"If you don't take precautions, someone else will decide"
Luise Heine has been an editor at since 2012. The qualified biologist studied in Regensburg and Brisbane (Australia) and gained experience as a journalist in television, in the Ratgeber-Verlag and in a print magazine. In addition to her work at , she also writes for children, for example for the Stuttgarter Kinderzeitung, and has her own breakfast blog, “Kuchen zum Frühstück”.
More posts by Luise Heine All content is checked by medical journalists.A living will must be as specific as possible, the Federal Court of Justice ruled at the beginning of August. Otherwise it is invalid. However, this is not so easy to implement for medical laypeople. The best way to approach this difficult subject is explained by Dr. med. Rüdiger Ilg * in a interview.
Dr. med. Rudiger Ilg
Privatdozent Dr. med. Rüdiger Ilg is chief physician at the Clinic for Neurology and Neurological Rehabilitation of the Asklepios Clinics in Bad Tölz.
Dr. Ilg, what exactly does an advance directive do?
This enables you to set out in writing how you would like to be treated in situations in which you can no longer express yourself - for example, because you are in a coma. In the living will you state which therapeutic measures you want and which you do not. Typical keywords here are artificial nutrition or life-prolonging measures.
Who is this important for?
In principle: for everyone! Otherwise it might be too late one day. Especially people who suffer from serious chronic diseases should take early preventive measures. In addition, with such a disposition you relieve your relatives. They then have something on hand that tells them what you would have liked.
The chronically ill are one thing - but how do you deal with emergency patients?
It's always a difficult situation. Of course, I cannot stop resuscitation to look for a living will. You have to clarify later whether there is one. Provided that the patient has dealt with the subject of living wills beforehand and made one.
What is the best way to go about this?
Take time to deal with the topic together with your relatives and also with a doctor you trust. With its help, it is easy to specify what you want in the event of a problem.
Because very few can imagine what the therapeutic measures mean in detail?
Exactly - that's why talking to doctors in advance is so important. A classic fear topic is, for example, artificial feeding via a gastric tube. Many patients fear that this is a one-way street: they believe that once they have it, it will stay that way for the rest of their lives. However, each measure can also be ended again if the overall situation or the patient's will changes. There is no automatism there.
And maybe you don't want a nasogastric tube if it just extends your life, but you do if there is hope that you will get better.
Right, it always depends on the situation. This must always be critically weighed up in each individual case with all those involved in order to find the best possible approximation of the patient's wishes.
It seems quite complicated to consider all eventualities.
Yes, but there are very good forms, for example from the Federal Ministry of Justice. They provide a solid framework for the formulation of an advance directive. It is important, however, that you personalize them. Everyone has personal attitudes, experiences, values, religious or ideological views. Perhaps you have experienced a medical measure with relatives or friends as particularly positive or negative. You can include something like this in your living will. This then helps to establish a framework how you would have decided in cases that you could not determine in advance.
The Federal Court of Justice recently ruled that living wills must be very specific in order to be effective.
The more specific it is, the better. There is little we can do with vague formulations such as “I don't want to be caught in a hose”. But even standard formulations never exactly apply in everyday practice. Even the most concrete formulation can never encompass everything, the individual course of the disease is simply too different for that. There are many situations in which, as a doctor, authorized representative or carer, a decision has to be made in the interests of the patient, even if the situation at hand was not specifically foreseen in the advance directive.
So even the best disposition cannot take everything into account.
An advance directive is only an approximation of the patient's will, but it is still better than having nothing in hand. It is even better if you combine the living will with a power of attorney.
What is it?
With this you authorize a person who then represents your will. This can be a relative or a friend. As doctors, we can then, together with the authorized representative, try to transfer the living will to the corresponding situation. That helps a lot. The more clues we have for the patient's will and values, the better!
If no one is around to ask: How do you even find out that someone has made an advance directive?
You can leave the living will in a familiar environment or have it with your family doctor. And there is the possibility of depositing the document with the Federal Chamber of Notaries. You will be given a small ID that you can put in your wallet. Then your doctors will know and can request the ruling from there.
What role do advance directives actually play in everyday clinical practice?
A very decisive one! Because the therapy goal also depends on it. This is never purely medical, but always depends on the patient's consent and ideas. Take, for example, a patient with severe cancer. The goal here can be to maximize life. Or the focus is on the highest possible remaining quality of life, for example being able to die painlessly with the family. The patient should decide for himself which option it should be.
However, only a few take advantage of this possibility of self-determination - why is that?
We will all die. Nevertheless, one's own death is a topic that one does not like to deal with. If someone says, “I don't want to deal with that right now” - that's perfectly fine. But everyone who is interested in the topic should take the opportunity to prepare for situations in which they can no longer express their opinion. Otherwise, someone else will inevitably have to make the decision for you - and they may be completely wrong.
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