Advance directives – respect the will of seriously ill people

What if you are no longer able to have a say in a medical decision due to an accident or a serious illness? With a living will, also known as a living will, you can express that you do not want any treatment that would artificially prolong life in situations of illness that will lead to death. This is not about active euthanasia – that is forbidden by law in Germany. For many of those affected, however, the living will is an opportunity to die independently, with dignity and without pain.

Living will, Power of Attorney, Power of Attorney

In principle, there are three ways to make provisions for the worst-case scenario.

  1. With a  living will, the signatory determines what medical  treatment they want in the event that they are no longer able to express themselves.
  2. A  power of attorney  gives a person you trust power of attorney in financial and personal matters. This person then decides when you are no longer able to do so yourself.
  3. With a  guardianship  order, you give the court a recommendation as to who should be appointed as a guardian. This is only necessary if you have not granted a power of attorney.

Fear of needing care

Over 900,000 people die in Germany every year. According to a survey by Infratest on behalf of the patient protection organization Deutsche Hospice Foundation, around half of Germans would rather choose suicide than require nursing care. Accordingly, 51 percent of women and 49 percent of men see a way out in accompanied suicide.

The  fear  of needing care is therefore great for many people.

What is a living will?

A living will refers to the dying process or to an unchangeable failure of vital bodily functions with foreseeable consequences of death. It contains instructions for  end-of- life care,  whereby a possible  treatment waiver  – such as resuscitation measures – can be expressly named. That means forgoing life-prolonging treatment when terminally ill and dying.

Palliative care is also meant, which includes the administration of pain-relieving drugs to terminally ill people, even if   the onset of death can be accelerated by these drugs as a side effect.

Legal situation: what do you need to know?

Living wills have been legally regulated in the German Civil Code (BGB) since September 1st, 2009. It is defined as a written declaration that allows or prohibits specific medical treatments or interventions if the author can no longer express himself independently.

What does a living will look like?

There is  no ready-made form for a living will.  But it must show that the author gave some thought to the circumstances of his death and clearly formulated his will to do so. It must also be  signed and dated  . A notarial certification is not necessary. The patient can informally revoke his decision at any time.

The aim of this legal regulation is to ensure more legal certainty with regard to the waiver of life-prolonging or life-sustaining measures in the event of a life-threatening condition of a person.

The Federal Ministry of Justice and Consumer Protection offers design suggestions for a  living will.

Recommendations for a living will

The German Medical Association recommends that living wills contain statements on the following situations:

  • dying phase
  • unstoppable serious suffering
  • permanent loss of communication skills
  • Need for ongoing serious interventions such as ventilation,  dialysis , artificial nutrition and ventilation as well as organ replacement

You should also ask yourself questions about:

  • pain sensitivity
  • willingness to endure pain
  • fear of disability
  • disfigurement
  • dependency

It is also recommended to write down:

  • what experiences one has had with illness, pain and physical limitations
  • what experiences one has had with the death of others
  • What religion do you belong to?
  • what makes life worth living for yourself

It is always advisable to seek medical advice before drafting the living will.

The living will can, but does not have to, be kept by the family doctor. In addition, a living will should be updated or reconfirmed about every two years.

Euthanasia by living will?

Euthanasia is a topic that not only heats up people’s minds, but is also the subject of many myths. Where the difference between indirect and passive euthanasia. What is the legal situation?

Indirect euthanasia – what is it?

What exactly is meant by passive or indirect euthanasia? In the case of indirect euthanasia, targeted, professional pain and symptom treatment, which carries a  life-shortening risk  , is permitted.

A terminally ill patient, for example, can be given daily doses of morphine at their own request – even if this is in the living will – but this may lead to death more quickly (“palliative sedation”).

What is passive euthanasia?

Passive euthanasia  is allowing death due to old age or illness by  forgoing life-prolonging measures. However, pain relief and basic care continue to take place. Examples of passive euthanasia include not doing:

  • artificial respiration
  • artificial feeding and hydration
  • certain medications
  • a dialysis
  • resuscitation

Is this legal or not?

Indirect euthanasia is not a criminal offense because it falls under treatment in which the shortening of life occurs as an unintended side effect.

Passive euthanasia is also permitted. At the express and unequivocal request of the patient, physicians can and must discontinue life-prolonging treatment or abstain from it altogether. This is euthanasia by letting die. However, it must be made clear that the patient understands and accepts the consequences of their decision.

It is important that humane accommodation, attention, personal hygiene, the relief of pain,  shortness of breath  and  nausea  as well as quenching hunger and thirst are guaranteed. However, the patient is not transferred to an intensive care unit, therapy that has already started is canceled or further treatment is omitted.

Active euthanasia: Banned in Germany

Active euthanasia is punishable, even if the patient expressly requests it. For example, if a doctor ends a patient’s suffering with a lethal dose of morphine, that is active euthanasia. Active euthanasia for the purpose of  painlessly killing a dying person  is illegal; if it is carried out against the will of the patient, this is punished as murder.

If euthanasia has been performed because the patient has expressly requested it, then this is punishable under § 216 of the Criminal Code as euthanasia with imprisonment from six months to five years.

Legalize active euthanasia?

Active euthanasia is already legal in Belgium, Luxembourg and the Netherlands. In Germany, too, the idea is circulating that patients should be able to decide for themselves when it is time for them to leave. So far, however, ethical and legal debates have not led to a decision.

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