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Epidemiology, Biostatistics and Prevention Institute

Medical end-of-life decisions

Advances in medicine have made it increasingly possible to extend the end of a person’s life. As a consequence, also the need for medical decisions that have a
direct influence on how long the patient lives has increased. This study examines
the decision-making practice regarding continuing, withholding or withdrawing life-prolonging procedures. For this purpose, in 2013/14, 9,000 death certificates from the German-, French-, and Italian-speaking parts of Switzerland were randomly sampled. For each death certificate, the issuing physician was asked which medical procedures were used or forgone, for what reason, and who was involved in the decision-making. The study aims to deliver valid information on the type and prevalence of medical end-of-life decisions in Switzerland. Comparisons with other European countries
and with the first study of this kind in Switzerland, conducted in 2001/02, will
provide insights on trends. A special focus is given to continuous deep sedation until death.The results of the study aim to improve awareness of ethical aspects in medical end-of-life decisions and to contribute towards improving the quality of life of persons with terminal illness.



  • Medical end-of-life practices in Switzerland: A comparison of 2001 and 2013.
    Bosshard G, Zellweger U, Bopp M, Schmid M, Hurst SA, Puhan MA, Faisst K.
    JAMA Internal Medicine 2016;176(4):555-556
  • Medical end-of-life decisions in Switzerland 2001 and 2013: Who
    is involved and how does the decision-making capacity of the patient impact?
    Schmid M, Zellweger U, Bosshard G, Bopp M. Swiss
    Med Wkly 2016;146:w14307
  • Medizinische Entscheidungen am Lebensende sind häufig.
    Bosshard G, Hurst SA, Puhan MA für die Swiss Medical End-of-Life Decisions Study Group.
    Swiss Med Forum 2016;16(42):696-698
  • Medical end-of-life practices in Swiss cultural regions: a death certificate study.
    Hurst SA, Zellweger U, Bosshard G, Bopp M.
    BMC Medicine 2018;16:54
  • Continuous deep sedation until death in patients admitted to palliative
    care specialists and internists: A focus group study on conceptual
    understanding and administration in German-speaking Switzerland.
    Ziegler S, Schmid M, Bopp M, Bosshard G, Puhan MA.
    Swiss Med Wkly 2018;148:w14657
  • Physician-related determinants of medical end-of-life
    decisions – a mortality follow-back study in Switzerland.
    Bopp M, Penders YWH, Hurst SA, Bosshard G, Puhan MA.
    PLoS ONE 2018;13(9):e0203960
  • Using sedative substances until death – A mortality
    follow-back study on the role of healthcare settings.
    Ziegler S, Schmid M, Bopp M, Bosshard G, Puhan MA.
    Pall Med (accepted Nov 2018)

Weiterführende Informationen


Matthias Bopp (Project Leader)

Milo Puhan

Margareta Schmid

Ueli Zellweger

Sarah Ziegler