Berne, 24.10.2024 – Intervention d’Anne Lévy, directrice de l’OFSP, à l’occasion de la 8e Conférence internationale de santé publique sur les soins palliatifs, à Berne – La version orale fait foi.
Ladies and Gentlemen – on site and online
Dear colleagues
Welcome to Switzerland! Welcome to Bern! For those of you here in the city: I hope you enjoy your stay in Switzerland. And, of course, I hope you will find some time to visit the city of Bern.
I would like to take this opportunity to express my sincere thanks to the organisers of the City Festival. I am really impressed by the wide range of activities. And I am also impressed by the very colourful and yet sensitive approach to the subject of dying, death and grief.
And I am very happy about the opportunity to open today’s Policy Summit with my colleagues from the World Health Organization and from Rwanda, and to share our perspectives on the «Bern Declaration».
Before addressing the issues raised by the Bern Declaration, I would like to deal with a misconception that I am often confronted with, unless I am talking to palliative care professionals. Many people think that palliative care means that «there is no more hope», that you are giving up on someone. Of course, this is not true. That’s why we are all here today.
Opting for palliative care means ensuring that patients receive comprehensive care. It means giving them the best possible quality of life at the end of their lives. It also means accepting the inevitability of death and the unavoidable fact of dying.
In addition to medical and nursing care, palliative care takes into account the complexity of the human being and human life. What is crucial is the patient’s view of his or her personal quality of life. So the patient’s wishes are at the centre of palliative care. Support can be psychological, or it can take the form of religious or spiritual guidance. It may also include regular schooling for children receiving palliative care. This kind of support is just as important as help with nutrition or relief from pain and suffering.
Let’s be clear about this: most of us find it difficult to come to terms with death and dying, whether it’s our own death, the death of a loved one, or the death of a patient. I can certainly understand that. I feel the same. It is difficult for me as well. So I absolutely agree that we need to strengthen not just health literacy but «death literacy» – as it’s called in the Bern Declaration.
Dying has a low priority in healthcare, and it is rarely talked about. The main focus of healthcare is – of course – on preventing or delaying death. And yet, not everything that is medically possible is always best for the patient. What’s more, far too often we treat the end of life as an unexpected event.
In Switzerland, however, only a small minority of deaths are truly unexpected. Death is often preceded by chronic illness or increasing frailty. This also means that there is usually enough time to think about and discuss end‑of-life treatment options. This includes discussing how to deal with possible health declines and acutely threatening situations in a timely and forward-looking manner, together with the loved ones, whether they are caregivers or not.
I strongly support the aims of the Bern Declaration. We must approach the end of life as an inseparable part of life – as individuals, as health and public health professionals, and as a caring society.
How do we get there?
At this point, for the benefit of our international guests, I must comment briefly on the Swiss healthcare system.
In Switzerland, each of the 26 cantons is responsible for providing appropriate healthcare for its population. This applies equally to acute hospitals, nursing homes, hospices, outpatient care and other healthcare services. The cantons also cover part of the costs – in particular, the costs for nursing care, inpatient treatment and services not covered by the Federal Health Insurance Act.
What we can see is that palliative care services in Switzerland are unevenly developed and financed, and what services are available will depend on which canton you live in or even which doctor you are treated by.
The Confederation has a coordinating role in palliative care. For example, together with our partners, we have developed a joint national palliative care strategy. This gave rise to the national palliative care platform, which not only provides a forum for the cantons and all other partners to exchange experiences and ideas at annual meetings and in webinars, but also involves a website, providing study results, policy documents, and an overview of national, cantonal and regional palliative care projects.
In fact, a lot of progress has been made in recent years. In 2013, only 4 cantons had inpatient hospice structures. Ten years later, 15 cantons have such hospice structures. Mobile palliative care services have also been expanded – by a third – from 14 to 21 cantons with such services.
At a very early stage, the Federal Office of Public Health also focused on improving the financing of palliative care services, within the scope of its competence. In 2012, for example, coverage of the costs of coordination services provided by nurses in complex care situations was improved. And specific codes have been introduced to improve the classification of inpatient palliative care treatments.
Although much has been achieved, much remains to be done. This will still require close cooperation between the Confederation, cantons and stakeholders.
We need more mobile palliative care services, so that people can spend their last days at home – if they and their relatives so wish – receiving the best possible care. But we also need to develop our hospice services. Palliative care should be available to all dying people, regardless of their diagnosis. This includes the very elderly in nursing homes, people with dementia and people with disabilities, as well as newborns, children and adolescents with terminal illnesses.
I mentioned earlier that several actors are responsible for the financing of palliative care in Switzerland, and that financing also reflects the federalist system. This means that financing can vary from canton to canton. While this makes it challenging to find solutions, we are working hard on this issue. Our goal is to ensure that whoever needs palliative care in Switzerland can access it. The Federal Council is expected to report on this matter by mid-2025.
As you can see, there is still work to be done on all sides.
We must all come to understand death and dying more as an integral part of life.
At the same time, we must ensure that everyone is well taken care of at the end of his or her life.
That’s why I very much appreciate the Bern Declaration.
- It focuses on human needs at the end of life.
- It takes into account the social environment.
- It emphasises the importance of neighbourhood and community.
- It addresses values such as solidarity, thoughtfulness and compassion.
I’m convinced that we can rise to these challenges.
The more we work together, the better we will do. Everyone has a part to play – healthcare and public health professionals, individuals and society as a whole.
Thank you!
Dernière modification 29.11.2024
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