Patients' Rights Debate
June 26, 2008
When it comes to questions of life or death, Germans are fairly united. Two out of every three want to decide for themselves whether to undergo emergency medical treatments.
Some German politicians have taken up the cause of patients' rights. A bill introduced on Thursday, June 26, in Germany's lower house of parliament sets legal guidelines for making what are often referred to as living wills or advance health care directives. The bill is being supported by around 200 parliamentarians from various parties.
German patients have been allowed to draw up living wills since the beginning of the 1980s. These documents allow them to choose the type of medical treatment they would receive in case of a serious illness. For example, a patient could decide how long he wants to be kept on artificial life support.
Not always easy answers
The problem is that while living wills are supposed to come into play when a patient is unconscious or for some other reason can't make decisions, it is by no means airtight. If a physician has doubts, a court decides.
The current discussion in Germany focuses on clarifying what circumstances need to exist for a patient's wishes to be carried out. Social Democrat Joachim Stuenker and his colleagues feel patients should have as much of a say as possible.
"If one takes the right to self-determination seriously, then the patient needs to be given the right to decide whether to introduce or terminate a life-prolonging measure during each phase of the disease,” supporters said in a statement clarifying their position.
Gateway for arbitrariness
For opponents, like Green Party head Renate Kuehnast, the law “opens the door to caprice.”
It would mean that a living will made in the past might not be the actual decision of the patient, Kuehnast said. It's the same view held by Chancellor Angela Merkel's conservative Christian Democratic Union.
Both the Roman Catholic Church and the Protestant Church are also expected to lobby against the law. They warn that allowing people to reject treatment and choose death in the face of illness opens an ethical can of worms.
The religious groups want patient wills to be valid only in cases when a patient is facing a terminal illness. The groups are hoping to introduce this alternative proposal in parliament by the end of September.
Patients need extra guidance
Gian Domenico Borasio, a professor of palliative medicine at the University of Munich, sees problems with both proposals.
He feels debates over the validity of living wills miss the point. Borasio feels patients with serious diseases need to be offered better pain relief. He also feels they need advice so that they can create living wills that will help both themselves and the doctors.
When patients are interested in making a living will, they should do so only after consulting with a doctor, he said. The doctor can explain what treatment options exist for various diseases, which allows the patient to make an informed decision.
Solutions not seen as adequate
Germany's hospice foundation has taken a similar stand. The group supports special care facilities for terminally ill patients.
People need to understand what is happening to them in order to make good decisions, said Eugen Brysch, who heads the hospice group's executive committee.
He read the draft of the proposed legislation as well as the alternate proposals.
"Both are very one-sided,” he said.
Brysch agrees with Borasio that detailed consultation needs to be part of any plan.
Some have suggested that living wills should be allowed only after a patient meets with a lawyer or notary. While that sets the bar high for drafting a living will, at the least a physician should be consulted, Borasio says.
Risky business for doctors
Bernd Kieser said he things meeting a lawyer before drawing up a living will is a good idea. The lawyer is on the board of the dvvb, a group which specializes in legal issues surrounding patient care. He has serious problems with the proposed law.
“Actually the entire thing needs to be regulated in the criminal code. The doctor would then know that he remains exempt from punishment, even when, for example, he doesn't perform a lifesaving measure at the request of the patient.”
Any attempt to change the law will face an uphill battle. Various initiatives have failed before in parliament. The issues surrounding living wills remain delicate ones.
“With topics such as this, you shouldn't operate with a crowbar,” Norbert Roettgen of the CDU recently said.