assisted suicide; place of death; life-shortening; prevalence; euthanasia; end-of-life decisions; forgoing treatment
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BackgroundEthical issues in end-of-life decisions have been widely discussed in the literature from a theoretical perspective. However, data on doctors’ actual decisions is scarce. Currently, Swiss figures are limited to one single survey conducted ten years ago in the German speaking part of the country. Comparisons to other countries showed marked differences regarding "doctor-assisted-dying" (in particular assisted suicide) and "non-treatment-decisions". Differences in physicians' attitudes towards end-of-life decisions in the three linguistic areas of Switzerland suggest, that actual end-of-life decision-making substantially varies by region.ObjectivesMain goal of the study is to achieve an up-to-date, detailed picture of the prevalence of end-of-life decisions, to look for variation and to explain patterns of decision making by:- giving an up-to-date analysis of end-of-life decision-making- establishing comparisons between practices in the German, the French and the Italian speaking part and comparing results to other countries - evaluating changes over time in the German speaking part- disentangling physician/patient/cultural/regional health-care-system determinants of decision-making- finding physician- and patient-related determinants for selective types of decisions.Data and MethodsA stratified random sample (N=9000) of death certificates will be used to trace certifying physicians. These are asked to fill in a questionnaire on medical decisions preceding death. The questionnaire contains all core questions used in the study a decade ago, i.e. measures taken or forgone; intentions concerning these measures; persons involved in the decision making process; characteristics of the physician. To guarantee anonymity of the physician, the questionnaires will be collected and anonymized by the Swiss Academy of Medical Sciences. When receiving the filled in questionnaires, the research team will not have any more access to physicians’ names or addresses.Relevance of expected resultsChanges in medical guidelines, attitudes towards health care aims, and the social and financial context of health care may influence physicians’ decision-making. End-of-life decision policies are nearly permanent topics on the political agenda and in the expert and public debate. Up-to-date results on assisted suicide will be of particular interest, as Switzerland has a worldwide unique model of officially tolerating the involvement of so-called right-to-die societies.This study provides important knowledge about current medical end-of-life decision-making in Switzerland and its variation within the country, allowing for valid comparisons with other countries. This will help understanding how socio-cultural differences (e.g., between the three different linguistic areas or concerning the religious affiliation of the deceased) or differences in physician characteristics impact on the prevalence of medical end-of-life decisions. A particular strength is the possibility to analyze and disentangle physician-, patient- and region-related determinants. In addition, the study will provide for the first time trend data for Switzerland and - as an important contribution to the search for broader European patterns - reliable data covering a French speaking population. The study results will enable an important empirical knowledge base helping physicians, public health policy makers, and the general population to engage in an interdisciplinary dialogue and to develop rational, evidence-based standards and policies of decision-making.