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, and has published medical-ethical guidelines on this topic.
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. 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.
Most recently, the Central Ethics Committee of the SAMS appointed a subcommittee in May 2015 to completely 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. Information on this study and the previously valid SAMS guidelines on end-of-life care, along with other relevant documents are available under Background.
Current 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 shared decision-making and advance care planning of end-of-life treatments and measures. They address, for example, the right to self-determination, issues around quality of life, suffering and its alleviation, care and support for relatives, and decision-making models such as advance care planning (ACP). Assisted suicide in patients not facing imminent death is also explicitly addressed.
The section on assisted suicide had proved controversial in the public consultation and led to uncertainties in practice after publication of the guidelines. This section was therefore amended and was adopted by the various SAMS bodies in 2021.
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.
Under Assisted suicide, this specific topic is discussed in more detail, including FAQs.
Case study «Management of dying and death»
From 2018 to 2024, the «Primary and Hospital Care» journal featured selected topics with practical examples from everyday medical practice to illustrate the SAMS medical-ethical guidelines. Part 4 of this series (available in French/German) concerns the management of dying and death.