Advance Care Planning

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Health, illness and quality of life are decisive factors for a dignified end-of-life. Addressing treatment options and the end-of-life at an early stage are prerequisites for promoting self-determination. 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 in Switzerland.

Advance care planning is about initiating discussions about personal values, wishes, expectations and ideas with regard to treatment and care in the event of illness, accident or need for care, and about recording these in a tangible form for third parties in case he or she loses decision-making capacity. Advance care planning is a dynamic process aimed at ensuring 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.

 

In order to promote and improve advance care planning, measures must be taken in Switzerland with regard to advance care directives, counselling and/or funding. Against this background, the Federal Council has commissioned the FOPH, Section National health policy, in collaboration with the SAMS, to set up a working group on «Advance Care Planning» to steer the national process.

 

The basis for this work is the postulate 18.3384 (available in German or French), which the Federal Council passed on 18 September 2020. In this report, the Federal Council identifies areas in which measures need to be adopted, including inter alia advance care planning; advance care directives are often unavailable, not found or inapplicable for professionals because the included statements are not meaningful in an emergency situation. Furthermore, the end-of-life is often treated as an acute event, whereas around 70 per cent of deaths in Switzerland are foreseeable and could be anticipated.

 

Objectives and approach

The working group set up by the FOPH and SAMS aims to shape and concretise the concept of advance care planning. 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.

 

The work began in May 2021. The first objective of the working group is to develop a national consensus on the form of advance care planning to ensure self-determination for patients who are ill or at the end-of-life.

 

The implementation concept (Version May 2021) is available in German or French.

 

The implementation of concrete measures includes consultation with experts and the formation of subgroups. Possible topics include, for example, 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 project’s progress through its usual communication channels (Bulletin, website and newsletter).

 

 

Composition of the working group

Franziska Adam, Spitex Switzerland, Outpatient Care
Stefan Berger, H+ (Guest)
Simone Bertogg, LangzeitSchweiz (Guest)

Dr. med. Gabriela Bieri, SFGG, Geriatrics/Inpatient Long-term Care
Piero Catani, SAGES, Social Work
Dr. phil. Christine Clavien, Delegate Network Romandie, Ethics
Prof. Dr. med. Monica Escher, MER, 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, ACP-Swiss, Advance Care Planning
Prof. Dr. med. Dagmar Keller, SSERM, Emergency Medicine
Claudia Kubli, Curaviva Switzerland, Long-Term Care/Residential Homes
Silvia Marti, GDK (Guest)
Dr. med. Jana Siroka, FMH, Internal Medicine and Intensive Care Medicine
Annina Spirig, Pro Senectute Schweiz, Counselling and Stakeholder Organization
Michael Wehrli, SGI-SSMI, Intensive Care Nursing
Prof. Beat Reichlin, Conference for the Protection of Children and Adults KOKES

 

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)

 

 

 

CONTACT

Dr. Manya Hendriks
Project Manager Ethics