Treatment teams often have to make medical decisions in situations where patients lack capacity. Advance care planning enables individual goals and preferences for future medical treatment to be discussed at an early stage. We offer all USZ patients the opportunity to discuss their personal goals and preferences and to record them in a "Plus" living will.
Anyone who is seriously ill should have a say in their treatment and be able to incorporate their values and wishes into it. A living will is your tool for clearly and comprehensibly formulating your expectations regarding your treatment. As long as you have the capacity to make decisions, every medical measure and every therapy that could be considered for you will be discussed with you. Before you give your consent, the advantages and disadvantages of various options will be weighed up with you. Only then will you be asked for your consent.
Please bring a copy of your living will with you on admission to hospital. Give them to your medical team. They will file a copy in your patient file so that the treatment teams are aware of your wishes. Keep the original at home. It is important that the living will corresponds to your current wishes and is discussed with your relatives and the doctors treating you. Our doctors and nursing staff will also talk to you about this. They would like to clarify with you whether your living will is meaningful for treatment in hospital.
In the living will, you can specify which treatment you want or refuse, or which life-prolonging measures you do not want if you are no longer able to express your wishes. This may be the case during an operation, especially if intensive care is required. You can also appoint an authorized representative to represent your will if you are unable to do so yourself. The doctors will then make the decisions about your medical treatment with this person or these persons.
Advance Care Planning (ACP) allows you to record your expectations and concerns regarding future medical treatment in such a way that they can be implemented in a crisis situation or if your illness worsens. Well informed and educated about the respective chances of the various treatments, we work with you to formulate and document the living will “Plus”, a kind of extended living will.
In a detailed and structured discussion (lasting approx. one hour), you determine your personal treatment expectations and limits together with specially trained counselors. Think about whether you would like to take part in the first interview alone or with someone you trust. Be sure to take an existing living will with you. Otherwise you do not need any preparation or prior knowledge.
Our experience shows that it usually takes two appointments to complete the “Plus” living will.
Your personal consultation will be conducted by trained specialists at the USZ and is an integral part of the “Plus” living will.
For patients who are currently being treated at the USZ, the consultation will be charged via the treatment costs. If you are not a patient with us, we currently have to charge a flat rate of CHF 150 per hour. However, ask your health insurance company whether the consultation costs will be covered.
As long as you are capable of judgment, a living will will not be observed. It only becomes effective if you are unable to make a decision in a crisis situation (i.e. if you are no longer able to express yourself). But then it is considered your declared will.
Like the usual living will, ACP planning is only valid in the event of incapacity. You can also specify how to act in different situations: for example, in the event of an acute emergency, in the event of prolonged incapacity or in the event of permanent incapacity.
In addition, specific medical emergency plans for patients with chronic and serious illnesses can be drawn up at home on the basis of ACP advice. This reduces hospital admissions that are not desired by the patient, as immediate treatment of the complaints can also be provided by the patient or relatives.
Forward-looking care planning benefits everyone: you, your family and the medical staff.
Everyone should think about retirement planning, regardless of age and state of health. Ideally, you should start planning when you are healthy – i.e. before you actually have an urgent need.
However, Advance Care Planning is particularly important if you:
To ensure that your preferences and wishes are known and respected, it is important to address this issue. As part of the ACP consultation, we encourage you to talk to your family, friends, doctors and other healthcare professionals to find out and communicate what is really important to you.
This is not always easy. That is why we are happy to help you start this discussion.
A living will can set out how a person wishes to be treated in the event of incapacity. The living will should contain clear instructions on desired or refused medical treatment, especially for a life-threatening crisis situation (treatment goal). It is also possible to specify the situations in which life-sustaining measures are no longer desirable. To this end, a description of personal values and preferences regarding quality of life and the treatment goal is important for the implementation of the advance directive by the treatment team.
In addition, one or more authorized representatives can be named in a living will to represent the documented will in the event of incapacity.
The living will exclusively regulates medical treatment and measures in the event of incapacity. The advance care directive, on the other hand, allows you to appoint a person to take care of your financial, legal and personal affairs if you become incapacitated.
While the living will sets out the medical wishes and can include medical representation, the advance care directive covers the administrative, financial and legal powers of representation.
A living will can be drawn up without a template; all that is required is the date and the signature of the person making the advance directive. An advance care directive must either be handwritten or notarized if a template is used.
A living will applies immediately if a person is incapable of judgment (accident, operation, serious illness). The advance care directive is activated by the child and adult protection authority (KESB) in the event of prolonged incapacity and is only valid from then on.
The original living will should be kept safely at home and accessible to trusted persons. It is advisable to send copies to important persons, such as relatives or the authorized person, as well as to the doctor or hospital treating you. Registration with a central office can also be useful to ensure that you can be found in an emergency. It must be ensured that the latest version is always stored.
Yes, a living will can be amended, supplemented or revoked at any time as long as the person has capacity. It is important to review your living will regularly to ensure that it reflects your current wishes, circumstances and medical knowledge. Each amendment should be dated and signed in person to ensure its validity.
Your contact person is Isabelle Karzig-Roduner, Co-Head of Clinical Ethics.
We are happy to draw up an advance plan for your patients with disease-specific emergency planning based on the jointly discussed treatment goal.
You can also carry out this type of forward-looking treatment planning yourself. As a pioneer of Advance Care Planning, the USZ offers various training courses on the subject.