Medical end-of-life decisions: prevalence and trends in Switzerland


Advances in medicine have made it increasingly possible to extend the end of a person’s life. Medical decisions that have a direct influence on how long the patient lives are becoming ever more frequent. This study examines the decision-making practice regarding the use of life prolonging procedures or withholding or withdrawing such procedures.

Project description (completed research project)

Medical care and life prolonging procedures at the end of life, as well as the patient’s right to self-determination have been the subject of broad public and political discussions for years. In addition to ethical aspects, the question of financial viability is being raised more and more, particularly as medical progress increasingly enables prolonging terminal illness. Reliable information on medical end-of-life decision-making practice is scarce. It can be assumed that the decision-making is not only defined medically but is also influenced by cultural norms and the attitudes of patients, family members and treating physicians.


This study aims to deliver valid and up-to-date information on the type and prevalence of medical end-of-life decisions in Switzerland. Comparisons will be drawn between the different language regions of Switzerland and with other European countries. A comparison with the first study of this kind in Switzerland, conducted in 2002, will also provide insights on developments and trends. The starting point will be 9 000 randomly sampled death certificates from the German-, French-, and Italian-speaking parts of Switzerland. For each death certificate, the issuing physician will be asked what medical procedures were used, for what reason, prior to the death of the patient, and how the decision-making processes went, and who was involved in the decision-making.


This study will provide a reliable evidence base and landmark for medical practice, policy decisions, and development of guidelines, but also for public discussion. The results should lead to improved awareness of ethical aspects of medical end-of-life decisions and contribute towards improving the quality of life of persons with terminal illness.

Original title

Medical end-of-life decisions: prevalence and trends in Switzerland

Project leader

  • Prof. Dr. med. Milo Puhan, Institut für Epidemiologie, Biostatistik und Prävention, Universität Zürich
  • Dr. Georg Bosshard, Alterszentrum Oberi, Winterthur
  • Dr. Karin Faisst, Institut für Sozial- und Präventivmedizin, Universität Zürich
  • Prof. Dr. med. Felix Gutzwiller, Institut für Epidemiologie, Biostatistik und Prävention, Universität Zürich
  • Prof. Dr. Samia Hurst, Institut für biomedizinische Ethik, Universität Genf
  • Dr. Christoph Junker, Sektion Gesundheit, Bundesamt für Statistik, Neuchâtel

Institutionelle Zusammenarbeit

  • Bundesamt für Statistik, Neuchâtel
  • Schweizerische Akademie der Medizinischen Wissenschaften, Basel
  • End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Belgium
  • Institut für biomedizinische Ethik, Universität Genf



Further information on this content


Prof. Dr. Milo Puhan Universität Zürich
Institut für Epidemiologie, Biostatistik und Prävention
Hirschengraben 84 8001 Zürich +41 44 634 46 10

Products of the project