In a medical emergency, it is crucial to act immediately while also taking the patient’s presumed wishes into account. To ensure this, various forms exist. A national working group has analyzed their role and recommends a standardized form for the whole of Switzerland. Public feedback on this concept is open until the end of February 2026.
The most common advance care planning (ACP) document is the advance directive. Some forms contain a compilation of instructions for emergency situations. If this is not the case, a separate ACP emergency form can be a useful addition.
In Switzerland, there is currently no standardized definition or approach. For this reason, the national ACP working group has set up a sub-working group to clarify the significance of these forms and their relationship to other ACP documents. The aim is to introduce and use a standardized ACP form for emergency situations nationwide (see recommendation 11 of the ACP roadmap).
Open to feedback: Concept «ACP for emergency situations»
Since the summer of 2024, the sub-working group has closely examined issues relating to patients’ presumed wishes in emergency situations. The focus is on seriously ill or frail individuals who are at increased risk of sudden deterioration in health, which is often accompanied by a loss of decision-making capacity. If patients’ presumed wishes are recorded in writing and immediately available, they can be acted upon. The greater the likelihood of serious complications or emergency situations, the more important it is to consider which medical measures are desired and which are not.
The group is proposing the development of a nationwide, standardized ACP form. The form should be completed with the support of a consulting professional and, unlike an advance directive, it can also be completed on behalf of individuals who lack decision-making capacity. In this context, the medical profession has a key role to play.
The recommendations are set out in a concept paper. Feedback on these recommendations is welcome until the end of February 2026. All interested institutions, organizations and individuals are invited to review the concept paper and provide feedback. A feedback form is included in the concept paper. The invitation letter and feedback form are available in French and German:
Legal aspects
The SAMS has commissioned Prof. Dr iur. Regina Aebi-Müller of the University of Lucerne to prepare an expert opinion on the legal issues. The main aim was to clarify the legal status of «Medical order for life-sustaining treatment» forms, which are used in many cantons and hospitals, in relation to the Swiss Civil Code (CC), which refers only to «advance directives» and «treatment plans» as ACP instruments.
The following findings can be derived from the legal opinion regarding the positioning of the ACP form for emergency situations and similar existing forms.
Although the form is not explicitly mentioned in the legislative framework, it is a valid ACP document that must be taken into account in treatment. This is true for two reasons: first, an advance directive can be limited to specific situations – including acute emergencies. Second, there is a connection to the treatment plan, which must cover not only the current medical situation but also a foreseeable emergency situation.
From a legal perspective, the existence of a separate legal form for emergency situations is an advantage. Ideally, both the advance directive and the treatment plan should contain information on personal values, treatment goals and scenarios in the event of incapacity. However, in an emergency, it is often difficult to determine the right course of action quickly enough. The emergency form fills this gap and makes a vital contribution to ensuring that the patient's presumed wishes are respected.
Composition of the sub-working group
Professor Mio Filipovic, SGI-SSMI, Intensive Care Medicine, President
lic. theol., dipl. biol. Sibylle Ackermann, Ethics, SAMS (ex officio)
Dr Gabriela Bieri-Brüning, Zurich, Geriatrics/Inpatient Long-term Care
Professor Monica Escher, Geneva, Palliative Care
Monica Fliedner, Berne, Palliative Care (on behalf of Professor Steffen Eychmüller)
Dr Caroline Hartmann, Berne, Law
Isabelle Karzig-Roduner, RN, MAE, MScN, ACP-Swiss, Zurich, Advance Care Planning
Professor Dagmar Keller, SSERM, Saint Maurice, Emergency Medicine
Professor Tanja Krones, Zurich, Clinical ethics
Dr Barbara Loupatatzis, Wetzikon, Advance Care Planning
Dr Philippe Luchsinger, Affoltern, Family Medicine
Dr Marc Lüthy, Basel, Rescue Medicine
Dr Daniela Ritzenthaler, Lausanne, Ethics
lic. iur. Michelle Salathé MAE, Basel, Ethics and Law
Dr Andrea Trippini, Lausanne, Intensive Care Medicine
Silke Walter, MSc Palliative Care, APN, Liestal, Care