Gute Lebens- und Sterbensqualität: Versorgung und Versorgungslücken von Palliative Care in der Schweiz

Half a century ago, the progress in medicine has become best visible in the intensive care units with the new possibilities of prolonging life. These possibilities have also challenged the relationship between medicine and death. The traditional view of death as an enemy had to be reviewed in the context of breathtaking advances in prolonging biological life. The nurse, social worker and physician Cicely Saunders was the first to implement a palliative care approach in a hospice in London. A next milestone was the WHO definition of Palliative Care that brought into light the importance of this new approach to suffering and death within medicine at a global level of public health. It was followed by an important research activity that not only showed the effectiveness of palliative care in promoting quality of life under life-limiting conditions, but also on promoting wellbeing and bereavement adjustment of families and the effectiveness in allocating scarce healthcare resources. Switzerland has built up an important palliative care network, especially under the auspices of professional organizations and the Federal Office of Health and supported by private initiatives. The National Strategy Palliative Care and the Swiss National Research Foundation have fostered an important research about the access to palliative care services, advance care planning, ethical and spiritual issues. Nevertheless, following the quality of death study of the Economist, Switzerland is not ranking among the top places in the recent global quality of death index. The financing of palliative care services had a considerable weight on the ranking and showed a considerable size of out of pocked expenditures for patients and families with palliative care needs. The article describes the challenges this poses for a comprehensive access to palliative care services. Following the WHO definition, they are to be seen not as “extra services” for those who can afford them, but essential elements of a universal health coverage, applying the principle that “the palliative care team follows the patient”. In order to avoid tacit steering effects due to gaps in financing palliative care services, an integrated, patient-centered palliative care approach is needed in Switzerland with all the relevant stakeholders in the field. This will be paradigmatically shown with the concept of a comprehensive advance care planning.