Adult protection

The adult protection law aims to reinforce the independence of the person in need of assistance, family solidarity and to reduce the intervention of the State to a minimum.

Therefore, if neither the family nor a private or public service can provide sufficient assistance and the person has not taken measures to ensure his/her protection, it is up to the court to intervene by means of deputyship measures adapted to the person's needs.

If you are encountering difficulties in managing your administrative and financial affairs, if you are in debt or if you have difficulty understanding the letters you receive or the actions you need to take, consider asking for help from those close to you (family, partner, cohabitee, friends, neighbours, etc.).

If you do not want your close relations to intervene in your affairs or if you do not have any relatives who can help you, you can ask for help from public or private institutions that are specialized in providing assistance.

Your close relations or the institutions that are caring for you will be able to assist you in your different actions: to fill in your administrative documents, to complete your requests for admission to an institution, to inform you about your rights, to help you establish a budget, to negotiate the reimbursement of significant debt, etc.

The law provides for 3 main categories of adult protection measures:

• The own arrangements for care, namely the advance care directive and the patient decree which you can make in anticipation of the loss of autonomy or the deterioration of your state of health.
• The statutory measures, i.e. those that automatically designate your spouse or registered partner to represent you in all acts of daily life, and those that designate the relatives who can represent you in medical matters in the absence of the patient decree.
• The court-ordered measures, such as deputyship and care-related hospitalisation, if there are no own arrangements for care, measures applied by operation of law, or if these measures are not sufficient.

The areas covered by the protective measures are as follows:

• Personal care (organization of daily life and leisure activities, care for a person, medical care, suitable living space, education and vocational training, etc.)
• Management of financial affairs (management of income and other assets as well as debts, etc.)
• Management of administrative affairs (budgeting, payment of bills, applications for social benefits, mail processing, various administrative procedures, representation to third parties, etc.)
• Management of legal affairs (conclusion of contracts, legal representation, etc.)
• Medical decisions (understanding diagnoses, choice of care, treatment follow-up, etc.)

The purpose of own arrangements for care is to designate in advance, in an advance care directive or a patient decree, the person or persons who will represent and assist you on the day when you are no longer able to do so because of a significant impairment of your physical or mental health.

The instructions you write in these documents will guide the decisions to be made by your representative(s).

Only if you become incapable of judgment, will these measures take effect.

Advance care directive

The advance care directive provides you with specific or general protection by allowing you to designate one or more natural persons (cohabitee, relative, notary, etc.) or legal entities (bank, foundation, association, etc.) to provide you with future assistance, in the event that you lose your capacity of judgment, in one or more of the following areas:

• Personal care (organization of daily life and leisure activities, care for a person, medical care, suitable living space, education and vocational training, etc.)
• Management of your financial affairs (management of income and other assets as well as debts, etc.)
• Management of your administrative affairs (budgeting, payment of bills, applications for social benefits, mail processing, various administrative procedures, representation to third parties, etc.)
• Management of your legal affairs (conclusion of contracts, legal representation, etc.)
• Medical decisions (understanding diagnoses, choice of care, treatment follow-up, etc.)

This directive may be revoked or modified at any time, as long as you are capable of judgement, and the persons appointed are free to accept it or not.

The trusted person(s) designated by you will be your representative(s) because of incapacity.

To ensure that your representatives can represent you, the court will have to validate the directive when your incapacity of judgment is medically attested.

Your representatives will have to go to court to obtain a document confirming their right to act as representatives, which allows them to take all the necessary steps with certain institutions (bank, insurance, etc.).

Your representative(s) for incapacity may relinquish his/her/their duties at any time by applying to the court. In the absence of a substitute appointed by you, the court will evaluate whether another representative should be appointed.

Formal rules for the establishment of an advance care directive

If you intend to draft the advance care directive yourself:

• Write your directive entirely by hand
• Date and sign it also by hand
• Specify the tasks you wish to entrust to the person or persons of your choice
• Indicate the contact information of your representative(s) for incapacity
• If you consider it useful, name one or more substitutes for all or part of the tasks entrusted to them

It is also possible to have it drawn up by a notary.

It is of utmost importance that your advance care directive can be easily found in case of need. To do so, you can have the place of deposit of your directive registered in the central civil status database by contacting the Civil status Office of the district in which you live.

Patient decree

A patient decree allows you, through a written document, to give advance instructions to your doctor on medical procedures you will or will not accept, should you become incapable of judgement. They will apply to all doctors who will have to take care of you, without the intervention of the court.

In this document, you also have the option of designating one or more natural persons (cohabitee, relative, friend, etc.), who will be responsible for ensuring that your wishes are respected in medical matters, should you no longer be capable of doing so yourself. This person or these persons will be your therapeutic representative(s).

If you have not given specific instructions about what medical procedures you will or will not accept, your therapeutic representative will have the authority to authorize any medical procedure at his/her discretion (surgery, palliative care, artificial life support measures, etc.).

Once the patient decree is activated, your therapeutic representative(s) will be able to give up their duties. In the absence of a substitute designated by you, she/he/they will have to go to court to designate another representative.

If several relatives consider themselves to have such power, or if they are unable to agree on the medical procedures to be undertaken, the matter may also be referred to the court.

Formal rules for the establishment of a patient decree

• Date and sign your patient decree by hand
• Specify the instructions you wish to give to the doctors
• Indicate the contact information of your therapeutic representative(s), if you have designated one
• Name, if you consider it useful, one or more substitutes for all or part of the tasks entrusted to you, indicating their contact information

It is of utmost importance that your patient decree can be easily found in case of need. To this end, transmit them to your treating physician or have them entered into your electronic medical record.
 

Access to patient decree models

Your loss of independence may be so great that you can no longer ask for help. In this case, and if you have not made your own arrangements for care, the law designates a legal representative among your close relations who will be responsible for your well-being and the proper management of your affairs.

Representation by your spouse or registered partner

If you are married or bound by a registered partnership and you become incapable of judgement, your spouse or registered partner automatically has the legal power to represent you in all acts of daily life, namely:

• Personal care (organization of daily life and leisure activities, care for a person, medical care, suitable living space, education and vocational training, etc.)
• Management of your financial affairs (management of income and other assets as well as debts, etc.)
• Management of your administrative affairs (budgeting, payment of bills, applications for social benefits, mail processing, various administrative procedures, representation to third parties, etc.)
• Management of your legal affairs (conclusion of contracts, legal representation, etc.)
• Medical decisions (understanding diagnoses, choice of care, treatment follow-up, etc.)

For actions outside the scope of daily life (extraordinary acts such as: real estate transactions, establishment of a usufruct, termination of a lease contract or a usufructuary lease, important banking operations, participation in a lawsuit, acceptance or disclaim of an inheritance, participation in a partnership, etc.), your spouse or registered partner must, before carrying out the planned act, ask the court for authorization. She/he may do so by means of a letter accompanied by any documents deemed useful.

Your spouse or registered partner may write to the court at any time to obtain a document confirming his/her right to act as a representative, which allows him/her to carry out all necessary procedures with certain institutions (bank, insurance, etc.).

He/she can renounce his/her duties as a legal representative at any time by applying to the court which will then determine whether another representative should be appointed.

Representation in medical matters

If you lose your capacity for judgement and have not given your doctor any instructions (patient decree), the law establishes a list of people who are entitled to represent you and to authorize or not authorize any act in the medical field on your behalf (for example, surgery, palliative care, artificial life support measures, etc).

These appointed therapeutic representatives are, in order of priority:

• Your spouse, registered partner or cohabitee
• Your descendants, if they regularly take care of you
• Your mother and father, if he or she regularly takes care of you
• Your sisters and brothers, if they regularly take care of you

She/he may give up her/his position as a therapeutic representative at any time. In the absence of another representative listed in the previous paragraph, he/she will have to apply to the court to appoint another representative.

If several close relatives consider themselves to have such power, or if they are unable to agree on the medical procedures to be undertaken, the matter may also be referred to the court.

The court, as the adult protection authority, intervenes only when the support provided by relatives, specialized public or private institutions, own arrangements for care or statutory measures, proves insufficient to enable you to exercise your rights, meet your obligations or guarantee your well-being.

The court can be informed by any person (relative, neighbour, social worker, independent doctor, independent psychologist, lawyer, etc.) of the situation of someone in difficulty. Similarly, the person in need of assistance can request the court's help him/herself. Finally, the court may take action ex officio when it finds that a situation requires its intervention.

It should be noted that persons bound by professional secrecy (psychologist, doctor, lawyer, etc.) must ensure that they are released from their secrecy prior to any report, either by the person concerned or by the competent cantonal authority.

In principle, only the situation of persons residing in Geneva can be reported to the court. If the person concerned lives in another Swiss canton, the report must be sent to the adult protection authority of the place of residence (COPMA). If there is any doubt, the report should be given to the court, which will forward it, if applicable, to the appropriate authority.

Steps to report a situation to the court

The person reporting the situation must:

• Send a letter written in French and signed to the court, indicating your complete contact information (last name, first name, date of birth, nationality, address, telephone number, e-mail) or drop it off directly at the court desk or at the Greffe universel.
   
• Indicate the complete contact information of the person who is the object of the report (last name, first name, date of birth, nationality, address, phone, e-mail, etc.).
   
• Explain as precisely as possible the situation (contact details of the attending physician, state of health, difficulties encountered in daily life, state of assets and debts, support from family and friends, etc.).
   
• Attach to the letter any document in his/her possession that could attest to the difficulties encountered (medical certificate, statement of accounts, certificates from institutions, etc.).

In case of emergency: if you feel that a person is in danger, contact immediately the police (117) who will take the first steps to bring him/her to safety and liaise with the services responsible for his/her protection.
 

The court does not provide legal advice.

The deputyship

If the court finds that you are partially or totally unable to safeguard your property or personal interests yourself due to a health impairment (mental deficiency, dementia, dependency, psychological disorders), another state of weakness, a temporary incapacity of judgment or absence (disappearance without a death certificate), it establishes a deputyship.

Deputyship means appointing a person, called a deputy, to assist you or act on your behalf in areas where you need support. The deputy acts under the supervision of the court.

When it establishes a deputyship, the court takes into account the extent of the need for assistance and adapts the measures it pronounces to the concrete situation. The court can pronounce 4 types of deputyship, from the most lenient to the most restrictive for your autonomy, which can sometimes be combined:

• Assistance deputyship: you continue to take all steps yourself with the assistance of a deputy appointed at your request.
• Representative deputyship: you continue to take the steps you are capable of taking yourself. For all other acts, the deputy will represent you (for example, to renew a passport, manage an estate, set up home care, represent you in a lawsuit, find an apartment, make certain medical choices, ensure that your expenses are in line with your budget, pay your bills, etc.).
• Advisory deputyship: you continue to undertake the actions that the court deems you are able to undertake alone. For all other acts, you must obtain the authorization of your deputy (for example, to enter into certain contracts, make important expenditures, etc.).
• General deputyship: your deputy represents you and makes decisions in all areas of your life.

When required by law or necessary, such as in the case of inappropriate commitments, compulsive purchases or interactions with malicious third parties that threaten your assets, the court may restrict the exercise of your civil rights and/or block access to certain elements of your income and assets (bank accounts, safe deposit boxes, pensions, real estate, etc.).

The court can modify or terminate a deputyship at any time, either upon request or ex-officio, depending on changes in your situation (for example, loss or regaining of autonomy, change in your place of residence or family situation, etc.).

Care-related hospitalisation

Care-related hospitalisation (PAFA) is an involuntary committal to a psychiatric hospital or other institution (home, medical-social institution, etc.). It is used to protect and assist a person who is endangering himself/herself due to a mental disorder, mental disability or severe neglect.

Such placement may be ordered by:

• A doctor from outside the placement institution who has a recognized post-graduate degree registered in the register of his/her profession or
• The court

In case of emergency, the police, the emergency service (144) and/or the psychiatric emergency service of the Geneva university Hospitals (HUG) should be contacted.

In addition to the placement for assistance, the court is also competent to:

• Review the merits of a physician's placement decision, treatment without consent, or any other measure limiting freedom of movement
• Extend a physician's placement decision beyond 40 days if necessary

The court can modify or terminate a deputyship at any time, either upon request or ex-officio, depending on changes in the situation (e.g., stabilisation or significant improvement in health status, etc.).

Your deputy is committed to your well-being and protection. He/she is appointed by the court according to your situation and the actions to be taken.

The court takes into account your wishes and/or those of your close relations. Above all, it ensures that the designated person accepts his/her mission and has the necessary skills and availability to perform the tasks assigned to him/her.

There are 3 types of deputies depending on your situation:

• A close relative, if possible, who intervenes in principle free of charge
• A private professional if your assets exceed Fr. 50’000.-, whose fees are deducted from your assets
• An employee of the Adults' protection Service (SPAd) if your assets are less than or equal to Fr. 50’000.-, whose fees are mainly paid by the State

For more information on adult protection deputies, see the page Deputies and protection appointees or the deputy’s practical guide (for deputies).

Step 1: reporting

Anyone can contact the court if he/she feels that a person living in Geneva needs help or protection.

Steps for reporting to the court

The person reporting the situation must:

• Send a letter written in French and signed to the court, indicating your complete contact information (last name, first name, date of birth, nationality, address, telephone number, e-mail) or drop it off directly at the court desk or at the Greffe universel.
   
• Indicate the complete contact information of the person who is the object of the report (last name, first name, date of birth, nationality, address, phone, e-mail, etc.).
   
• Explain as precisely as possible the situation (contact details of the attending physician, state of health, difficulties encountered in daily life, state of assets and debts, support from family and friends, etc.).
   
• Attach to the letter any document in his/her possession that could attest to the difficulties encountered (medical certificate, statement of accounts, certificates from institutions, etc.).

Step 2: the investigation

The court examines the request to determine precisely whether the implementation of a protective measure is necessary. To this end, it gathers all the useful information from the various persons or institutions that can shed light on the situation of the person concerned, either in writing or during a hearing.

At the hearing, the person concerned is normally heard in person.

If necessary, the court may order a psychiatric examination.

If the interests of the person require it, the court may order provisional protective measures (interim measures) during this phase of the investigation.
 

Representation for the person concerned

The court may appoint a lawyer as deputy ex-officio whose role is to assist the person concerned throughout the proceedings before the court, to ensure that his/her rights are strictly respected and to represent him/her at hearings if the person concerned cannot actively participate because of his/her health condition.

Step 3: decision

At the end of the investigation, the court decides whether or not to establish a measure and makes a decision.

If a deputyship is established, the court appoints a deputy for the person concerned.

This decision may be appealed to the Chambre de surveillance de la Cour de justice within the time limit indicated on the decision.

Step 4: Follow-up of the measure

As long as the measure lasts, the court follows the evolution of the situation, notably by periodically requesting reports and accounts from the deputy.

If the situation changes, the court can adapt or lift the measures in force at the request of the person concerned, the deputy, relatives, third parties or ex officio.