Misfortune can strike any one of us and throw our lives off course. Who can make medical decisions when you are no longer able to? With an advance healthcare directive, you and your family retain a sense of self-determination and can define what happens should you lose capacity of judgement. Swiss Life answers the most important questions.
If you are admitted to hospital unconscious, you will not be in a position to tell the doctors what medical treatment you would like. With an advance healthcare directive, you define in advance how you want to be treated and who can make decisions on your behalf.
1. What is an advance healthcare directive?
With an advance healthcare directive, a person capable of judgement defines, among other things, their medical treatment preferences in the event that they lose capacity of judgement. This includes, for example, whether or not they want to be resuscitated or put on a ventilator.
You can also specify in an advance healthcare directive who should be authorised to make decisions on your behalf should you lose capacity of judgement. This person then has full authority to discuss medical interventions with the attending doctor, to make decisions on that basis and to ensure your personal wishes are respected.
2. Who can create an advance healthcare directive?
Any person capable of judgement can create an advance healthcare directive. The advance healthcare directive is a very personal right and something you can only create for yourself.
3. Who makes the decisions if there is no advance healthcare directive?
In the absence of an advance healthcare directive, the following persons will have legal right of representation in the specified order to decide on medical interventions if a patient is incapable of judgement, provided they have also provided that patient with regular personal assistance:
- Anyone appointed to act as proxy in relation to medical interventions
- Spouse or registered partner
- Cohabiting partner
- Children
- Parents
- Siblings
If multiple persons with decision-making authority (e.g. children) fail to reach an agreement amongst themselves, this may in extreme cases lead to an organisation such as the child and adult protection authority (KESB/APEA) having to intervene.
4. Why is it useful to have an advance healthcare directive?
- You retain your ability to make self-determined choices and ensure that there are no unwanted medical interventions.
- You protect your loved ones from having to make difficult decisions by taking responsibility yourself.
- You determine yourself which medical interventions are permissible, such as whether or not you want life-sustaining or life-prolonging treatment.
- You decide whether or not you want to be supported by medicine or machines.
- The medical staff is obliged to abide by your instructions.
5. How do you formulate an advance healthcare directive?
In your advance healthcare directive, you specify which medical interventions you do or do not consent to in a given situation. You can also nominate a person you trust to make healthcare decisions on your behalf if you are no longer able to do so yourself.
Medical interventions include treatment by a doctor, therapeutic and care precautions and details of personal preferences (e.g. specific operations, procedures, therapies, medicines, pain relief, prolongation of life, artificial nutrition and ventilation, terminal care, place of death, organ donation, autopsy). It is important that the advance healthcare directive makes clear to medical staff what “quality of life” means to you personally.
If you have any specific formulation queries or are unsure about anything, you should seek the advice of qualified specialists.
Various organisations provide templates for advance healthcare directives. For example, the Swiss Medical Association (FMH) has a short version and a detailed version available for download.
6. When is an advance healthcare directive valid?
The advance healthcare directive must be drawn up in writing, personally dated and signed by hand to be legally valid. It does not need to be certified – this is not a legal requirement.
It is recommended that you review, re-sign and re-date the advance healthcare directive every two years to confirm your current wishes. However, this is not required for the directive to remain valid. If the content is amended, the directive should be completely redrafted.
7. When does an advance healthcare directive take effect?
The provisions of an advance healthcare directive only come into force if the person loses capacity of judgement (temporarily or permanently) and medical interventions are necessary. A doctor determines the person’s capacity of judgement.
8. Where can I store the advance healthcare directive?
You should store the signed advance healthcare directive in a place that can be found quickly in an emergency. You are also advised to give a copy to your family and/or your family doctor and to always carry a card (e.g. in your wallet) indicating the existence and location of the advance healthcare directive. If you have an electronic patient record, you can also save a copy of the advance healthcare directive there.
Tip
You can have the existence and location of the advance healthcare directive entered on your health insurance card. Doctors are obliged to consult the insurance card prior to any further treatment of a person who is incapable of judgement and will therefore be aware that a directive is in place.
9. How much does an advance healthcare directive cost?
Depending on the provider, templates for advance healthcare directives may be free of charge or you may have to pay a fee.
10. Will I have to amend my advance healthcare directive because of the changes in inheritance law applicable from 2023?
You do not need to amend your advance healthcare directive due to changes in inheritance law. The amended provisions of inheritance law that came into force on 1 January 2023 have no impact on existing or new advance healthcare directives.
Advance directive
It is a good idea to draw up an advance directive as well as an advance healthcare directive. This determines who should represent you in personal, financial or legal matters should you lose capacity of judgement.
Questions?
Our experts will be happy to advise you.
