Germany Debates Physician-Assisted Death

Seven to eight million people have written living wills in Germany, but there are 250 different versions of the document in the case of critical illness. And whether they hold up legally is an open question.

There's a huge discrepancy in the law, explained Ulrike Riedel, a lawyer and member of the government's commission of inquiry on the ethical and legal matters of medicine. "The commission of inquiry decided in favor of a very strict limit of range. We said that because it is so difficult to interpret a will written in advance, we will simply install an objective limit. That means that if someone isn't fatally ill, he must continue to be treated."

But the German government wants to eliminate the ambiguity. Justice Minister Brigitte Zypries (photo) drafted a bill last year to allow people to decide for themselves whether life-sustaining machines or medication should be withheld if they became fatally ill. But in the face of heavy criticism she rescinded the proposal in February.

Political parties divided

Now it's up to the Bundestag, Germany's lower house of parliament, to confront the divisive issue. The two sides which cross party lines, either favor the justice minister's liberal approach or the more restrictive stance brought forward by the ethics commission, which puts patients' health before their wishes.

A first bill is expected to be drafted before the Bundestag session ends in the summer, and government insiders predict a law will passed in summer 2006.

A federal court decided in 2003 that living wills are binding for doctors and caregivers, but life-sustaining measures can only be suspended if the illness is fatal. The main issue is whether patients whose condition isn't necessarily fatal -- largely those plagued by severe dementia or suspended in a persistent vegetative state -- will be permitted to have treatment suspended.

Judging what one can't judge

After around three months in a coma, it's very rare that patients are ever able to lead a normal life again, explained Christoph Müller-Busch, a Berlin doctor who advises the justice minister. But Müller-Busch, like Riedel, pointed out that one of the difficulties is whether the patient has written his living will before falling ill or afterwards.

"You don't know how you will feel if you've really got dementia. You don't know how you'll feel if you're in a somnolent condition, if you want to be treated or not when you're in the process of losing consciousness. You make a living will for a time, for a situation, that you can't judge," said Riedel.

The fact is that doctors don't know what coma patients experience, whether they actually suffer from things like lack of communication or artificial respiration, Müller-Busch said. And until new legislation comes into effect, the 12,000 comatose patients in Germany who could theoretically recover one day will be kept alive at all costs.