Terminal Illness & End-of-Life Administration in Switzerland: 5-Step Official Checklist

1. 1

   Coordinate Specialist Palliative Care, Spitex Home Nursing, and Hospice Services

   The first step is taken through the treating medical team at the hospital (Spital) or the general practitioner (Hausärztin or Hausarzt) to assess palliative pain and symptom management needs and issue a medical nursing prescription (Pflegeverordnung):

   • Home and inpatient palliative networks: For care at home, local Spitex (home care nursing) services work alongside specialized mobile palliative services (Brückendienste) to provide nursing and support. Because healthcare structures in Switzerland are organized by canton, the regional sections of the specialist association palliative.ch (Swiss Association for Palliative Medicine, Care and Support) help families locate mobile palliative teams, hospital palliative units, and inpatient hospices in the respective canton [1].
   • Mandatory health insurance coverage: Under a physician's prescription, compulsory basic health insurance (Obligatorische Krankenpflegeversicherung, OKP) reimburses medical and nursing palliative care services provided at home (by Spitex), in hospital, or in a nursing home in accordance with the Healthcare Benefits Ordinance (Krankenpflege-Leistungsverordnung, KLV), as explained by the federal authority Bundesamt für Gesundheit (Federal Office of Public Health) [2]. Clarify early with the care team and health insurer (Krankenkasse) which basic care costs and any cantonal residual financing or hospice daily rates are covered in the canton of residence [2].
2. 2

   Prepare a Written Advance Directive under Art. 370 et seq. ZGB and an Emergency Plan

   While the ill person retains capacity of judgment, they can establish a binding written advance directive (Patientenverfügung) under Articles 370 et seq. of the Swiss Civil Code (Schweizerisches Zivilgesetzbuch, ZGB) specifying which medical measures (such as cardiopulmonary resuscitation, mechanical ventilation, or artificial nutrition) they consent to or refuse if they later become incapable of judgment [3]:

   • Appointing a therapeutic representative: The directive should also designate at least one trusted representative (plus an alternate) to inform the medical team of the patient's presumed wishes and make healthcare decisions on their behalf in an emergency [3].
   • Formal validity and official templates: To be valid under Swiss law, the Patientenverfügung must be in writing, dated, and personally signed by the ill person; it does not need to be handwritten in its entirety, meaning recognized standard forms can be used [3][4]. Proven short and comprehensive templates with guidance are provided by the medical association Verbindung der Schweizer Ärztinnen und Ärzte FMH (Swiss Medical Association) and the humanitarian organization Schweizerisches Rotes Kreuz (Swiss Red Cross) [3][4].
   • Distribution and emergency access: Provide copies of the signed Patientenverfügung and a medical emergency plan (covering symptom management at home) to the general practitioner, Spitex, and the representative, and record a note on the health insurance card (Versichertenkarte) or in the electronic patient record (elektronisches Patientendossier, EPD) [3].
3. 3

   Execute a Legally Valid Advance Care Mandate under Art. 360 et seq. ZGB and Bank Mandates While Capacity Exists

   Whereas an advance directive covers purely medical treatments, an advance care mandate (Vorsorgeauftrag) under Articles 360 et seq. ZGB governs personal care (everyday living and housing arrangements), financial affairs (income, assets, payment transactions), and legal representation before authorities, banks, and insurers in the event of future incapacity of judgment [4][5]. Without a Vorsorgeauftrag (and where the statutory representation rights of spouses or registered partners do not suffice for extraordinary asset management), the competent Child and Adult Protection Authority (Kindes- und Erwachsenenschutzbehörde, KESB) will examine appointing an official deputyship (Beistandschaft) if incapacity occurs [4][5]. Under Article 361 ZGB, strict formal requirements apply [4][5]:

   • Holographic execution (Eigenhändige Errichtung): The entire text must be handwritten from beginning to end, include the place and date, and be personally signed [4][5].
   • Public authentication (Öffentliche Beurkundung): If the ill person can no longer write the entire text by hand due to illness, the Vorsorgeauftrag must be publicly notarized by an authenticating official (Urkundsperson / notary) [4][5].
   • KESB validation and bank powers of attorney: The Vorsorgeauftrag takes formal legal effect only once incapacity of judgment actually occurs and the competent KESB examines and validates the document [4]. The storage location of the Vorsorgeauftrag can be registered with the civil registry office (Zivilstandsamt) in the civil status register [4][5]. So that relatives can handle banking and bill payments while the person still has capacity of judgment, a separate bank power of attorney (Bank- und Kontovollmacht) should also be signed directly with the Swiss banks on their own forms.
4. 4

   Use Paid Caregiver Leave under the Code of Obligations, Helplessness Allowance, and Respite Services

   Employed relatives in Switzerland can draw on statutory leave provisions, disability/care allowances, and cantonal respite support [6][7]:

   • Paid caregiver leave (Betreuungsurlaub): Under the Swiss Code of Obligations (Art. 329g OR), employed relatives are entitled to paid leave to care for a family member or life partner with a health impairment, as outlined by the federal authority Bundesamt für Sozialversicherungen (Federal Social Insurance Office) [6]. This short-term caregiver leave covers up to three working days per event and at most ten working days per service year (in addition, parents caring for a severely ill minor child are entitled under Art. 329h OR to 14 weeks of caregiver leave compensated via the income compensation scheme, Erwerbsersatzordnung) [6].
   • Helplessness allowance (Hilflosenentschädigung): If the ill person permanently requires third-party assistance or personal supervision for everyday activities (such as dressing, personal hygiene, eating, or mobility), check eligibility for a Hilflosenentschädigung under Old-Age and Survivors' Insurance (AHV) or Disability Insurance (IV) with the cantonal compensation office (Ausgleichskasse) or IV office; official fact sheets and forms are provided by the Informationsstelle AHV/IV (AHV/IV Information Center) [7]. The allowance is independent of income and wealth but subject to statutory waiting periods (generally six months of uninterrupted helplessness under AHV, or one year under IV) [7].
   • Immediate home respite: For immediate relief at home, cantonal sections of the Schweizerisches Rotes Kreuz, the Cancer League (Krebsliga), and municipal relief services offer hourly care and visiting services [4].
5. 5

   Prepare the Will, Pension Beneficiary Nominations (1st and 2nd Pillars), Vital Documents, and Estate Administration

   While full capacity of judgment exists, the ill person can establish their estate plan by executing a last will (Testament under Art. 498 et seq. ZGB - either handwritten, dated, and signed in full, or publicly notarized) or a notarized inheritance contract (Erbvertrag) while respecting statutory forced heirship shares (Pflichtteile), and prepare for key Swiss pension and probate rules:

   • Vital documents and 1st Pillar (AHV): Gather key documents (family record book or certificate, Familienbüchlein / Familienausweis, AHV insurance card, occupational pension statement, Pillar 3a/3b policies, and written funeral wishes kept separate from the will). After a death, claims for survivors' pensions (Hinterlassenenrenten - widow's, widower's, and orphan's pensions) must be filed with the competent compensation office (Ausgleichskasse) where the deceased last paid AHV contributions or drew a pension, as documented by the Informationsstelle AHV/IV [8].
   • 2nd Pillar (Occupational Pension / Pensionskasse) and Pillar 3a: Review the pension fund regulations (Vorsorgereglement) as well as vested benefits and Pillar 3a foundations during the person's lifetime. Many pension funds require a written beneficiary declaration (Begünstigungserklärung / support agreement) for unmarried partners that must be submitted to the Pensionskasse while the insured person is still alive.
   • Certificate of inheritance and 3-month disclaimer deadline: Following a death, the competent cantonal court or inheritance office (Erbschaftsamt) at the last place of residence issues the certificate of inheritance (Erbenbescheinigung / Erbschein) upon application so heirs can jointly access estate accounts, as described on the official Swiss authorities portal ch.ch [9]. If the estate is over-indebted, the statutory deadline to disclaim the inheritance (Ausschlagung der Erbschaft under Art. 567 ZGB) is strictly three months from learning of the death; anyone considering disclaiming must not order an Erbenbescheinigung or interfere in estate affairs beforehand, and may instead request a public inventory (öffentliches Inventar) or an information-only certificate to inspect assets and liabilities [9].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   Cantonal and Regional Sections for Palliative Care in Switzerland — palliative.ch - Schweizerische Gesellschaft für Palliative Medizin, Pflege und Begleitung
2. [2]
   Palliative Care, Advance Care Planning, and Compulsory Health Insurance Benefits — Bundesamt für Gesundheit (BAG)
3. [3]
   FMH Advance Directive (Patientenverfügung) - Templates, Guidelines, and Wallet Card under the Swiss Civil Code (ZGB) — Verbindung der Schweizer Ärztinnen und Ärzte (FMH)
4. [4]
   Advance Care Mandate (Vorsorgeauftrag), Advance Directive, and Validation by the KESB — Schweizerisches Rotes Kreuz (SRK)
5. [5]
   Adult Protection Law (Art. 360 et seq. ZGB): The Advance Care Mandate and the Advance Directive — Bundesamt für Justiz / Schweizerische Eidgenossenschaft (admin.ch)
6. [6]
   Paid Leave for Caring for Relatives (Art. 329g OR) — Bundesamt für Sozialversicherungen (BSV)
7. [7]
   Helplessness Allowance (Hilflosenentschädigung) under AHV and IV — Informationsstelle AHV/IV
8. [8]
   AHV Survivors' Pensions (Widow's, Widower's, and Orphan's Pensions) — Informationsstelle AHV/IV
9. [9]
   Accepting or Disclaiming an Inheritance and Certificate of Inheritance (Erbenbescheinigung) — ch.ch - Schweizer Behördenportal