Cultural differences affect end of life decisions

A carer holds an older person's hand - end of life decisions vary across the country Keystone

Cultural factors play a large role when it comes to how Switzerland’s linguistic regions make end of life decisions, a study has found.

Almost two thirds of deaths in Switzerland are not unexpected, through illness or failing health, a statement released on Friday by the universitiesExternal link of Geneva and Zurich said. The study looked at how cultural backgrounds in a multilingual country like Switzerland – which nevertheless has a common legislative framework – affects difficult end of life decisions.

Researchers found that there were significant differences between regions, but that these differences were often less than with the neighbouring country with which the linguistic region shared a border.

The results came from an anonymous questionnaire sent to nearly 9,000 doctors who had signed one or more death certificates. The study, published in the journal BMC MedicineExternal link, is part of a wider National Research Programme End of LifeExternal link.

Assisted suicide: low uptake

Deaths were preceded by one or more end of life decisions in more than three-quarters of cases and these were mainly to withhold or withdraw life-sustaining treatment (70% German-speaking Switzerland, 59.8% French-speaking, 57.4% Italian-speaking), the universities said.

The use of assisted suicide remained marginal, with around 1.5% of expected deaths in this way in the German and French-speaking parts and no recorded cases in the Italian-speaking part.

Assisted suicide, in which a person is given a deadly drug to administer themselves, is legal in Switzerland. Active euthanasia, in which another person administers the drug, is not.

+ Read more on assisted suicide here

The involvement of patients in the decision-making process in end of life choices were “significantly lower” in Italian-speaking Ticino, the authors said. They assume here that there is a more family-based approach in Ticino than in other parts of Switzerland, especially in French-speaking Switzerland.

International comparison

Similar studies have been conducted in neighbouring Italy and France, the statement noted.

“If we don’t die the same way in all regions of our country, our approaches are still more similar in relation to each other than that of our neighbours,” said Samia HurstExternal link, direc­tor of the Institute for History, Ethics and Humanities at the Faculty of Medicine at Geneva University and co-investigator in the project: Medical end-of-life decisions: prevalence and trends in Switzerland.External link

“In some respects, French-speaking Switzerland thus resembles German-speaking Switzerland more than it resembles France, which is in line with the increased role of patient autonomy in Switzerland. Never­theless, the differences observed between our regions are similar to the differences noted between our neighbours, thus also suggesting cultural specificities associated with the language regions.”

There is as yet no comparable study for Germany or Austria, Hurst said.