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Open Access 01-12-2018 | Research article

Medical end-of-life practices in Swiss cultural regions: a death certificate study

Authors: Samia A. Hurst, Ueli Zellweger, Georg Bosshard, Matthias Bopp, for the Swiss Medical End-of-Life Decisions Study Group

Published in: BMC Medicine | Issue 1/2018

Abstract

Background

End-of-life decisions remain controversial. Switzerland, with three main languages shared with surrounding countries and legal suicide assistance, allows exploration of the effects of cultural differences on end-of-life practices within the same legal framework.

Methods

We conducted a death certificate study on a nationwide continuous random sample of Swiss residents. Using an internationally standardized tool, we sent 4998, 2965, and 1000 anonymous questionnaires to certifying physicians in the German-, French-, and Italian-speaking regions.

Results

The response rates were 63.5%, 51.9%, and 61.7% in the German-, French-, and Italian-speaking regions, respectively. Non-sudden, expected deaths were preceded by medical end-of-life decisions (MELDs) more frequently in the German- than in the French- or Italian-speaking region (82.3% vs. 75.0% and 74.0%, respectively), mainly due to forgoing life-prolonging treatment (70.0%, 59.8%, 57.4%). Prevalence of assisted suicide was similar in the German- and French-speaking regions (1.6%, 1.2%), with no cases reported in the Italian-speaking region. Patient involvement was smaller in the Italian- than in the French- and German-speaking regions (16.0%, 31.2%, 35.6%). Continuous deep sedation was more frequent in the Italian- than in the French- and German-speaking regions (34.4%, 26.9%, 24.5%), and was combined with MELDs in most cases.

Conclusion

We found differences in MELD prevalence similar to those found between European countries. On an international level, MELDs are comparably frequent in all regions of Switzerland, in line with the greater role given to patient autonomy. Our findings show how cultural contexts and legislation can interact in shaping the prevalence of MELDs.

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Title: Medical end-of-life practices in Swiss cultural regions: a death certificate study
Authors: Samia A. Hurst
Ueli Zellweger
Georg Bosshard
Matthias Bopp
for the Swiss Medical End-of-Life Decisions Study Group
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2018
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-018-1043-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Medical end-of-life practices in Swiss cultural regions: a death certificate study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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