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Living wills

June 18, 2009

It's a dilemma for doctors and relatives. What should be done for patients who can no longer communicate. How much longer should they be kept alive with machines? A new living will law puts patients' wishes first.

A hand fills out an advanced directive
Millions of Germans have already filled out living willsImage: AP

It's an issue that politicians, doctors, lawyers and theologians have passionately debated in Germany for the last six years. Nine million Germans have filled out so-called advanced directives, spurred by high profile cases like that of Terri Schiavo in the US or Eluana Englaro in Italy, in which court decisions ultimately determined whether the women, in persistent vegetative comas, could be allowed to die.

Advance directives, or living wills, let people spell out how they'd like to be treated medically if an accident or illness leaves them unable to communicate their wishes. Now those advance directives are officially binding.

The German parliament voted 317-223 in favor of the law, which was supported by members of the Social Democrats, the Greens, and the Free Democratic Party. Because the issue was considered a matter of conscience, the usual requirement to vote with party was lifted.

While other proposals on the table would have limited the validity of advanced directives, the new law means doctors will have to follow the instructions in the directives even if this means the patient will die, and even in cases where the patient could survive if further measures were taken.

A woman carrying an image of Terri Schiavo and her mother at a protest
The law aims to prevent conflicts like that which surrounded Terri SchiavoImage: AP

If the patient has asked that no life-support measures be taken, then none can be taken. Those given power of attorney must make sure the directive is followed.

Victory for patients, challenge for doctors

While the new law is meant to provide legal clarification for situations that are often morally ambiguous, some doctors are not convinced. Speaking to Deutsche Welle before the vote, Joerg-Dietrich Hoppe, president of the German Medical Association, said that he was dissatisfied with all the proposals.

"For us doctors, none of them are suited to avoid the conflicts that we are exposed to, between failing to render assistance on the one hand and committing bodily harm on the other," he said.

For those Germans who have already filled out advanced directives, however, the Bundestag decision means that now they can be sure they will receive only as much medical treatment as they want. Assisted suicide or euthanasia remains illegal.

Editor: Susan Houlton

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