What to do if it is unclear whether a patient can decide for himself or herself?

How is the ability to judge measured? The authors of the SAMS essentially use four criteria to determine judgement. These include, for example, cognitive ability, i.e. whether someone is able to record and decide on information about their own state of health.

The SAMS has published the new guidelines, now publicly accessible. The FMH medical association will decide on them at its next meeting. The guidelines will then be binding on doctors. 

According to IBME's Director, professor Nikola Biller-Andorno, who played a key role in drafting the new guidelines, the clarifications have so far been more or less a black box. 

For the decision-making process on medical treatment, the presence or absence of judgement is central. In principle, judgement is assumed, but if there are justified doubts, an evaluation must be carried out.  

A study accompanied by the Central Ethics Committee of the SAMS showed that doctors have great uncertainties in assessing their ability to judge,  see Biller-Andorno N, Trachsel M: Decision-making incapacity at the end of life and its assessment in Switzerland.  

The SAMS therefore drew up medical-ethical guidelines on the subject of judgement based on the results of the study. The guidelines "Judgment in medical practice" provide guidance for all health professionals involved in such evaluations. They lay down the principles to be observed when clarifying the ability to judge and describe the procedure for evaluation in general and in individual fields of action (e.g. general practitioner medicine, emergency and intensive care medicine, palliative care).

The U-Doc, the tool for evaluating and documenting judgement capability, is published in English, German and French on the website of the Institute for Biomedical Ethics and Medical History of the University of Zurich.

   

Giovanni Spitale

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