulwén. I took notes diligently during her speech.

First, I would like to ask if Carita Boulwén could explain what gender identity is according to the Sweden Democrats. Is it something that exists and should be taken seriously? How does MP Boulwén think when she describes a group of people as having an existence that is ideologically driven – what does that mean?

In what way is the connection between biological sex and legal sex broken just by the amendment that we voted through last year, as opposed to what has applied according to the law we have had since 1972? In what way does the amendment contradict facts?

In this debate, it often sounds like those who are in favor of an amendment to the gender identity law, who want to take gender identity seriously and argue that self-determination is a good basis, do not understand that there is biological sex.

Then it becomes a very strange discussion. For example, I have been asked if I know that there are only eggs and sperm and similar types of very strange comments. For me, it is very clear that if one asks such a question, it means that one does not understand what the difference is between biological sex, legal sex, gender identity, and gender expression.

What was decided in the Riksdag was precisely what was to apply for the change of legal gender. It was not what was to apply for one to gain access to different types of healthcare interventions. But in the post from the member here and in the previous debate, all of this was mixed together. Therefore, I now take the opportunity to ask a few questions.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Carita Boulwén (SD)

Mr. Speaker! Thank you, Member Westerlund, for your questions!

I must say, as a member previously said: There were very many questions. I did not manage to note down everything.

Does gender identity exist? Yes, there are genders, and there is gender identity. But when it comes to legislation, it should be such that you are either a man or a woman. All statistics are based on gender, simply, not on gender identity. That is where we see the problem. You can very well experience that you do not belong to the gender you were born into, but that should not affect our laws and rules in this country.

This creates quite a lot of problems both within healthcare and within sports, where we see men competing against women in women's sports. It creates problems.

That is the difference. We want there to be a clear distinction when it comes to biological sex and when it comes to one's own gender identity or one's own gender perception.

Then there is this matter of ideological driving. Yes, I want to mean that it is very many lobby organizations that have been driving these issues and that have been involved and influenced in preschool and school. One sees that politicians do not dare to go against it. If one does not join this train, it is often considered that one does not want the well-being of all people and that one is an evil person.

These are very complex things to discuss. Many times one refrains from it; one just goes along with it. I do not think we do children and young people a service by just going along with this train. Many children and young people who are suffering and who experience that they have a different gender identity do need care.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Westerlund (MP)

Mr. Speaker! I thank you for the answer. It feels like there is basis for a very small round-table discussion, which we perhaps may have at some other occasion.

There is an incredible amount that separates our views – it is very clear.

In Swedish legislation, there are several different grounds for discrimination. There is the ground of gender. In that, for a long time now, persons who have changed their legal gender – and who have undergone various types of treatments, as applied previously – have also been included. They are included in the ground of gender. Then we have the other ground for discrimination, which is called gender expression and gender identity, which, so to speak, covers all other trans people. Gender identity thus already affects Swedish legislation. It is because we try to respect all people and also work against discrimination against trans people. So, it is nothing new here.

In this debate, both in the chamber today and in the public sphere, examples often arise that are not quite applicable in a Swedish context. This concerns, for example, this matter regarding sports.

I have had quite a lot of contact with the Swedish Sports Confederation regarding their position on this issue. The various examples raised in the debate do not come from the Swedish context. The Swedish Sports Confederation has produced a basis for how they envision that one should work with the inclusion of trans people and intersex people in Swedish sports. There, they are quite clear that there is a very large difference between, for example, children's and youth sports and mass sports, which aim for a general improvement of public health, and elite sports. They also do not think that just because one changes legal gender, one should suddenly be allowed to compete in any category whatsoever, in any way.

That discussion is being had in the Swedish sports movement. It has nothing to do with this law, which we are trying to discuss here today.

I would wish that there were more facts and more connection to the Swedish context and the laws that we have here when we, here in the chamber of the Swedish Riksdag, discuss our Swedish laws and our situation in Sweden.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Carita Boulwén (SD)

Mr. Speaker! I do not know if I perceived any concrete question.

It is a number of representatives within the profession, including pediatricians and specialist doctors, and within psychiatry, who warn that when one takes the first step and changes legal gender, one completes the process.

We know that very many children and young people are confused in their puberty but that they end up in the right place when they come out of puberty. Many of them have suffered, as I said in my speech. They have been subjected to bullying or abuse of some kind, which makes them feel as they do.

This is something that we must take seriously. We think it is irresponsible to lower the age limit when it comes to legal gender when one risks getting them into continued treatment. The age limit should instead be raised. It is said that it is only when one is 25 years old that the brain is mature.

These are very important issues. Children and young people risk falling between the cracks, so that they do not receive the care and help they need. If one perceives that one has a different gender identity, one has some form of gender dysphoria. One then does not feel they belong to the gender they were born into. And one wants, in this case, to have a change of the personal identity number. I do not understand how that would make these children and young people feel better. I do not think we should let them go so easily, but we really need to investigate. If one is to change legal gender, it should be preceded by a proper investigation, and one must receive the diagnosis of gender dysphoria. It is fundamental for us in this issue.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Mr. Speaker! In the Tidö Agreement, those born abroad have been made to take over the role of scapegoats for all of Sweden's problems. Dismantling safety systems, welfare, and legal protections is easier to justify if one points at certain groups and starts there.

In healthcare, the policy becomes clearest in the government's proposal to introduce a reporting law and to limit the right to interpretation services. By pointing out minorities as scapegoats, the government avoids taking responsibility for the fact that the policy is not working in Sweden right now, that growth is among the lowest in Europe, that unemployment has ticked up to 8.1 percent, and that food prices have increased by 25 percent since 2022.

What is the situation with the healthcare? I am quite concerned. I am thinking about if we, for example, were to get a pandemic in Sweden – or a crisis or a war. The number of intensive care beds has decreased by 5 percent since before the pandemic. That is something one can wonder about.

Another question that I think is extremely important and concerns prioritization relates to primary care, which feels very far away, i.e., primary healthcare. We have received various types of criticisms in the Committee on Health and Welfare regarding this. According to patient surveys, the accessibility, participation, and continuity in care have not improved during these years, writes Vårdanalys. This may be because there has been an extreme crisis within healthcare for two years – 2023 and 2024. But it is a huge problem.

There is another issue that I want to raise, which concerns prioritization. Researchers at Jönköping University and Stockholm University have analyzed the connection between income and life expectancy in Sweden over a fairly long period – 1962–2021. The gap regarding expected life expectancy has increased significantly.

The difference in life expectancy between men with the lowest and highest income has increased from 3.5 years in the 69s to almost 11 years where we stand now. For women, the difference in life expectancy has increased from 3.8 years to 8.6 years during the same period. These are quite stark figures that speak of great inequality.

I will now move on to speaking about cancer.

Every year, 3,000 women in Sweden fall ill with gynecological cancer. It can be uterine cancer, ovarian cancer or cervical cancer. These diseases differ, of course.

It is important to detect cancer early and get a grip on it in its early stages, because then one can do much more than later. But that requires stable care. Women who regularly participate in various screening programs for gynecological cell sampling reduce the risk of being affected by cervical cancer by approximately 90 percent, which is an immensely pleasing figure. Screening according to the national care program will strengthen the protection further.

For other gynecological cancers, however, there is no screening today. We have discussed what the state should do and not do. There, I believe the Moderaterna have raised that it might be good if the state took a slightly firmer grip on screening – something we can agree on!

We believe that the government should return with proposals that lead to more people undergoing screening for gynecological cancer. Today, there are also large differences, Mr. Speaker, between the regions. Region Stockholm-Gotland has reported a participation rate in studies at primary disease of 19 percent, while Sydöstra regionen has a participation rate of 1.4 percent.

Participation in these types of studies is crucial for developing new treatment methods and medicines that are tested and approved. Studies play a decisive role for progress within medical science but also for the patients' direct survival and quality of life. We believe that the government should return with proposals to strengthen care for gynecological cancer and make it equitable across the entire country.

I move for approval of reservation 3.

Breast cancer is the most common cancer among women in the Western world, and it is also increasing. A total of 61,000 cancer diagnoses are made every year in Sweden, and of these, over 9,000 are breast cancer diagnoses.

80 percent of all those who have received a breast cancer diagnosis are over 50 years old. Breast cancer has become increasingly common, but at the same time, the possibility of surviving the disease has, fortunately, also increased. That more and more people can be cured is considered primarily due to improved treatment and to the mammography screenings, which cause breast cancer to be detected earlier. Vänsterpartiet has, together with the previous government, introduced free mammography throughout the country for women between 40 and 74 years.

Approximately half of all cases of breast cancer are detected during screening with mammography, and three-quarters of the tumors are detected in women who are 55 years of age or older. At the same time, every fifth woman affected by breast cancer has reached the age of 74, and at 74 years, the screening ends.

The age limit is therefore 74 years and is based on Socialstyrelsen's recommendations on age limits. The recommendations are justified by the fact that it has not been possible to prove that breast cancer screening for women over 74 years would reduce mortality among the elderly. This is, in turn, due to the fact that there are no studies on breast cancer screening for that specific group. Socialstyrelsen has not taken a position on other data or requested new studies or pilot projects. We in Vänsterpartiet regret this.

In light of the fact that life expectancy has increased and that a majority of the changes found in older women are precisely cancers that need to be treated, there are reasons to review these recommendations. There must not be any type of age discrimination when it comes to this type of treatment.

The government should work actively for equal mammography even for women over 74 years of age in order to counter age discrimination. We want the government to task the appropriate authority with submitting a proposal on exactly this.

Now I will move on to something completely different, namely genital mutilation, which is a loathsome practice.

Between 13,000 and 23,000 girls are estimated to be at risk of being subjected to female genital mutilation. These are very high figures. Vänsterpartiet has previously proposed the introduction of mandatory training on female genital mutilation for staff within healthcare, the school system, social services, school health care and so on in order to detect this.

We also want the government here to task the appropriate authority to follow up and evaluate the knowledge-enhancing measures on female genital mutilation that must be carried out.

The emergency reception at Södersjukhuset in Stockholm has for several years worked methodically and effectively to spread knowledge about female genital mutilation. The activity has focused on offering support and care to girls and women who have been subjected to female genital mutilation. The activity has also had an educational mandate, where they have trained staff within health and medical care and social services all over Sweden.

Through the work of Amelmottagning, a broad knowledge and deep understanding of the issues have been disseminated, and we believe that the government should appoint an inquiry to see if organizations that have specialist competence regarding female genital mutilation can be given an expanded responsibility and function as regional or national centers of expertise.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Niels Paarup-Petersen (C)

Mr. Speaker! I would like to begin by moving for approval of reservation 13.

I want to speak today about euthanasia.

"If you are reading this, I have passed away." So began the former Buddhist monk, business executive, and summer talk show host Björn Natthiko Lindeblad's farewell message to the public when he chose to end his life.

Natthiko Lindeblad came to the conclusion that his life had reached a point where death was preferable to life because life with ALS no longer had much more to offer than pain, paralysis, and a slow death. That he chose to induce death earlier, simpler, and faster is not so difficult to understand.

But Natthiko Lindeblad did not choose death, Mr. Speaker. Death had already chosen him. He did, however, choose how he would meet death. He chose to decide over himself, over his life and his suffering – a choice he unfortunately is not allowed to make in Sweden. His final act, his liberation, was not a choice he had a right to.

Euthanasia is not permitted in Sweden today, Mr. Speaker. The doctor who helps people like Natthiko Lindeblad violates the rules when they provide dying assistance to achieve a dignified end. It is not reasonable.

So it doesn't have to be that way either. Many countries – more and more, in fact – allow euthanasia. Denmark and England are the latest two countries to have started the process of introducing euthanasia. But Swedes are already traveling today, for example, to Switzerland to get the help that they cannot get in Sweden. It costs, of course, a lot of money, and one cannot go there if a disease progression has gone too far. With today's legislation, it is therefore only those who have enough money and are healthy enough who can escape suffering through their final time in life. The one who does not have money or is in the absolute final moment of life is not given that opportunity.

It cannot be a reasonable order.

It is already happening, however, and I do not think it requires that much to investigate whether people in Sweden receive help to have a dignified and secure death. There are secret groups that travel around and help people who want help to leave life in a dignified way without suffering when it is anyway about to end. Secret, because the doctor who helps a person end their suffering is punished by losing their medical license. So it happened for the doctor Staffan Bergström, who helped Natthiko Lindeblad.

In principle, this is not regulated in Swedish law, which also contradicts the European Court of Human Rights' requirement that precisely this must be regulated when it is not illegal. The Swedish Council on Medical Ethics, Smer, has several times asked various governments to investigate the issue of euthanasia. But neither the Reinfeldt government in 2008 nor the Löfven government in 2017 have wanted to listen.

Nor even the current government has wanted to investigate the issue, despite a new and solid basis from Smer, despite that the Swedish population is overwhelmingly positive towards following other countries' examples and giving people power over their final moments on earth, and despite that the majority of all doctors, nurses etcetera are in favor. Eight out of ten among the population are in favor of introducing some form of euthanasia. Among doctors it is a little more than half, but among healthcare personnel generally it is also eight out of ten who are in favor.

Two parties in Sweden's Riksdag are currently preventing an investigation of the issue from being conducted. One needs to ask why the Social Democrats and the Christian Democrats want the wallet to decide whether the final time of life should be freed from suffering. Is that equality? Is that Christian ethics?

Mr. Speaker! The first freedom that was created is said to be the right to faith. The last freedom is the right to decide over one's own life. Why are we allowed to decide over so many things but not have the right to decide over our death? Euthanasia is truly no simple issue. I have extremely great respect for it. But it is important. The fact that it is difficult does not mean that we should refrain from discussing it – on the contrary!

An existential question such as people's right to have power over their own death deserves both discussions and conscious decisions. Therefore, it is good – I really want to say that – that politics does not take this type of decision lightly. It is reasonable that it takes time, because it must be well-considered. I believe we can all at least agree on that. But if it is to be well-considered, it should also be reasonable to investigate the issue. To block an investigation is to block the discussion that the question and the people who suffer and are ill deserve.

Natthiko Lindeblad wrote in her public farewell letter: ”If you think like I do, that everyone, under certain circumstances, should be allowed society's help to a dignified and safe death, then make your voice heard.” A majority of the population, a majority within healthcare, and a majority in the Riksdag have heard him and think that the issue should be investigated. Sweden's population has, as said, made their voice heard. They want to see a change. But the Social Democrats and the Christian Democrats are still answerable. Shall those without money suffer unnecessarily, or will the parties listen to the population and the healthcare staff and say yes to investigating euthanasia? I hope for the latter.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Christian Carlsson (KD)

Mr. Speaker! I would like to thank the member for raising a very important and ethically difficult question.

I want to begin by saying that I feel immense humility before the suffering that seriously ill people can experience. I understand that there are occasions when one, as a patient, wishes that everything would just end. It is important that all people are given a dignified existence also in the final stage of life. Therefore, it is important that pain and anxiety are alleviated. But when it comes to introducing euthanasia in Sweden, the Christian Democrats rightly believe that it would be the wrong path to take.

It may naturally appear to be a simple solution to introduce euthanasia, but we see many problems. One is that a diagnosis or assessment of expected life expectancy can easily be incorrect. Someone who is seriously ill can also suffer from mental illness and depression, which can lead to suicidal thoughts. But those thoughts can disappear and be transitory.

In many other countries, a tangible risk has been seen that the person who applies for euthanasia due to age or illness does not actually do it for their own sake, but because they feel like a burden to society because they cost money or for family and relatives who also suffer in the difficult situation. We do not think that any human being should have to feel that way. In Oregon, it has been reported to be the third most common reason for requesting the lethal dose. No one should have to choose between continued care and taking their own life. That is why Kristdemokraterna says no to this.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Niels Paarup-Petersen (C)

Mr. Speaker! I think Member Christian Carlsson raises many reasonable questions – and it is precisely because there are many reasonable questions from both sides that the issue should be investigated. That is my, the Center Party's, and the parliamentary majority's view. It is also the majority's view among the population and among the healthcare staff because it is a very difficult question. I appreciate that Christian Carlsson also says that. It is an ethical balancing act, definitely.

For example, Denmark has just conducted an investigation regarding this. It is the latest country to have conducted such an investigation – I do not mention it only because I come from there. In it, it is pointed out that difficult trade-offs must be made. They say that the assessment must be very clear – and be made by not just one doctor, but two – that it concerns someone who has a very short time left in life. It is not enough to just say that one wants euthanasia. Some time must pass between saying it the first time and then saying it again. One must also be able to perform it oneself. Of course, no one else should be able to do it for you. It is an example of boundary settings.

It must be said that there are countries that do this very easily. I believe we are in complete agreement that we want to avoid that. But there is also a great deal of suffering that the healthcare system in its current state cannot take care of. It is also about security for a lot of people to know that the possibility exists.

In the current situation, it is actually as I said, that this conflicts with the European Court of Human Rights' decision. When this is not illegal, it should be regulated. In the current situation, it is not regulated by law where the line is drawn for whether one commits a crime when helping someone or not. That in itself makes it so that we, regardless of which side we stand on in this, should agree that this must be investigated. We need to be able to ensure that this actually becomes a regulated area – for the sake of the healthcare staff but also for the one who, in their final moment, has severe pain.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Christian Carlsson (KD)

Mr. Speaker! Those who advocate for euthanasia often highlight that this would be a matter of being able to choose for oneself. Some even believe that it should be a human right to be able to request euthanasia. But the question then becomes who should have the right to euthanasia. Whose life is valuable enough to be lived? And who is sufficiently ill for the state to be able to choose to take that person's life?

The question is whether one even needs to be ill if it is fundamentally about self-determination and rights. I think the experience from countries such as the Netherlands and Canada is truly frightening. There, one has seen an avalanche-like increase in the number of euthanasia cases. More and more people request euthanasia, and more and more are granted euthanasia.

This type of legislation unfortunately tends to expand. It often begins with something that it is easy to feel sympathy and understanding for. And what the Member of Parliament also expresses is that the person should have a very short time left to live and that there should be no hope. There should be a great deal of suffering. But soon demands are heard that more and more groups should be included because it is considered a matter of freedom of choice and a human right. From it having been intended only for the terminally ill and those living with incurable suffering, it has progressed to the point that today, for example in the Netherlands, there is no requirement that one must suffer from a terminal illness.

What euthanasia entails is de facto that we get a state that values some citizens' lives so highly that suicide must be prevented, while others' lives are valued so lowly that we are prepared to take their lives. This implies a dangerous shift in the view of one another and when it comes to the respect for human dignity. That is why the Christian Democrats say a firm no to introducing euthanasia in Sweden. Furthermore, we do not wish to investigate the issue.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Niels Paarup-Petersen (C)

Mr. Speaker! I must respond to what Christian Carlsson says about the state choosing to take people's lives. That is not what should happen. It is very important. We are in complete agreement on that. It is important to differentiate. The state shall not take people's lives. We are in complete agreement on that. I do not want to open up for any legislation that allows the state to take people's lives. It is very important!

What I and the Center Party want to investigate is whether there are instances where the state can enable a person to, on their own initiative, with many boundaries and controls, be given the opportunity to take their own life in a way that ensures they do not go through severe pain and suffer in the absolute final stage of life. It is incredibly important. I do not want the state to decide over people's lives. Everyone's life is equally worth living. That cannot be questioned. It is not the state that should decide that. I believe, however, that we all know that suicide occurs. We know that it already happens that people get help. There are known cases that have been written about in the newspapers. There are also TV documentaries about them. This exists, but it is not regulated.

I also want to be very clear about the other part, that is to say that the state shall not take lives. It is the human being themselves who decides. In the current situation, we have no legislation on this. The question needs to be answered: Why is it so when we know that this happens? People are helped to take their lives, and it likely happens hundreds of times every year in Sweden. We want to regulate everything else – sometimes perhaps a bit too much, which we can probably agree on – but just when people lose their lives, we are apparently not to have any rules. It is not reasonable.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Westerlund (MP)

Mr. Speaker! There are obviously several of us here in the chamber who are passionate about roughly the same issues. There will be some repetitions in my speech. I will try to shorten it somewhat. I want to speak about breast cancer screening, even though several have already taken it up.

Last summer, I saw an appeal from the Breast Cancer Association against ageism. It was about older women's right to mammography. The Breast Cancer Association stated that every fourth case of breast cancer is found in a woman over 75 years old and that more than twice as many women over 75 die from their breast cancer than younger women do.

The Breast Cancer Association was, of course, strongly critical that Socialstyrelsen, despite this, decided to continue recommending that older women should not be called for mammography. Socialstyrelsen made this decision after an investigation in 2022, when they looked at a potentially raised age limit for breast cancer screening. They came to the conclusion that since no studies exist on breast cancer screening for older people, they could not prove that breast cancer screening would reduce mortality. Therefore, they decided to maintain the upper age limit at 74 years.

In my opinion, politicians should not interfere in how healthcare should be conducted. It is best managed by specialized doctors based on science and proven experience, supported by knowledge support and guidelines from responsible authorities. But this is not about healthcare, as several previous speakers have also mentioned, it is about recommendations for screening. It appears very unfortunate that the lack of studies including the elderly leads to older women being denied screening despite clear statistics on the higher mortality.

It seems reasonable to at least initiate new studies or perhaps a pilot project with the aim of gaining access to more information. Many actors were critical when the decision was made to continue with the same recommendation for 74 years, including a senior physician at Karolinska who is also the registrar for the National Quality Register for Breast Cancer.

Mr. Speaker! Everyone knows that early detection of breast cancer improves survival. It also provides the opportunity for milder treatment. That is why we have mammography screening for all women between 40 and 74 years of age. Mortality has been nearly halved since the screening was introduced.

Breast cancer is the most common cancer among women. Every year, 9,000 women and additionally 60 men fall ill with breast cancer. Registry data that Socialstyrelsen could have looked at show that every fourth case of breast cancer affects a woman over 75. Their tumors are larger and are found at a more advanced stage of the disease. Older people therefore also die more often from breast cancer: 114 women in the age group 75–89 years compared with 48 women in the age group 60–74 years per 100,000 women.

Here, one can be reminded that women's life expectancy has increased from 80 to 85 years between 1990 and 2022. Thus, many more have good chances of a longer healthy life now than just 35 years ago. These women also do not want to die of breast cancer unnecessarily.

Miljöpartiet therefore wants it to be ensured that screening for, for example, breast cancer shall not be discriminatory regarding age. The age limits should be reviewed and updated based on new research and other available knowledge. If one does not think the research is sufficient, more research can be initiated, but as mentioned, there is statistics.

We also consider that the issue of genetic testing and screening to early identify women with an increased risk of breast and ovarian cancer needs to be investigated. This is what our reservation 8 is about, and I move for its approval.

Mr. Speaker! The previous government tasked Socialstyrelsen in March 2020 with describing what interventions are provided for menopausal symptoms in primary care and in gynecological specialist care. The assignment resulted in a report that showed a need for improved information and guidance for women. As usual, it also showed large regional variations when it comes to advice, support, and treatment.

In the agency's report, it was proposed that a national knowledge support should be developed regarding advice, support, and treatment of climacteric symptoms from a holistic perspective. It is very pleasing that this work has been taken further and that guidelines are now underway with planned publication in the autumn. I will follow this work closely.

I will also continue to follow the work to improve care for endometriosis, something that this government has also said it wants to put a lot of effort into. There are already national guidelines, which is good. Socialstyrelsen has a mandate to strengthen the implementation of the guidelines. Cooperation is being undertaken with the regions to increase knowledge about the use of the guidelines. It is very much needed.

It would also be very useful to establish a national quality register for the entire endometriosis care and not just for certain parts of the surgery. A priority for me is also that TLV should be given a mandate to ensure that the medicines that have been developed specifically for the treatment of endometriosis are included in the high-cost protection.

This was actually all I intended to speak about, but I just want to say something further regarding a healthcare issue that we have discussed a few times.

I would wish that those who want to debate gender-affirming care would take part in the knowledge from those who are specialists, for example, the people at the National Board of Health and Welfare who work on developing knowledge support or the doctors who work with the care itself. It is not them we have heard in the debate. These specialists in child and adolescent psychiatry are, with quite few exceptions, themselves involved in just that gender-affirming care. It was a very unfortunate element in last spring's debate that led to a good deal of incorrect claims being spread and that the doctors who are truly knowledgeable were not heard in the discussion. It leads to people receiving incorrect information and perhaps driving political issues in a way that is not the very best.

I also think it is important that people get help with all their problems. One should naturally receive an investigation for all the ailments one feels. It can involve different types of psychiatric problems, and one should of course get help with those. I do not believe that anyone here in the chamber thinks that a certain type of care should be offered lightly. It should of course be given after a careful investigation, and that is also done by the doctors who work with gender-affirming care. I therefore really recommend contact with the specialists who are knowledgeable in the area of gender-affirming care.

(Applause)

In this speech, Jacob Risberg (MP) agreed.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Carita Boulwén (SD)

Mr. Speaker! Thank you, Member Westerlund, for the speech! There was a lot in your speech regarding cancer screening that we fully agree with. These are truly very important measures, and there should be no discrimination whatsoever in terms of age.

I would like to take up what concerned gender dysphoria. We mean that one is either born as a girl or as a boy. Then there are, in very few cases, uncertainties at birth, but those usually rectify themselves over time. It is therefore about extremely few cases. The vast majority are born as a man or as a woman.

What we see as problematic is that one does not have the possibility to live fully as what one actually is. We mean that it is largely about gender norms. If one feels that one is not like a woman, as one was actually born as, but identifies more as a man, it should not matter. You are who you are regardless of whether you were born as a man or as a woman.

I would like to ask the member some questions.

There is a body identity disorder that causes a persistent and intense desire to be amputated. The debut usually occurs in the teenage years. In the early 2000s, a couple of cases were noted internationally where doctors in Asia and the USA performed amputation of healthy legs at the patient's request. In Canada, it was reported quite recently of a 22-year-old man who underwent amputation of two fingers after having had a body identity disorder for a long time. He felt very well after having had this done, he stated himself. Before he got to do it, he felt very poorly and had thoughts of taking his own life.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Westerlund (MP)

Mr. Speaker! Now we are talking again about somewhat different issues. When it comes to these doubts about whether one is a girl or a boy when one is born, we are talking about intersex people, I assume. Infants can rarely express a gender identity. Intersex people are not the same as trans people. It is a completely different group of people.

With the exception of just intersex people, where biological sex is not unambiguous, everyone is born as either a boy or a girl. But here we come back to the difference between biological sex and gender identity, a feeling that many children can express at the age of two to three when they perhaps start thinking that they are boys or girls. For the absolute majority, people's biological sex and gender identity correspond. Most are not trans people. Then it is very easy. In context, it can be mentioned that most intersex people are also not trans people; they also have an unambiguous gender identity, even if the biological sex is not unambiguous. It is important to keep all these things separate.

I am truly in favor of because care is conducted based on science and proven experience. I am not aware of the specific cases the member mentioned, but they were about something other than trans people. I am not aware of any instances in Swedish healthcare where we would recommend that doctors remove, for example, a leg if someone were to want that. I truly think that we should continue to stick to the Swedish context and be clear that we consider that Swedish healthcare should be conducted based on the available knowledge of various kinds, both different types of research and proven experience. I am completely in favor of us continuing to do so.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Carita Boulwén (SD)

Mr. Speaker! I continue with the question that I did not have time to finish asking.

In Sweden, requests for the amputation of healthy body parts are regarded as a psychiatric issue. Care offers psychological treatment rather than surgical interventions. This practice stands in contrast to the handling of gender dysphoria, where gender-affirming surgery can be offered after a thorough investigation. A person who wants to remove a healthy arm because it does not feel right to have it is, however, denied surgery and receives a referral to psychiatry.

Swedish law today prohibits female genital mutilation. It is a prohibition that is absolute. It does not matter whether the person concerned is of legal age or consents to the procedure themselves – this is correct, because the purpose is to protect the individual from irrevocable bodily harm that is not medically justified.

At the same time, extensive gender surgery is permitted in Sweden today within the framework of so-called gender-affirming care. This care includes procedures such as the removal of breasts, uterus, and testicles, even though the medical benefit is often disputed and even though several countries in Europe are now introducing significant restrictions on such care. I wonder what the member stands on this. That is what I am genuinely interested in hearing.

As I mentioned earlier: The man who had two fingers amputated felt unwell before it was done and felt better afterwards. Where do we draw the line? I know it is a complex issue, and this is not directly the same thing. But in the long run – where do we draw the line for when one should go in and surgically remove healthy tissue? As I said, genital mutilation is prohibited under Swedish law. The question then is: How does the member view the fact that genital mutilation is actually performed in Sweden?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Westerlund (MP)

Mr. Speaker! The member himself just said exactly what is my answer, namely that after a thorough investigation, one can receive different types of care interventions within the framework of gender-affirming care. That is the point. That is what science and proven experience are. We have a gender-affirming care that contains elements such as, for example, hormone treatment or surgery. Then, it is far from everyone who wants surgery. There have also been fewer now since one is no longer required to have surgery to change legal gender, which I think is super positive. One can have whatever body one wants and still change legal gender. That is how it should be, I think. But when an intervention or a hormone treatment occurs, skilled doctors perform a thorough investigation and a holistic assessment of whether this will make the person feel better. If that is the case, I am in favor of us having that care, if that is what this member wondered.

I am against gender mutilation. Traditional gender mutilation is not done with the purpose that a person should begin to feel better mentally, but rather based on cultural perceptions of what happens otherwise. It is therefore a different issue.

The point is that this should be done within the framework of the healthcare's competence with the available and gathered knowledge of what usually makes people feel better. It is also a misconception that there would be no evidence at all that gender-affirming care helps. That is not true. Then the doctors dispute exactly how much evidence is needed for one to consider it reasonable with different types of measures. I think they should absolutely continue with that. I also look forward to more research on this.

I also of course think that one is allowed to be exactly as one wants to be. One is allowed to be a tomboy, and one is allowed to be a girly guy. It is great with this young guy who was in the media recently and who wants long hair, makeup, hair clips and so on and still identifies as a boy. I am completely in favor of this. This discussion is not about that.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Patrik Björck (S)

Mr. Speaker! It is with those words that we always begin our speeches in the chamber. It happens sometimes that one forgets it, but that belongs to the exceptions. It feels particularly important to me not to forget it, because I intended to take up this ball of gender identity that the MP from the Green Party played up.

Mr. Speaker! I initially move for approval of reservation 12. Then I shall explain why I do so and why I consider this to be a very important issue. Unfortunately, it is a hidden issue in the general debate. When it is discussed, the proponents of so-called self-determination try to mix up the cards. We have heard a very good example of this in the chamber here today from Miljöpartiet. It was done very skillfully and expertly. The member knows the questions and knows exactly how the smokescreens should be laid so that one can avoid answering the real questions. But I will come to that.

A year ago, we made a very unfortunate decision here in the Riksdag. We decided on a new law that in principle makes it possible to choose which gender one has – whether one is a man or a woman, whether one is a gentleman or a lady, Mr. Speaker. The decision risks creating many different problems. There were many and heavy arguments against the decision, but only few and weak arguments for. If the Riksdag were to approve reservation 12, one could embark on a path back from an unfortunate decision. Among the members who voted for the new law, there were different motives and reasonings. It was naturally the same among the members who voted against. I voted against, and I shall explain why. It is my opinions I am speaking of. I do not speak for everyone who voted as I did.

The first reason to vote against the new legislation that was decided a year ago – it is among other things this that the member from Miljöpartiet is trying to "fog over" – is that it is based on a mistaken perception of the world. It is mistaken because of how the world looks when we study it in a rational and scientific way. I actually think that we who voted against it can be quite in agreement on that. One cannot choose gender. We belong to the gender we are born into, and that gender we are born into is also the gender we have when we die. These are indisputable facts. It is not possible to choose gender.

According to my experience, one also cannot choose sexual orientation. I do not have as strong a biological argument for it. But I am convinced that one cannot.

My experience is based on conversations with people of different sexual orientations. It is nothing that one has chosen. In any case, I have not met anyone who says they have chosen it. Perhaps there are. I am not quite as firm on that point as when it comes to the fact that one cannot choose gender.

I was born a boy, a man, and I am heterosexual. That is how it is. I did not choose it. I will return to this matter of sexual orientation a bit later in my speech.

Many strange claims occur in this debate. I can agree with that. One of them is that one would have been born in the wrong body. That is also not possible. There is a body and nothing right or wrong. One can for various reasons be dissatisfied with the body that one was assigned. But that is something completely different.

Among those who voted for the new law, there were those who believe that one cannot simply choose gender. Furthermore, there are many genders to choose from. That is, of course, also not true. When I tell people outside this house that there are members of parliament who believe that one can choose gender, most of them laugh a little distrustfully.

When I tell them that there are also members who believe that there are many genders to choose from, most of them stop laughing, shake their heads and wonder: What are you actually doing there? Do you have nothing important to occupy yourselves with? Are there no real problems to solve?

This may be an explanation for why we could end up so wrong on the issue. Even those who do not actually believe that gender is something one can choose do not think the issue is important, and then they do not care. It is, of course, a speculation on my part. But I believe it could be a reason why we have ended up so wrong.

Mr. Speaker! That we have legislation based on faith and not on knowledge, based on delusion and not on science, is naturally reason enough not to implement such legislation.

Mr. Speaker! But there are other weighty arguments against the law that was adopted a year ago and which, if nothing is done, will enter into force on July 1 this year.

There is a reason why the collective Swedish women's movement fought against this legislation and a mass of unreasonable phenomena in society which, although they are not included in the legislation, are based on the same misconceptions and are driven by the same groups and individuals. These are groups that have skillfully worked with lobbying and have come very far in changing society according to their own faith and misconception-based perceptions.

I myself stumbled upon this question when I noticed a strange debate on social media. It was about avoiding the word woman in healthcare. It was actually a party colleague of mine who spoke out and pointed out the absurdity of stopping calling women women.

It resulted in a hate campaign that surprised me both for its strength and for its lack of reason in substance. I tried to understand what was about to happen and realized that under the radar, a social change was being carried out that few wanted and that was not being debated publicly. It was, of course, skillfully executed, but nonetheless uncomfortable.

Those who had objections were to be silenced and subjected to character assassination. Many fell silent, but the women's movement, which saw what was at stake, fought back. What the women's movement saw was, of course, that if the concept of woman is hollowed out, the work for equality is hindered. Without women, no women's movement. That is also why it is predominantly women who fight back.

It is equality on all levels in society that is threatened. Economic, political, and sporting influence in all its forms for women is threatened. For the women's movement, a social analysis based on the understanding of the gender power structure is completely central. It is no stranger than that for the workers' movement it is completely central to have a class analysis to understand how society functions, or for that matter to be very precise with the concept of the worker. These are completely central concepts for the workers' movement in the same way that gender are central concepts for the women's movement.

Men can laugh all the way to the bank, the boardroom, or the podium. It is not male boxers who protest at IOK when they discover they have been paired against four women on the way to the gold medal. It is women who experience discomfort when their spaces, such as changing rooms, are not perceived as safe. It is women who feel threatened if they are forced to shower with men. It is also only women who have ended up in legal disputes when they have questioned that this occurs.

That the gender order is biology is not something one can get around by letting people choose something that cannot be chosen. It is so obvious that it feels strange to have to say it. It is even stranger that it is being questioned here in the Swedish Riksdag.

I have not read the judgment from the Supreme Court in London that was brought up here earlier in the debate. But I can state from the news reporting that it is women who are cheering. The question has been about defining who is a woman. How did we end up there?

The answer from the Supreme Court in London is that gender is determined at birth. In the United Kingdom, they have let old knowledge become new, and so they have left superstition behind.

How could one end up there? How does one end up in a situation where the Supreme Court in London is to legally adjudicate who is a woman?

The development that led up to the unfortunate decision we made on April 17 last year threatens girls and women, Mr. Speaker, and nota bene girls and women regardless of their sexual orientation. All girls and women are threatened by this development. To satisfy a small group of men, half of humanity is being thrown under the bus.

But there are more weighty arguments against the decision that was made a year ago and which should be overturned as soon as possible. The first to be affected are, as said, girls and women, regardless of sexual orientation. But it is something that has been noticed too little, I believe. Those who are next in line to be affected, I believe, are all hbt-plus persons regardless of gender.

First and foremost: When it becomes public what is going on, there is a great risk that the obviously unreasonable in the belief about what gender is will lead to a backlash for the entire LGBT+ community and can be used to take back many decades of important progress for everyone's equal value and for the self-evident right to love whoever one wants. It is a great risk that the LGBT movement is taking.

The second obvious risk is that if it can be argued that gender is something one can choose, it is naturally much easier to argue that sexual orientation is something one can choose. If you can choose, there will always be someone who thinks you made the wrong choice. To satisfy a small group of men, the entire LGBT+ community is thrown under the bus. It is a very big risk one is taking.

There are further arguments for why this development is dangerous. It is a development that undermines democracy. I am among those who believe that popular movements are an important part of Swedish democracy. But as was pointed out in an editorial in Expressen the other day, membership engagement in popular movements has decreased so sharply that small, well-organized groups can take over and conduct extreme influence work using the good reputation and standing of old organizations.

Who questions Amnesty International? Everyone knows that they are on the right side. Who sees that an organization formed to support political prisoners and work so that one would not be imprisoned for their opinions is now working to create political prisoners, women who fight for their rights?

A few words to the hbt-movement. I believe it is time for some self-reflection. Is this where you wanted to end up? You should settle accounts with patriarchal structures. You do not even reflect on the fact that you appoint Agnes Wold as your greatest enemy.

Either you have lost it completely, or you have achieved all your goals and can shut down the operation. If you do not have bigger problems than Agnes Wold, you have no problems. Agnes Wold naturally stands up for everyone's equal value and everyone's right to love whoever they want. I do too.

I gladly accept the award of the Rosa tisteln. It has now become some kind of honorary title for those who have the strength to stand up for common sense and everyone's equal value. I accept it with pride. Was that how you intended it to be?

Experiences from our surrounding world indicate that the development that the unfortunate legislation is a result of continues. Demands will be made to legalize surrogacy and so on – all in some kind of ultra-liberal, choice-extremist ideological spirit.

One of the few and weak arguments for the unfortunate decision on April 17 last year was that it would improve the situation for children and young people with mental health problems. Unfortunately, everything indicates the opposite. There is no scientific evidence that young people with identity problems and mental health diagnoses would feel better if one simply confirms their diagnoses.

It is also important to remember that the healthcare scandal regarding the treatment of children and young people occurred under the current legislation. It is therefore not a question that has to do with this, but it is a separate issue. And it is, of course, a great tragedy. On the other hand, it is important to remember that this healthcare scandal occurred as a result of the same distorted perception of reality that led to the unfortunate decision on April 17 last year.

For the sake of clarity and given the exchanges of remarks that have taken place here, I intend to be very clear that I think the current legislation, which makes it possible for adults to change their legal gender after a thorough investigation and after a government decision, is good. It is a reasonable balance between society's need for order and a small group of individuals' special needs.

This can never be a matter of freedom of choice, because then we go completely astray. And that is what we are about to do with the new legislation. One does not choose parents, body, age, or gender. Those are things that one simply has to accept.

Everyone should be treated with respect; that is one thing. That one is allowed to love whoever they want is, for me, a self-evident truth. That one has the right to believe that they suffer from electromagnetic hypersensitivity or were born in the wrong body is one thing. But that society should subordinate itself to that belief is another. When WHO, the Swedish Radiation Safety Authority, or the National Board of Health and Welfare do not find any scientific evidence for electromagnetic hypersensitivity, it is not because they lack respect for the people who believe they suffer from it. It is because they take their social responsibility.

It would have been madness if authorities and legislators had subordinated themselves to delusions. One can imagine a situation where the Public Health Agency had had a group of anti-vaxxers in the leadership during the pandemic. It might have been respectful towards the anti-vaxxers but devastating for our society.

It is okay, Mr. Speaker, to believe that the earth was created 6,000 years ago – we have examples of that in this chamber. But if authorities, the National Agency for Education, colleges and universities accepted this in their operations and if we legislators enacted laws based on such beliefs, it would be dangerous to society.

I look forward to a debate on these issues with those of you who believe that one can choose a gender. Present your best arguments – you who believe that there are many genders to choose from! Please request a reply to me now and explain it to me and your voters so that we understand! Debate is useful, and I believe that this issue needs to be debated much more and much more publicly. Opportunities are needed to blow away the smoke screens.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Westerlund (MP)

Mr. Speaker! I sat and waited quite a long time to hear which of my remarks the member considered to be pure madness. I understand that the member means that it is pure madness, but I didn't really get any example.

For example, I have not heard anyone in this discussion use the phrasing that one believes that one can be born in the wrong body. I have not said it, and I have not heard anyone else say it either.

When it comes to the discussion about choosing gender, and when the member expresses himself as he did just now, I cannot interpret it in any other way than that he believes that gender identity does not exist. That is what we are talking about. It is not about choosing gender in the sense that I would believe it is possible to replace every single cell in a body or anything of the sort. It is not about me suddenly being able to get sperm instead of eggs, which I was born with.

It is not that which the discussion is about, but rather it is about whether we believe that gender identity exists and whether we think it should be respected or not. It is nothing that emerged in this chamber last spring, but this is, as said, Swedish legislation that has existed for quite a long time. In 2009, the grounds for discrimination regarding other trans people than those who are often called transsexuals was introduced. They have been included in the grounds for discrimination previously.

I think it is unworthy to talk about delusions. The only delusion I have heard the member speak about is the notion that one believes that gender identity exists, that is to say that trans people exist.

I believe that trans people exist. I also believe that men and women exist. There is no contradiction here. I am a woman, for example. I was born as a girl and am a woman now. There is nothing strange about that. I perceive the member as a man – please correct me! I also perceive the Speaker as a man. There is nothing strange about it. It is very difficult for me to understand where the conflict lies that leads to the harsh words.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Patrik Björck (S)

Mr. Speaker! I especially thank the member of the Green Party for requesting a reply. But no, I do not believe that I called the member of the Green Party crazy or anything of the sort. I said that the member of the Green Party was an example of how one spreads smoke screens when discussing these issues. I think that is a bit different.

Then I said that there is a lot of madness in this debate, and by that I do not mean specifically this debate but the large societal debate. There are also discussions in the large societal debate about being born in the wrong body and so on. It was not a quote from anyone participating here.

On the other hand, accused – so one might put it – I the member from Miljöpartiet for spreading a smokescreen. It is about trying to pretend that it is not about biology. It is, after all, the case that the very definition of man and woman is biology. Then, of course, one may have identities, perceptions, or different ways of living. One can love whoever one wants and live one's life however one wants.

But we still must have some order and tidiness in this society somewhere. Then the person who changes sex must do so under regulated forms. Just as the member says, Mr. Speaker, it has been possible to do it in Sweden for a long time. We had a way of doing it under regulated forms that has been modernized over time. It was introduced in 1972 and has thus been modernized several times. It is very much possible that one could have reviewed that legislation and tweaked it a bit.

What goes completely wrong is when it becomes a so-called self-determination. This legislation is so stumblingly close to a self-determination that the so-called small threshold that remains is next to nothing worth. It is if one can choose for oneself that it goes wrong. It is that which I strongly oppose. It is then the equality work and the women's movement's work that is strongly hindered.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Ulrika Westerlund (MP)

Mr. Speaker! Again: Gender has different dimensions. When one talks about gender, one must keep that in mind; otherwise, it is not possible to have the discussion about whether trans people exist or not. Gender has several parts. Gender has a biological part. Then we have legal gender, which is a social construction that all states in the world have, as far as I know. Furthermore, we have gender identity and gender expression. All of these are a whole that together form gender.

If one wants to talk about gender only in terms of biological sex, we are back to it being very difficult to combine that with a recognition that trans people exist. The existence of trans people is not about what their bodies look like or whether biological sex exists or not, but it is precisely about gender identity.

I am of the opinion that what happened last spring was precisely that we tweaked the existing legislation and made an adjustment where we approached the recommendations from all major MR bodies in the world that have commented on this, where self-determination is recommended. We approached this, even if it is not full self-determination.

I do not think it is very good when members of Sweden's Riksdag describe a popular movement, which the LGBTQ movement actually is, as a kind of suspect lobbying activity that is engaged in some kind of undercover influence work.

The LGBTQ+ movement has been enormously clear about what it thinks on the issue. When the member uses the abbreviation LGBT+ themselves, trans people are included there. Does the member mean that the entire LGBTQ+ or LGBT+ movement has allowed itself to be deceived by some strange forces somewhere, that one is not looking out for one's own best interests, that it is something one does not know, that one does not respect women, that one does not respect lesbian women, and so on?

There is no one who is promoting any kind of thesis that goes out on, to take another misconception as an example, that lesbian women would not have the right to say no. If I do not want to have sex with a trans woman, I naturally do not have to. One must not have sex with people who do not want to.

This is what often comes up: that it would threaten lesbian women. It is a strange delusion.

(Applause)

In this speech, Jacob Risberg (MP) concurred.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Patrik Björck (S)

Mr. Speaker! Yes, trans exists. Trans exists because there are genders to transition from, so to speak. If there had been no genders, there would have been no trans. We can be completely in agreement on that.

The question is who decides what is written in my personal identity number, my passport, or something of the sort. What society has the right to decide over is whether I am a man or a woman. I cannot decide that myself. There has been an opportunity to change it during life, and I think that is good. But it must be regulated, and it must not be self-determination. In some way, the concept itself disappears if one owns it oneself.

On the other hand, one owns one's identity entirely by oneself. Society has nothing to do with it. It has nothing to do with how people dress or behave, how one moves or dances, whether one uses makeup or a wig even if one is a man or something like that. Society has nothing to do with it.

Priorities within health and medical care

All people shall be allowed to live in peace and quiet, in peace and without harassment. One shall be treated the same as all people and have the same human worth. But those questions are owned by the individuals themselves. We shall not interfere in them.

We had a discussion here earlier about whether it was reasonable for society to intervene in euthanasia or not. There was a member from the Center Party who thought that society should not intervene in it. I might think that society should intervene in it, but that is another question. That can always be discussed.

I cannot decide my own gender myself, because then the possibility of regulating society in a democratic way would disappear. Then the possibility of working for equality and equal rights would disappear. That is the problem with self-determination.

One owns one's own identity. If one has a trans identity, one owns it oneself. But if one is to change one's legal gender, there must be some kind of regulatory framework for it. I thought that what we had was quite good. It is possible that one could have tweaked it a bit; I don't know. But to go from there, as we have done now, to almost a self-determination is completely the wrong way to go.

I believe that this will slowly but surely be rolled back – maybe not today, but it will happen. Because it is wrong.

The deliberation was hereby concluded.

(A decision was to be taken on 29 April.)

The speech at riksdagen.se, in Swedish (opens in a new tab)