A review of the second dialogue event
"Self-determination at the end of life: Legal regulations". On 21 April, around 80 specialists from the fields of research, administration and practice gathered at Hotel Kreuz in Berne to discuss issues relating to this topic.
The adult protection law came into force in 2013. It allows adults of sound mind in Switzerland to write a living will that will maintain the right to self-determination should their capacity to exercise judgement become impaired at a later stage in life. The new law also aims to strengthen this right to self-determination. Can this goal be achieved? How are living wills applied in practice? In cases of doubt, what can be done to assess whether an individual is capable of making their own decisions at the end of life? And how can living wills be prepared so that they best respond to the interests of the terminally ill?
These and other issues were discussed in depth at the second dialogue event for NRP 67 "End of life”. The event was organised by NRP 67 in cooperation with the Federal Office of Justice. David Rüetschi, Vice Director of the Federal Office of Justice, made it clear from the outset that all new legal standards have to prove themselves in practice. Legislation is usually evaluated no earlier than three years after it has entered into force. That was also the case with the adult protection law. As such, he expressly encouraged the research that is being conducted as part of NRP 67 since it can be readily incorporated in the evaluation.
Research projects by Regina Aebi-Müller (represented by Bianka Dörr), Nicola Biller-Andorno (represented by Marcel Trachsel) and Tanja Krones were presented during the dialogue event. Among the findings was the fact there are still many difficulties when it comes to dealing with the practicalities of living wills. For example, medical teams often have trouble interpreting the information provided in them. On the other hand, doctors who assess people's capacity to exercise judgement in cases of doubt generally do not do so in a structured way. Experiences with advance care planning were also presented. This is an approach that could incorporate the experiences and interests of all stakeholders, including relatives.
The representatives of care provision organisations who had been invited – Patrick Fassbind (KESB Bern), Markus Loher (Pro Senectute Switzerland) and Jean-François Steiert (Federation of patient centres) – explicitly welcomed the research and saw their own personal experiences confirmed in the projects. They made it clear that the process of drawing up and discussing a living will is just as important for how the end of life is approached as the final document itself. This was also confirmed by the lively discussion with other participants at the event. Living wills and the corresponding processes are important tools in ensuring that the terminally ill retain the right to self-determination; it will just take some time to implement them in Switzerland.
The next dialogue event will look at assisted suicide and will take place in Berne on 4 July 2016.