Advance care planning (ACP) strengthens self-determination in healthcare, especially in situations of incapacity. Everyone should be able to plan their care in advance if they wish to do so. A national working group co-led by the SAMS and the Federal Office of Public Health (FOPH) aims to further establish ACP in Switzerland and to embed it in daily practice.
When engaging in advance care planning (ACP), individuals must take time to reflect on their personal values, wishes, expectations and ideas regarding treatment and care in the event of illness, accidents or the need for medical attention. This involves recording one's wishes for third parties in case the person loses decision-making capacity. Planning one’s care in advance increases self-determination and reassurance, regardless of age or health status.
ACP is voluntary, but should be accessible and understandable for all who are interested in the topic. The Swiss Federal Council formulated a need for action in a postulate report 18.3384 (available in German or French). Healthcare professionals often cannot find or access advance care directives, or cannot use them because the respective 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 strengthen the awareness, accessibility, and quality of ACP, 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 ACP 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.
Roadmap with 12 recommendations
Since 2021, the broad-based working group led by the FOPH and SAMS has analysed the need for action. A model with concrete recommendations was open for public consultation from 17 May until 15 July 2022. Taking into account the 170 comments received, the working group published the «Roadmap for the implementation of advance care planning (ACP) in Switzerland» in March 2023. The roadmap outlines 12 recommendations that should help to expand and anchor the use of ACP further in everyday (medical) practice. The document is available in four languages:
Supplements to the roadmap:
With «spectra», the FOPH provides information about projects, programmes and new trends in the fields of health promotion and prevention. The spectra podcast n° 25 is dedicated to the topic of ACP and also features Valérie Clerc, Secretary General of the SAMS.
The recommendations listed in the roadmap are to be implemented in a phased manner. Works and projects will be carried out by subgroups, for instance on starter questions for ACP, on long-term care, and on the document «Medical order for life-sustaining treatment». The SAMS will report on the project’s progress through its usual communication channels (bulletin, website and newsletter).
Composition of the working group
Prof. Dr. med. Miodrag Filipovic, SGI-SSMI, Intensive Care Medicine, President
Franziska Adam, 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, palliative.ch
Nathalie Gerber, SRK Switzerland, Counselling and Stakeholder Organization
lic. iur. Debora Gianinazzi, Federal Office of Justice, Law (until end of 2021)
Renate Gurtner Vontobel, MPH, palliative ch
PD Dr. med. Dr. phil. Ulrich Hemmeter, SGAP, Geriatric Psychiatry and Psychotherapy
Prof. em. Dr. med. Dr. phil. Paul Hoff, Central Ethics Committee, SAMS, Ethics/Psychiatry
Dr. med. Eva Kaiser, mfe, Family Medicine (until end of 2023)
Isabelle Karzig-Roduner, RN, MAE, MScN, ACP-Swiss, Advance Care Planning
Prof. Dr. med. Dagmar Keller, SSERM, Emergency Medicine
Claudia Kubli, ARTISET (Federation of the branch associations CURAVIVA, INSOS and YOUVITA), Long-Term Care/Residential Homes (until end of april 2023)
Dr. med. Philipp Luchsinger, mfe, Family Medicine (from autumn 2023)
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. phil. Reka Schweighoffer, CURAVIVA, Long-Term Care/Residential Homes (from april 2023)
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. iur. Judith Wyder, Federal Office of Justice, Law (from 2022)
lic. rer. soc. Silvia Marti, GDK (guest)
Stefan Berger, H+ (guest)
Simone Bertogg, LangzeitSchweiz (guest, until May 2022)
Dominique Elmer, LangzeitSchweiz (guest, from June 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)
lic. phil. I Lea von Wartburg, FOPH (ex officio)