A review of the fourth dialogue event

​In his opening remarks, Stefan Spycher, Vice Director of the Federal Office of Public Health, said that research into medical provision for the dying fitted in well with the Federal Council’s "Health 2020" strategy, which enshrines palliative care as a key element. He went on to explain that one of the aims of this strategy is also to improve the care provided to the dying in Switzerland. Where health policy is concerned, funding-related questions are a key issue, he added. Spycher also regards ethical issues as important and sees NRP 67’s research activities as a key contribution to the strategy, since they take both these areas into account and should help to determine where there are inadequacies in services for the dying.

First, Konstantin Beck (CSS Institute) and Barbara Fischer (Polynomics) presented some of the research results from their health economics project "Priceless? The value of health care at the end of life". They demonstrated that the costs of caring for dying people vary greatly depending on the circumstances: only a very small proportion of cases (approx. 2 percent) cause excessively high costs, and the costs of end-of-life care fall the older the person in question is. The Swiss population is evidently more than willing to pay for end-of-life care, although there are noticeable differences between the German-speaking and French-speaking regions of the country.

The research project presented by Samia Hurst (University of Geneva), entitled "Medical end-of-life decisions: prevalence and trends in Switzerland", investigated what kind of end-of-life decisions doctors made, and who – from the doctors’ perspective – was involved in these decision-making processes. Compared with figures for 2001, there has been a marked increase in the practice of keeping patients under deep sedation until they die. According to Hurst, it is also striking that in one in every seven cases, an end-of-life decision was not discussed with either the family or the person dying, even when the patient was still capable of judgement.

Matthias Egger (University of Bern) used the results of the project "Regional differences in medical care at the end of life" to show that there are big regional differences in end-of-life care in terms of cost, place of death and intensity of treatment. Substantial differences were noted between the German-speaking and French-speaking regions of Switzerland. In the French-speaking part, for example, more people died in residential homes and hospitals than was the case in the German-speaking part. On the other hand, the research group was able to show that socio-economic differences had very little impact on end-of-life care.

The practitioner representatives participating in the dialogue – Michael Jordi, General Secretary of the Swiss Conference of the Cantonal Ministers of Public Health (GDK), Catherine Gasser, Head of the Department of Aftercare at Krebsliga Schweiz (the Swiss Cancer League), and Jürg Schlup, President of the Swiss Medical Association (FMH) – found that the results discussed, and especially those presented by Samia Hurst, provided valuable input for their work. They felt there was a need for action to improve communication between medical staff, the people dying and their families.

The practitioner representatives considered the clear presentation of the costs incurred at the end of life to be useful, but at the same time they raised the question of whether the human sciences had provided sufficient insights regarding the quality of life of the dying. What is meant by quality of life at the end of life? Not always measures to extend life, but, for example, the wish to die at home. If end-of-life care is to improve, palliative medical care therefore needs to be backed up with care that focuses on quality of life – something that is in many cases only too clearly lacking at the moment.

The fifth and last dialogue event on the cultural and social concepts and ideals related to good dying will take place in Berne on 8 December 2016.