Living will and advance directives: what you need to know

Advance directives and living will: definitions and differences

Advance directives is a generic term that encompasses all documents in which you express your wishes for your future medical care. The living will is part of this: it specifically concerns your end-of-life choices and the treatments you accept or refuse.

In Switzerland, the law has recognised these documents since 2013. They allow you to express your wishes when you can no longer do so yourself. Be careful not to confuse them with a succession will, which concerns the transfer of your assets after death.

Directives can also include the designation of a therapeutic representative and your preferences regarding organ donation.

Why draw up advance directives?

Drawing up advance directives allows you to keep control over your medical choices, even in the event of incapacity. You decide today which treatments you wish for or refuse tomorrow.

This process relieves your loved ones of an immense burden. In an emergency, they will not have to guess your wishes or make heart-wrenching decisions in your place. Medical teams also have a clear framework for treating you with respect for your values.

Anticipating protects your dignity and that of your loved ones. It is an act of kindness that forms part of a broader approach to advance planning.

What can be decided in a living will?

The living will allows you to express your preferences on a wide range of medical decisions. You can define the limits of interventions you accept and those you refuse.

Your choices can relate to life-sustaining treatments, comfort care, the place where you wish to be cared for, and even your position on organ donation.

The important thing is to be as precise as possible whilst remaining realistic: you cannot foresee all situations, but you can establish clear guiding principles.

Medical treatments

You can express your views on several types of medical interventions:

• Cardiopulmonary resuscitation in the event of cardiac arrest

• Artificial ventilation (machine-assisted breathing)

• Artificial nutrition and hydration (by tube or infusion)

• Dialysis in the event of kidney failure

• Blood transfusions

• Antibiotics to treat infections

You can accept or refuse these interventions depending on the circumstances: for example, accept resuscitation after an accident, but refuse it in the terminal phase of an incurable illness.

Palliative care and comfort

You can prioritise palliative care and comfort rather than aggressive treatment. This includes optimal pain management, even if treatments may reduce your alertness.

You also have the right to express your preferences regarding the place of end of life: home, hospital, nursing home (EMS) or palliative care facility.

Refusal of aggressive treatment is a recognised right in Switzerland. Your directives allow doctors to respect this wish without ambiguity.

Organ and body donation

Your advance directives can include your position on organ donation after your death. You can accept, refuse or specify which organs you wish to donate.

You can also express your wishes regarding the donation of your body to science for research or medical education.

These choices are personal and must be clearly formulated to avoid any confusion at the time of death.

How to draw up your advance directives in Switzerland

Drawing up your advance directives does not require any complex procedures. The process is accessible to everyone, but a few rules must be respected to guarantee the validity of the document.

You can use an official template or freely draft your wishes. The essential thing is to be clear, precise and to date your document.

Three elements are essential: respecting the legal validity conditions, clearly expressing your medical wishes, and designating a trusted person who can dialogue with the doctors.

Validity conditions

To be valid in Switzerland, your advance directives must meet a few simple conditions:

• Be of age (18 years old)

• Have capacity of judgement at the time of drafting

• Draft the document handwritten or typed

• Date and sign the document personally

No witness or appearance before a notary is mandatory. However, having your directives validated by a doctor or signing them in the presence of a witness strengthens their credibility.

Using a template or drafting freely

Several Swiss organisations offer templates for advance directives: the FMH (Swiss Medical Association), Caritas, Pro Senectute or the Red Cross. These forms facilitate drafting by guiding you step by step.

You can also freely draft your wishes, provided you remain clear and precise. Avoid vague formulations such as "I don't want to suffer" without specifying your limits.

Consulting your GP is strongly recommended: they will help you understand the medical implications of your choices.

Designating a therapeutic representative

The therapeutic representative is a trusted person whom you designate to interpret your wishes and dialogue with doctors if you can no longer do so.

This person must explicitly accept this role and understand its responsibilities. They do not decide in your place, but ensure that your directives are respected.

Choose someone close to you, capable of defending your interests even in difficult situations. Discuss your wishes openly with this person.

Where to keep and register your advance directives

Your advance directives only have value if they are accessible when needed. Keep the original in a safe and easily accessible place.

Give a copy to your GP, your therapeutic representative and your loved ones. Inform them of the existence of this document and its location.

Some Swiss cantons offer registers where you can record your directives. You can also carry an advance directives card which indicates where to find your complete document.

In an emergency, medical teams must be able to consult your wishes quickly.

Reviewing and updating your directives

Your advance directives are not set in stone. Your convictions and your situation may evolve over time.

Reread your document regularly, ideally every 2 to 3 years. Also think about revising it after a major event: diagnosis of a serious illness, death of a loved one, change of therapeutic representative.

To modify your directives, simply draft a new dated and signed document that cancels and replaces the previous one. Explicitly mention this revocation.

Inform your loved ones and your doctor of any update and retrieve old versions to avoid any confusion.

Advance directives vs funeral wishes: what is the difference?

Advance directives and funeral wishes are two distinct documents that complement each other.

Advance directives concern your end-of-life medical choices: the treatments you accept or refuse whilst you are still alive, even if unconscious.

Funeral wishes concern the organisation of your funeral after your death: burial or cremation, ceremony, place of burial.

These two documents allow for complete and coherent anticipation. They relieve your loved ones by sparing them from having to guess your wishes in difficult times.

Common mistakes to avoid

Certain mistakes can make your advance directives ineffective or a source of confusion:

• Drafting directives that are too vague: "I don't want to suffer" does not say which treatments you refuse

• Not discussing them with your loved ones: your directives risk surprising them or creating conflicts

• Forgetting to designate a therapeutic representative: no one will be able to interpret your wishes

• Never updating the document: your convictions from 20 years ago may no longer reflect your current wishes

• Keeping the document in an inaccessible place: bank safe deposit box, notary abroad

Take the time to draft clear directives, discuss them openly and make them easily accessible.

Resources and templates available in Switzerland

Several Swiss organisations offer free templates for advance directives:

• FMH (Swiss Medical Association): detailed medical template

• Caritas: simple and accessible form

• Pro Senectute: support for seniors

• Swiss Red Cross: template with explanations

Cantonal palliative care associations also offer personalised advice. Do not hesitate to seek support from a healthcare professional or social worker.

These resources help you draft directives that conform to your values and are adapted to your personal situation.

Drawing up your advance directives is an act of responsibility and respect towards yourself and your loved ones. This document allows you to keep control over your medical care at the end of life, even when you can no longer express yourself. Living will, choice of treatments, designation of a therapeutic representative: each decision counts to guarantee that your wishes will be respected.

Take the time to reflect on your wishes, discuss them with your doctor and your loved ones, and formalise your directives in writing. Keep them in an accessible place and remember to review them regularly. Do not forget that advance directives concern medical decisions, whilst your funeral wishes organise your funeral.

This process is part of a broader advance planning approach that relieves your loved ones of the burden of difficult decisions. Anticipating means offering serenity and clarity to those who remain.