Living will

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A living will is important when a person can no longer decide for himself. But precisely because it can be of such crucial importance, there are many uncertainties - here you can find out what you should be aware of.

Living will - the law

The first law on living wills came into force on September 1, 2009. Living wills are therefore only effective if they are drawn up in writing, signed by the exhibitor himself or signed by a notarized hand sign. A certification of the signature or notarization of the living will is not mandatory. Anyone who writes such a document must be of legal age and capable of giving their consent. A living will can be revoked informally at any time. Older living wills that were drawn up before the law came into force remain in effect. In future, the living will will be regulated by law in §§ 1901 a ff. BGB.

Living will does not replace the power of attorney

Living will? Health care proxy is enough, some think. This is not the case, a power of attorney serves to grant another person decision-making powers in emergency situations - that is, to clarify the "who". In contrast, the living will states what to do in the case of terminal care - that is, the “what”.

It makes sense to combine the living will with a power of attorney. This person you trust should ensure that your interests are also enforced. Give this person a copy of the living will.

Will declare with living will

As long as a person is still in full possession of his mental abilities, he can make the decision about all necessary medical measures himself. It becomes problematic, however, when a patient can no longer decide for himself due to an illness (e.g. dementia, vegetative state).

With a written living will, people can express before the occurrence of an emergency that certain medical measures will be carried out or omitted if they can no longer decide for themselves. The living will ensures that the patient's will is decisive for the treatment, even if a patient can no longer express it.

If the stipulations in a living will apply to the patient's current living and treatment situation, both doctors and legal representatives (caregivers, authorized representatives) are bound by them.

Decide beforehand

With a living will you can give instructions on terminal care in the event of an incapacity to make a decision. On the one hand, this involves a possible waiver of treatment. This means that no life-prolonging measures are taken when a person is terminally ill and dying.

On the other hand, it is about palliative treatment. Terminally ill people are given sufficient doses of pain relieving medication, even though they may have a side effect that may accelerate the onset of death. This has nothing to do with active euthanasia, which is prohibited by law - that is, the targeted killing of a person.

Avoid pitfalls

A living will must be in writing. It can be handwritten. Alternatively, you can also create these on your computer or typewriter or use appropriate forms. On the order, two people should testify to the author's will with their signature. Notarization or certification is possible, but not absolutely necessary.

Let your family members and family doctor know that you wrote this document and tell them where to find it. The best thing to do is to put a card in your wallet that indicates a living will.

Check your living will annually and sign it with a current date. It is therefore clear that your will remains unchanged. Because if the document is decades old, problems can arise. At your disposal, you can also explain how you personally feel about organ donation.

Clear wording

If the stipulations in an advance directive are too vague or general, they are not legally binding. That was decided by the Federal Court of Justice in August 2016. Then the representatives of the patient decide together with the doctors about the upcoming therapy - the basis is what the patient would probably have wished for.

So be as specific as possible! For example, don't write, "I don't want to be hooked on to tubes" or "I want to die in peace". These statements leave too much room for interpretation and are too unspecific.

Rather, instructions for specific illnesses are important. For example, consider the following situations:

Should artificial feeding be started, continued or canceled if you are in a vegetative state?
Should the dose of painkillers and sedatives be chosen so high that you do not experience any symptoms, even if the result may be a slight reduction in life?
Should there be resuscitation in the event of an illness that will lead to death in the event of sudden cardiovascular arrest or respiratory failure?

In addition to things that you refuse, you can also list things that you want. These include, for example, certain nursing measures such as oral hygiene to avoid feeling thirsty or special medication to effectively combat pain, shortness of breath, anxiety, restlessness, vomiting and other symptoms.

It is advisable to discuss a living will with your family doctor or another doctor you trust. He can best explain to you which measures are possible in which situations and which opportunities and risks exist. Then you can weigh up which decision best suits your values.

In the case of particularly serious decisions, doctors and representatives sometimes cannot agree on whether the intended decision actually corresponds to the will of the person concerned. In this case, the approval of the supervisory court must be obtained.

Missing living will

If there is no living will, the supervisor or authorized representative must determine the presumed will of the patient. This is done with reference to previous oral or written statements, ethical or religious convictions or other personal values of the patient.

Arbitration Board: The German Hospice Foundation has set up an arbitration board that advises on disputes relating to living wills. Relatives and doctors can get expert help there if the interpretation of a ruling is doubtful. The service is free. The arbitration board can be reached on 0231-7380730 or on the Internet at https://www.stiftung-patientenschutz.de/service/patientenverfuichtung_vollmacht/schiedsstelle-patientenverfuichtung.

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