In 2003 the Swiss Academy of Medical Sciences (SAMS) stated that "the obligation to maintain life, however, carries some qualifications. The patient's wishes in this respect are the overriding criterion for decisions to reject or discontinue life-saving measures". If this is recorded in a patient's directives, the SAMS believes that they should be followed "as long as there are no concrete indications that they no longer represent his or her present wishes". If there are no patient directives, an attempt must be made to determine their presumed wishes. The responsibility for decisions that are reached for or against further treatment of a patient should, the opinion continues, be shared and everyone involved, as far as possible, should accept them. "However, the final decision rests with the doctor directly responsible for the patient".