The Swiss end-of-life framework
Switzerland has a pragmatic and progressive approach to end of life:
- Developed palliative care, reimbursed by LAMal
- Legal assisted suicide under conditions (Article 115 of Penal Code)
- Advance directives legally recognised
- Significant patient freedom of choice
Palliative care
Definition
Palliative care aims to relieve physical and psychological suffering of those with serious illness, without necessarily curing.
Where to benefit
- At home: specialised Spitex, mobile teams
- In EMS: all Swiss EMS must offer palliative care
- Specialised hospital units: HUG (Bellerive), CHUV, USZ, Ticino
- Palliative care homes: La Maison de Tara (GE), Rive-Neuve (VD), Hospiz im Park (Aargau)
Coverage
- LAMal: covers palliative care like any medical care
- No upfront payment for most situations
- Psychological and spiritual support often included
Advance directives
Principle
Written document expressing your wishes about medical care if you become unable to consent (coma, advanced dementia, etc.).
Typical contents
- Refusal or acceptance of cardiopulmonary resuscitation
- Refusal or acceptance of artificial feeding
- Refusal or acceptance of intubation, ventilation
- Wishes for pain relief (even if it shortens life)
- Wish to be at home or in hospital for the end
- Therapeutic representative designation
Where to find forms
- FMH (medical form): paid, complete
- Caritas, Pro Senectute: free or low-cost
- University hospitals: personalised advice
- EXIT: for members
Validity
- No expiry but update regularly
- Written form mandatory, signed
- Witnesses optional but recommended
- Keep at home + give copy to GP + representative
Therapeutic representative
- Person making medical decisions for you if incapable
- Clearly designate in advance directives
- Often: spouse, adult child, close friend
Assisted suicide
Legal framework
- Long legal in Switzerland
- Article 115 of Penal Code: punishes aid to suicide only if motivated by selfish motive
- No active euthanasia (direct administration by third party remains illegal)
Conditions
- Patient discernment capacity
- Repeated request over time
- Serious, incurable illness or intolerable suffering
- Free, considered decision, without pressure
- Final act: the patient takes the substance themselves (drinks or activates)
Organisations
- EXIT (French and German Switzerland): best-known, 150,000+ members
- DIGNITAS (Forch, ZH): also accepts non-residents ("end-of-life tourism")
- Lifecircle: Basel
- Pegasos: Basel, founded by former EXIT members
Procedure
- Membership of the organisation (annual fee CHF 45–200)
- Reasoned request with medical file
- Interviews with doctor and organisation representative
- Mandatory reflection period
- Independent prescribing physician
- Act often at home or a neutral apartment
- Police always informed, routine investigation
Cost
- EXIT: membership + accompaniment fees CHF 1,500–3,000
- DIGNITAS: EUR 7,000–11,000 for non-residents
- Not covered by LAMal
EMS (Care homes)
The Swiss system
- 1,500+ EMS in Switzerland, ~95,000 beds
- Mixed public/private
- Costs: CHF 5,000–12,000/month by canton and care level
- Coverage: LAMal covers care, patient pays pension and accommodation
Financial aid
- AVS/AI supplementary benefits (PC): if pension insufficient, complements to cover costs
- Helplessness allowance (API): for heavy care, CHF 600–3,000/month by degree
- Cantonal aid: depending on situation
Choosing an EMS
- Visits before registration: essential
- Waiting list: can be long (3–12 months) for good establishments
- Criteria: care quality, atmosphere, activities, family proximity, religion
Palliative care at home
Specialised Spitex
- Home nursing: reimbursed by LAMal
- Psychosocial support
- Caregiver relief
- 24/7 in some regions
Family caregivers
- AVS credits for care tasks
- Helplessness allowance may fund family care
- Associative support: Pro Senectute, Caritas, Cancer League
Cultural and religious aspects
Catholicism
- Opposes assisted suicide
- Encourages palliative care
Protestantism
- More open to individual choice
- Vaud and Zurich Reformed Churches tolerate
Islam, Judaism
- Oppose assisted suicide
- Respect palliative care
Atheists and agnostics
- More inclined to choose assisted suicide
Tips
- Plan ahead: write advance directives from age 50 (or earlier)
- Talk to your family: avoids conflicts and unspoken issues
- Inform your GP of your wishes
- Choose a trusted therapeutic representative
- Learn about regional EMS before needing one (in case of accident, sudden illness)
- For assisted suicide: considered process, EXIT offers info and advice
- Palliative care: excellent in Switzerland, don't hesitate to request
- Support: Caritas, Pro Senectute, patient leagues offer free or low-cost support
