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ots-News: English

Dying in Switzerland - a review of current developments

07.02.2019 | 08:00 Uhr | Ressort: Economy | Quelle: Presseportal

Bern (ots) - All of us die - but the question is how? Today we
have a greater say in the way our lives end than ever before.
Nevertheless, most people do not die where they would like to. The
book "Das Lebensende in der Schweiz" (End of life in Switzerland)
reflects on what is currently known about dying in Switzerland. As a
conclusion: palliative care needs to be strengthened, but there are
still limits to the extent to which people can plan and control the
end of their lives.

Thanks to growing life expectancy and medical progress, people are
able to push death back until they reach an old age. While sudden
death has not disappeared, many people today have to contend with an
end-of-life phase that starts with disease and frailty, but only ends
with death years later. The end of life raises pressing questions for
us as individuals: How long do we still want to live and in what
circumstances? How do we want to die? What decisions need to be made?
And, not least of all, where do we want to die?

At the same time, doctors, carers, lawyers and sociologists are
all thinking about the end of life from a theoretical and practical
perspective. Up to what point is someone still capable of making
their own decisions? What rights do individuals have? Who decides
when to end life support? Is it possible to plan for decisions in
good time? And what does "in good time" mean in this context?

Taking stock from various perspectives

To mark the conclusion of the National Research Programme NRP 67
"End of Life", Schwabe Verlag is publishing a book entitled "Das
Lebensende in der Schweiz. Individuelle und gesellschaftliche
Perspektiven" (End of life in Switzerland. Individual and social
perspectives). The book provides a comprehensive survey of what
science currently knows about how people in Switzerland die, as well
as looking at the situation in other countries. Furthermore, it
reflects on this knowledge in the context of the key question of how
society can enable people to die with dignity.

The four authors draw on a wealth of experience and knowledge.
From 2012 to 2018, Markus Zimmermann (theologian, University of
Fribourg), Stefan Felder (economist, University of Basel), Ursula
Streckeisen (sociologist, Bern teacher training college) and Brigitte
Tag (jurist, University of Zurich) were members of the Steering
Committee of NRP 67 "End of Life". A year ago, the Steering Committee
published a synthesis report of the results from the 33 research
projects in the Programme. The new book goes beyond this report by
systematically examining the results of NRP 67 and the literature
that has been since published internationally. It goes into
particular depth on what is known about the processes of dying,
decisions at the end of life, end-of-life care, financial and legal
considerations, and ideals of dying.

Notions of what it means to "die well"

When it comes to ideals of dying, there are two diametrically
opposed schools of thought. For one thing, dying goes hand in hand
with a spiritual experience; it is seen as a process of maturation
and transition that can involve pain and loss of control. For
another, death centres around individual autonomy. It should occur as
free of complications as possible and at a self-appointed time. "To
better understand and deal with the conflicts that exist in society
about what the end of life should be like, it is important to develop
an awareness of different ideals of dying", says Markus Zimmermann.
"We are looking at a plurality of ideas and values, which explains
why even political end-of-life decisions are frequently the subject
of heated debate."

People are willing to pay

NRP 67 has shown that people in Switzerland are willing to cover
substantial costs at the end of life - the willingness is higher in
the French-speaking part of the country than in the German-speaking
part. Nevertheless, an open discussion of the cost-efficiency of
measures is needed. As NRP 67 documented, older people give rise to
fewer costs in the final stage of life than younger people. The
reasons for this are unclear and need to be investigated in greater
depth. As death approaches, are older people denied treatments? Or do
younger people receive too much, too expensive treatment at the end
of life?

Places to live and die

Four-fifths of people in Switzerland - and significantly more
women than men - die in hospitals and residential homes. Their needs
are not always taken into account. At present, many hospitals are not
equipped to support people in the process of dying or give them
appropriate care. Furthermore, residential homes regard themselves as
places to live.

"These institutions should make greater provision for the end of
life. There is a need not only to adapt basic attitudes to dying, but
also structures and processes", says Markus Zimmermann. "Dying at
home - which is what many dying people would like to do - is not
always a better alternative. Family members often feel overburdened
by this." The desire to die at home is an expression of longing for a
familiar, safe place. This longing is not fulfilled by converting the
living room into a "dying room" full of medical equipment and carers
coming in and out.

Encouraging palliative care

Timely and open dialogue between professional carers and the dying
and their families is often not taking place, even though it is
desirable. Palliative care has the greatest potential to improve this
situation. This comprehensive approach to providing support and care
centres around relief of suffering, helping to maximise quality of
life, taking into account social and spiritual needs, involving
relatives and ensuring that existing services are effectively
networked. "However, this is only possible if the everyday clinical
practice of dividing patients into those who receive curative care
and those who receive palliative care is abandoned. Introducing
palliative care at the appropriate juncture should become a natural
part of care and support during the final phase of life", says Markus

Pioneering eastern Switzerland

Eastern Switzerland is a pioneer in the field, since experience of
providing community-based palliative care has already been acquired
there. It has been found that success is dependent on planning and
gradually establishing a "culture of supportive togetherness" in
residential districts.

Nevertheless, Markus Zimmermann emphasises that no matter how
carefully the end of life is planned, the process of dying will
remain unpredictable and will frequently throw up unforeseen
questions. "There is only so much planning you can do for the final
phase of life, and that's something we have to live with."

(*) Markus Zimmermann, Stefan Felder, Ursula Streckeisen, Brigitte
Tag: Das Lebensende in der Schweiz. Individuelle und
gesellschaftliche Perspektiven (End of life in Switzerland.
Individual and societal perspectives). Schwabe-Verlag, Basel 2019,
228 pages:

German: https://schwabeonline.ch/schwabe-xaveropp/elibrary/start.x

French: https://schwabeonline.ch/schwabe-xaveropp/elibrary/start.x


National Research Programme NRP 67 "End of Life"

From 2012, NRP 67 delivered actionable and decision-making
knowledge for the final phase of life, dealing with living wills,
palliative care, assisted suicide, caring for dying relatives and
treatment decisions at the end of life. It identified gaps in
provision and delivered decision-making aids, both for the people
affected and for treatment providers, as well as examining the
ethical implications. NRP 67 had an alloted budget of CHF 15 million.

NRP 67: http://www.nfp67.ch/en/Pages/Home.aspx


The text of this press release, a download image and further
information are available on the website of the Swiss National
Science Foundation: http://www.snf.ch/en/researchinFocus/newsroom/Pag

Prof. Markus Zimmermann
University of Fribourg
Faculty of Theology
Avenue de l'Europe 20
1700 Fribourg
Phone: +41 (0)79 684 85 54
E-mail: markus.zimmermann@unifr.ch