Background Swiss legal norms with regard to the end of life situations changed substantially when the revision of the Swiss Civil Code (division III) took effect in January 2013, giving a formal legal status to advance directives (AD) and to the therapeutic representative.

Aim In our study, financed by the Swiss National Science Foundation (PNR67), we ask how these legal norms (AD in particular) are applied to and used in decision making by family doctors. Do they shape decisions and action of family doctors and how? How are they interpreted and adapted to the situation and to concrete needs?

Methods Based on content analysis of focus group interviews (91 family doctors, 72 nurses and 21 relatives in three cantons, one in each linguistic region),

Results We find three types of perception of the usefulness of AD for decision making in end-of- life situations and their management: They

1. make it more difficult

2. facilitate

3. do not impact on doctor’s behaviour.

Discussion and conclusion As we do not find consensus on their utility, we also find dissensus about the advance directives as a tool for communication and about the relief experienced by the patient in controlling his/her end of life by this legal instrument. We also find differences between cantons: the degree of importance attached to AD, the time when AD are used (critical time or at the beginning of end of life) and the level of use. These differences are partly due to differences in the palliative care structures in a federal system.