End-of-life decision-making poses significant challenges, not only for patients but also for relatives and the medical care team. The SAMS has been addressing issues relating to the management of dying and death for several decades.
The SAMS first published medical-ethical guidelines on the topic of end-of-life care in 1976. These guidelines, setting standards for medical conduct in this area, are regularly revised. Guidelines on the use of palliative care in all fields of medicine were issued in 2006.
Provision of treatment, care and support for patients who are facing death is a key medical duty, requiring a high degree of respect and considerable ethical responsibility. In May 2015, the Central Ethics Committee of the SAMS appointed a subcommittee to revise the 2004 guidelines on end-of-life care.
In the revision process, the subcommittee held expert hearings, took into account the results of the National Research Programme «End of Life» (NRP 67) and also drew on a study commissioned by the SAMS concerning Swiss physicians’ attitudes to assisted suicide.
This study, previously valid SAMS guidelines on end-of-life care and documents relevant to the development of the current guidelines are available under Background.
In force: guidelines 2018, adapted in 2021
The medical-ethical guidelines «Management of dying and death» were published in 2018 with the aim of facilitating discussions about dying and death and promoting joint decision-making and advance planning of treatments and measures at the end of life. They address, for example, the right to self-determination, issues around quality of life, suffering and relief of suffering, care and support for relatives or decision-making models such as Advance Care Planning. Assisted suicide in patients not facing imminent death is also explicitly addressed.
The chapter on assisted suicide had already led to controversial discussions in the public consultation and to uncertainties after publication of the guidelines. The chapter was therefore amended, adopted by the different SAMS bodies in 2021 and published in May 2022.
The new text explicitly states what was implicit in 2018: assisted suici de for healthy persons is not medically and ethically justifiable according to the guidelines. Assisted suicide is justifiable in the case of a patient with capacity if he or she is suffering unbearably from the symptoms of an illness and/or functional impairments, the severity of the suffering is substantiated by an appropriate diagnosis and prognosis, and other options have been unsuccessful or are rejected by the patient as unreasonable.
In order to ensure that the desire for suicide is well-considered and enduring, the guidelines now specify that the physician must – other than in justified exceptional cases – conduct at least two detailed discussions with the patient, separated by an interval of at least two weeks.
The patient’s desire not to continue living in this situation of intolerable suffering must be comprehensible to the physician on the basis of the previous history and repeated discussions. However, an objective determination of suffering is neither possible nor required by the guidelines. The guidelines also emphasize, however, that patients cannot claim to be entitled to assisted suicide, and that physicians are free to decide whether or not to consider this option.
The guidelines seek to mediate between different viewpoints and values, and to ensure that the self-determination of all parties – patients, relatives and medical professionals – is respected and protected.
Under Publications, print versions of SAMS medical-ethical guidelines (in French/German) can be ordered free of charge, and electronic versions are available in English.