Guidelines: Management of dying and death

SAMS » Ethics » Ethics in end-of-life care » Guidelines: Management of dying and death

Providing treatment, care, and support for patients faced with their own death is a key medical duty, requiring a high degree of respect and considerable ethical responsibility. The SAMS medical-ethical guidelines contain differentiated criteria that offer an ethical frame to physicians and other specialists providing treatment in challenging dying and death situations.

Since the publication of the SAMS «End-of-life care» guidelines in 2004, the topics of dying and death have been subject to increasing professional and public debate, including the question of which goals medical practitioners should pursue and which responsibilities should be assigned to them.

 

In May 2015, the SAMS Central Ethics Committee appointed a subcommittee to revise the 2004 guidelines. For the purpose of the revision of the guidelines, the subcommittee carried out expert hearings, considered the results of the National Research Programme «End of life» (NRP 67) and drew on sources such as a study commissioned by the SAMS on Swiss physicians' attitudes to assisted suicide.

 

The guidelines now cover not only end-of-life care but also discussions with patients who have been diagnosed with terminal disease, and management of the desire for death. Assisted suicide in patients not facing imminent death is also explicitly addressed.

 

According to the guidelines, assisted suicide is justifiable in the case of patients capable of judgement, if the symptoms of disease and/or functional impairments are causing them intolerable suffering, and other options have proved ineffective or been rejected as deemed unacceptable. The patient’s desire not to continue living in this situation of intolerable suffering must be comprehensible to the physician responsible on the basis of the patient's history and repeated discussions. The patient’s wish must be well thought out, lasting, and free from external pressure. Nevertheless, the guidelines also stress that patients are not entitled to assisted suicide, and that every physician is free to decide whether or not to consider such action.

 

The new guidelines aim to link different points of view and moral concepts, and to ensure that the right to self-determination of everyone involved – patients, relatives and medical practitioners – is respected and safeguarded.

 

Previously valid SAMS guidelines on dealing with end-of-life issues and documents on the development of the current guidelines (2018) are available under  Background.