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.
The revised guidelines were published in 2018. They now cover not only end-of-life care but also discussions with patients who have been diagnosed with a terminal disease and management of the desire for death. Assisted suicide in patients not facing imminent death is also explicitly addressed.
According to the SAMS guidelines, in the case of patients with capacity, assisted suicide is justifiable if the symptoms of disease and/or functional impairments are causing intolerable suffering and other options have proved ineffective or are rejected as unacceptable by the patient. 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. The patient’s desire must be well-considered, enduring and not due to external pressure. The guidelines also emphasise, 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.
In October 2018, the Swiss Medical Association decided that the SAMS guidelines «Management of dying and death» would not be incorporated in the FMH Code. In response to this decision, a statement was issued by the SAMS on 26 October 2018 (available in French and German).
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.
Previously valid SAMS guidelines on end-of-life care and documents relevant to the development of the current guidelines (2018) are available under Background.