Health, illness, and quality of life are decisive factors for a dignified end-of-life. To promote patients’ self-determination, addressing treatment options and the end-of-life at an early stage is a prerequisite. A national working group co-led by the SAMS and the Federal Office of Public Health (FOPH) aims to improve the framework conditions and quality standards of advance care planning in Switzerland.
Advance care planning requires conversations about personal values, wishes, expectations and ideas with regard to treatment and care in the event of illness, accident or need for care. It also requires recording a person’s wishes for third parties in case the person loses decision-making capacity. Advance care planning is a dynamic process and aims to ensure that the wishes of the individual for or against medical measures are respected. This also includes that these decisions are supported or at least understood by family caregivers.
The Swiss Federal Council formulated a need for action in a postulate report 18.3384 (available in German or French). Advance care directives are often unavailable, unfindable, or inapplicable for professionals because the directives’ statements are not meaningful in an emergency situation. Furthermore, the end-of-life is often approached as an acute event, whereas around 70 per cent of deaths in Switzerland are foreseeable and could be anticipated.
To improve the framework and quality standards of advance care planning, the Federal Council established a national working group on «Advance Care Planning» in 2021 led by the FOPH, the Section National Health Policy, and the SAMS. The working group is tasked with steering the implementation of advance care planning measures on a strategic and thematic level throughout the entire process, and setting key priorities. It consists of experts from the fields of medicine, nursing, palliative care, social work, law, and ethics. Also represented are national professional associations, organisations of healthcare providers as well as patient and stakeholder organisations that offer consultation on the subject.
Model for «Advance Care Planning»
The broad-based working group led by the FOPH and SAMS has developed a model for the advancement and implementation of advance care planning in Switzerland. This model was open for public consultation from 17 May until 15 July 2022.
An article published jointly by the FOPH and the SAMS in the Schweizerische Ärztezeitung (SÄZ) describes the core elements of the model.
The numerous submissions in the consultation process are currently being evaluated. Based on the results, thematic in-depth activities will be defined and corresponding subgroups will be set up.
The implementation of concrete measures includes consultation with experts. Possible topics include the harmonization of quality standards for advance care directives or the improvement of access to the documentation of patients’ treatment wishes. Projects to raise awareness for professionals and the general public could also be developed. The SAMS will report on the project’s progress through its usual communication channels (bulletin, website and newsletter).
Composition of the working group
Franziska Adam, Scientific collaborator, Spitex Switzerland, Outpatient Care
Dr. med. Gabriela Bieri, SFGG, Geriatrics/Inpatient Long-term Care
Piero Catani, SAGES, Social Work
Prof. Dr. phil. Christine Clavien, Delegate Network Romandie, Ethics
Prof. Dr. med. Monica Escher, Division of Palliative Medicine
Prof. Dr. med. Miodrag Filipovic, SGI-SSMI, Intensive Care Medicine
Nathalie Gerber, SRK Switzerland, Counselling and Stakeholder Organization
lic. iur. Debora Gianinazzi, Federal Office of Justice, Law
Renate Gurtner Vontobel, MPH, palliative ch
PD Dr. med. Dr. phil. Ulrich Hemmeter, SGAP, Geriatric Psychiatry and Psychotherapy
Prof. Dr. med. Dr. phil. Paul Hoff, Central Ethics Committee, SAMS, Ethics/Psychiatry
Dr. med. Eva Kaiser, mfe, Family Medicine
Isabelle Karzig-Roduner, RN, MAE, MScN, ACP-Swiss, Advance Care Planning
Prof. Dr. med. Dagmar Keller, SSERM, Emergency Medicine
Claudia Kubli, CURAVIVA Switzerland, Long-Term Care/Residential Homes
Paola Massarotto, MNS, SGI-SSMI, Intensive Care Nursing (from 1.9.2022)
Prof. Beat Reichlin, Conference for the Protection of Children and Adults KOKES
Dr. med. Jana Siroka, FMH, Internal Medicine and Intensive Care Medicine
Annina Spirig, Pro Senectute Switzerland, Counselling and Stakeholder Organization
Michael Wehrli, SGI-SSMI, Intensive Care Nursing (until 31.8.2022)
lic. rer. soc. Silvia Marti, GDK (guest)
Stefan Berger, H+ (guest)
Simone Bertogg, LangzeitSchweiz (guest, until May 2022)
lic. theol., Dipl.-Biol. Sibylle Ackermann, SAMS (ex officio)
Dr. sc. med. Manya Hendriks, SAMS (ex officio)
lic. phil. I Flurina Näf, FOPH (ex officio)
Dr. sc. med. Milenko Rakic, FOPH (ex officio)