Living Wills

It is unconstitutional in Germany for a doctor to treat a person against his or her will, even if the patient is at risk of dying. But when it comes to those who can't communicate a so-called living will can help.

The German parliament will debate the sensitive issue on Thursday when parliamentarians consider draft legal guidelines that would apply to living wills. More than 30 members of parliament have signed up to speak, three times more than usually do during Bundestag debates.

An estimated 8 million Germans have made out a living will, setting out how they wish to be treated by medical staff in case of an accident or terminal illness. For example, in a living will, a person might specify that her life-support machines should be turned off if they are still necessary four weeks after a bad accident.

Currently the legal framework around living wills is unclear and open to multiple interpretations. Many have read a 2003 decision by Germany's federal court as ruling that a stipulation to end medical treatment is only binding if the illness or injury will inevitably lead to death. However, others have read the ruling differently.

A draft guideline introduced by Wolfgang Bosbach of the conservative Union bloc of parties would make patient stipulations regarding treatment or resuscitation only valid in the case of irreversible, terminal illness or injury.

An alternative draft, presented by Social Democratic parliamentarian Joachim Stünker, gives the wishes of the patient highest priority.

New guidelines needed?

According to Urban Wiesing of Germany's Federal Chamber of Physicians, doctors are acting correctly if they follow instructions given in a living will now, even if the patient dies.

"It is the will of the patient that counts," Wiesing said.

However, Wiesing stressed that doctors are still required to follow German law.

"If a patient asks for medically assisted suicide, a doctor can't do that because that's illegal," he said.

His group, along with the Marburger Bund doctors' federation, has come out against putting new legal guidelines in place, saying that patients need only to be better informed about what goes into making a living will.

"We are solving a problem here that was only created through politicians' debate of the issue," Frank Ulrich Montgomery, head of the Marburger Bund, told the Passauer Neue Presse newspaper.

Call for regulation

At the moment there is no legal framework setting out how a living will should be made.

That means medical staff are bound to consider even a couple of lines that a patient scribbled on a scrap of paper. But such information can lead to more uncertainty about a person's wishes, because their instructions are often too nebulous.

"It needs to be more detailed," said Wolfgang Kramer from the German Hospice Foundation. "In our experience, people write something down, but it can't be used in a concrete situation because it's too unspecific."

The German Hospice Foundation offers consultations on how to make a living will. Because there are so many topics to cover, the appointments usually last more than 90 minutes, and the result is a seven-page document.

"At the beginning there are wishes such as 'I don't want to suffer' or 'I don't want to end up attached to a tube,'" Kramer said. "But when you explain the different possibilities and the kinds of conditions that come with certain illnesses, then people make completely different decisions."

Wiesing from the Federal Chamber of Physicians was hesitant about calling for government regulation of living wills.

"Currently, the situation isn't that clear -- both for patients and doctors," he said. "We should all try to reduce this uncertainty but not at the cost of individual rights."