No, palliative care is not just for the terminal phase of life. It makes sense to address the various aspects of palliative care as soon as a diagnosis is confirmed: the alleviation of symptoms such as pain, shortness of breath or nausea, support for everyday life, psychological and spiritual aspects, etc.

Given the clinical situation, palliative care does not aim to achieve a cure, but to alleviate symptoms such as pain, shortness of breath, etc. and to keep the quality of life as high as possible after a life-shortening condition is diagnosed. Curative and palliative treatments can also be administered in parallel.

During the various phases of a serious illness, doctors and nurses are supplemented by professionals working in various disciplines, including physiotherapy, occupational therapy, dietary counselling, psychology, pastoral care and social work.

General care is usually provided for patients with stable disease progression. This general palliative care should be offered by all service providers in the healthcare sector, for inpatients by acute hospitals and caregiving institutions, and for outpatients by general practitioners and community nursing services.

Patients with complex disease progression require specialised palliative care. This applies to those suffering from multiple symptoms at the same time or whose symptoms fail to respond to the usual treatment. Or they may be people whose situation requires an interdisciplinary approach or for whom a difficult decision needs to be made. Specialised palliative care is offered in hospitals, nursing homes and specialist teams at home.

Information on diagnoses can be obtained from a GP or specialist doctor. When searching on the Internet bear in mind that the information varies in quality. This and the wealth of information often lead to uncertainty and anxiety. Thoughts on the following aspects should also be borne in mind: Where can I obtain help? What arrangements need to be made? Who would I like to inform? Does a power of attorney or advance directive exist? Who represents me when I am no longer capable of expressing my own wishes?

No, palliative care takes a holistic approach. In other words it covers psychological, social and spiritual aspects as well as physical ones. In addition to alleviating symptoms, specialists in palliative care help by 

• building up a care and treatment network
• supporting the decision-making process concerning the future course of action
• planning for emergencies
• recording the patient's own wishes in writing
• organising the final phase of life
• supporting relatives and carers. 

Various painkillers are used in palliative treatment. The quality (type) and intensity (strength) of the pain are decisive factors in the selection of these painkillers. They include non-opioids such as paracetamol, and opioids, for example morphine. Morphine is a powerful opioid and is administered for severe and extremely severe pain, as well as for shortness of breath that fails to respond to other treatments.

The services of palliative care aim to alleviate the suffering of those with an incurable illness and to preserve the best possible quality of life until the end. Treatment includes medical, nursing and therapeutic measures and support with social concerns. The sick person, their concerns and preserving their independence are key. Carers are included and receive specific support.

Palliative care services are provided by Stadtspital Zürich (Waid und Triemli), with a multidisciplinary palliative consultancy service, palliative consultations and a palliative care ward, by Spitex Zürich (community nursing service) with two specialist teams, and by the general care offered in the city's elderly and nursing homes. Pflegezentrum Mattenhof also offers beds for patients requiring specialist palliative care. 

The cantonal University Hospital Zurich has a Palliative Care Center with a ward and an outpatient clinic. Private facilities are also available and include Zürcher Lighthouse or Klinik Susenberg, which have likewise tailored their services to meet the needs of palliative patients. 

Kinderspital Zürich and Kinder-Spitex Kanton Zürich (Kispex, paediatric community nursing service) can provide specialist care for children and adolescents with life-shortening illnesses (paediatric palliative care).

Depressive symptoms and anxiety are frequently associated with serious illnesses. If symptoms such as depressed mood, loss of interest, inability to experience pleasure, listlessness, increased fatigue, anxiety and sleeping problems persist, it is important to obtain medical or psychological support.

Services are available for providing care and treatment at home. The patient's concerns should be discussed with their GP or with a private service.

Fatigue syndrome includes the symptoms of tiredness, exhaustion and listlessness. These cannot be alleviated by lots of sleep and rest and produce very detrimental effects in everyday life. Fatigue syndrome is often associated with serious illnesses such as cancer. Obtaining medical support is recommended if such symptoms occur.

General practitioners usually serve as the initial point of contact. At its Triemli site, Stadtspital Zürich offers a Palliative Care outpatient clinic, as does Universitätsspital Zürich. The professional association palliative zh+sh and the website Palliativkarte.ch can also provide information about relevant services.

Pallifon serves as a medical emergency helpline for palliative patients. It is free of charge and available 24 hours a day, 365 days a year (Tel. 0844 148 148).

For acute emergencies, the emergency ambulance service should be contacted, tel. 144.

Yes, it is free of charge for everyone and does not require a membership or prior registration.

A power of attorney (Vorsorgeauftrag) regulates personal situations in the event of any inability to give consent and authorises a close person or agent to act as a representative. An advance directive (Patientenverfügung) relates solely to medical issues in the event of an inability to give consent, which can arise suddenly, for example as a result of an accident, or develop insidiously, as in dementia.

Various agencies offer templates to download or order, including Curaviva, FMH, SRK.

A power of attorney and advance directive can basically be completed by anyone themself. However, this is challenging since they touch on ethical and existential issues and regulate important questions on life and death. Advisors possessing the necessary medical and legal expertise are available. They can help clarify wishes, ideals and unresolved questions, and they can also help you complete the documents. The consultations are usually subject to a fee.

You can obtain help from, for example, the Swiss Red Cross, Pro Senectute oder bei ACP Swiss. 

The emergency plan serves as a guide for all the parties concerned (patients, relatives and the treatment team) during medical crises. Used in combination with the most important drugs on site, it can help avoid unwanted hospitalisations. The plan should also specify what life-prolonging measures are desired in the event of an inability to give consent.

The emergency plan or action plan is usually drafted by a palliative care nurse and signed by a doctor.

For medical emergencies: Tel. 144

Emergency helpline for non-life-threatening emergencies: Pallifon, Tel. 0844 148 148 or Ärztefon, Tel. 0800 33 66 55.

Patients of specialist palliative care teams are given an on-call number so that they can reach a professional around the clock.

Wünsche und Anliegen können in einem Vorsorgeplan, in einer Patientenverfügung und im Testament festgehalten werden. 

Ideally, your own wishes will be documented at an early stage in an advance directive and a power of attorney. If a valid document exists in an emergency situation when you can no longer express your own wishes, your subsequent treatment will be based on that document. If no such information exists, a standard procedure that may deviate from your own ideas will be chosen. A representative can be appointed to implement your own wishes.

An Advance Care Plan (ACP) is based on your personal values and specifies the measures to be taken as your situation develops.

During an illness, employees are entitled to receive continued salary payments or daily allowances for a certain period. The procedures are regulated in the employment contracts but must not fall below the statutory minimum benefit. When these benefits are exhausted, social assistance can be claimed.

Medical, nursing and therapeutic services provided in order to diagnose and treat an illness and its consequences are covered according to the Health Insurance Act (HIA). This applies to both the outpatient and inpatient sectors. Since some services are not covered, or are only partially covered, it is important to clarify the responsibility for costs at an early stage with the health insurance fund.

The services are basically funded by compulsory health insurance and by the canton or local municipalities. However, not all costs are covered, depending on the type of service and the insurance policy in each case. It is advisable to clarify the responsibility for costs at an early stage with the health insurance fund.

A written, dated and signed advance directive is legally binding. Unlawful instructions, for example active euthanasia, are not implemented.

Ideally, you should consult professionals to ascertain the need, find the appropriate product and clarify the financing.

In Zurich city, equipment items such as walking aids, wheelchairs, positioning pillows, etc. for nursing at home are available at Krankenmobilien-Magazine. Oxygen equipment is issued by Lunge Zürich and nursing beds by Krebsliga Zürich.

A hospice is a place where people who are seriously ill and dying can obtain care and support – for several weeks if necessary.

Community nursing services (Spitex) can perform many of the associated tasks, while some services can be provided as needed by other professionals, e.g. occupational therapists. If the disease situation is very unstable or complex, a specialised palliative care team comes into play. Volunteers can also be used for certain assignments, particularly to give the relatives some respite. Home deliveries can be arranged for medicines, food and many other items.

Caregiving family members or carers are exposed to additional stress. Information on respite care for caregivers can be obtained, for example, from Entlastungsdienst des Kantons Zürich (respite service).

Mittagstisch, Mittagshort (lunch-time childcare during Kindergarten or school) and other hourly-based services can help bridge bottlenecks. Playgroups and toddlers' groups, community centres (Gemeinschaftszentren), ELCH-Zentren (parent and child), neighbourhood centres (Quartierzentren) and neighbourhood rooms (Quartierräume) offer various services. 

Children's daycare centres (Kitas) in Zurich city have places for 24-hour crisis interventions. If you need a nanny, contact nannyverein.ch.

Pet care can be regulated in a power of attorney. Zurich Animal Protection Zürcher Tierschutz has an information page that explains in detail all the relevant issues, for example an emergency card for pets.

No. Although palliative care considers dying to be a normal process, it does not offer active euthanasia. Consequently, when confronted with the wish for assisted suicide, palliative care specialists point to alternatives such as palliative sedation (see below) and support for the decision-making process. However, they do not play an active role in assisted suicides, for example they will not insert an intravenous catheter for the lethal medication. On the other hand, palliative care specialists do all they can to give the best possible care for the dying until they draw their last breath. When they receive good palliative care, many of those wishing to end their life ultimately renounce euthanasia.

Fasting until death or terminal fasting involves the voluntary refusal of food and fluids (VRFF). During VRFF, painkillers, sedatives and psychotropic drugs can be used to treat restlessness and delirium. Seriously ill people who wish to end their life prematurely in this way should be supported by a specialised palliative care team, since restlessness or dehydrated mucous membranes can be distressing.

Those who are already on the threshold of death and who are suffering from intolerable and untreatable symptoms such as pain, delirium (hallucinations, severe confusion, agitation) or shortness of breath, can be placed in an artificial sleep during their final hours. Palliative specialists can also implement this measure at home by medical and technical means.

Many questions concern the financial security of family members or pets, the estate or the funeral. The patient's wishes can be documented in an advance directive, power of attorney and the will.

A particular challenge nowadays for surviving relatives can be the digital estate (social networks, platforms, paid subscriptions, etc.) left by the deceased. Ensure that family members are given access to user names and passwords in good time. Digitise important deeds, documents and contracts and make these available to selected dependants in a secure place.

Yes, provided the necessary support is available. Municipal community nurses (Spitex Zürich) can visit three or four times a day to provide basic care or to monitor the situation. Specialised palliative care teams at Spitex Zürich can also support the seriously ill and those around them in unstable and complex situations. People who live on their own may require the help of a (chargeable) private 24-hour care service or a network of friends, neighbours and volunteers, if remaining at home alone is rendered impossible by stressful symptoms, a risk of falling or great weakness.

The palliative wards in the acute hospitals are intended for the stabilisation of palliative patients, for example when their symptoms become difficult to control or caregiving relatives exceed their stress threshold. Since the hospital stays are usually limited to a maximum of three weeks, solutions for the time after discharge should be sought at an early stage, for example in the form of a referral to a nursing home, hospice or discharge home with the support of a specialist team.