Assessing decision-making incapacity at the end of life

The last phase of a person’s life is often accompanied by a state of decision-making incapacity (mental incapacity and decision-making inability). But precisely at the end of life, there are often complex decision-making situations that require mental capacity and decision-making ability. This means that physicians have to assess whether a patient is competent. If physicians determine that a patient is not (or no longer) competent to make a health care decision, this has consequences for the further way of proceeding. It may trigger the use of the patient’s living will, or a person with a medical power of attorney for the patient will be consulted.

In a first phase of this study, the literature on the topic will be reviewed and existing assessment instruments analysed. In a second phase, 300 physicians will be surveyed to investigate empirically what the current assessment practice in Switzerland is. The third phase consists of integration and ethical discussion of the results and proposals for the drafting of guidelines. This phase will be monitored by a multidisciplinary, international panel of experts. In addition, the researchers also plan to develop a training module for physicians.

This study will make an important contribution towards the establishment of national standards for the assessment of decision-making capacity. These are important in view of the increasing acceptance of patient self-determination. The results can be helpful for the development of future guidelines, for example by the Swiss Academy of Medical Sciences.

Decision-making incapacity at the end of life and its assessment in Switzerland