Legal Rules on Palliative Care Under German Law

Salkić, Amina

doi:10.1007/978-3-642-40555-6_8

Amina Salkić¹¹

Part of the book series: Veröffentlichungen des Instituts für Deutsches, Europäisches und Internationales Medizinrecht, Gesundheitsrecht und Bioethik der Universitäten Heidelberg und Mannheim ((IMGB,volume 41))

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Abstract

During the last few years, palliative care has gained significant importance at the national, European, and international levels. In Germany, meanwhile, there is a broad consensus crossing all party lines that it is of utmost importance to develop needs-based palliative care. In order to achieve this goal, the legislator passed several laws regulating different aspects of palliative care and thus strengthened its legal basis, in particular, within the Fifth Book of the German Social Code. Other relevant policymaker followed by adopting corresponding substatutory rules and regulations.

Even though palliative care structures are growing steadily and spreading to most areas, their availability remains to be uneven, especially in rural areas. The ambitious goal of full coverage with comprehensive palliative care in patients’ homes has still not been achieved.

This chapter aims to provide an overview of the national legislation and existing regulations regarding palliative care under German law, their constitutional basis, and historic background.

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Notes

1.
World Health Organization (2002), p. 84. Compare also Scottish Partnership for Palliative Care (2006) p. 9.
2.
Saunders (1961), p. 548.
3.
In March 1998, then German Hospice Foundation initiated the publication of the Dortmund Declaration ‘Menschliche Zuwendung statt aktiver Sterbehilfe’ (Human Affection instead of Active Euthanasia). This nationwide campaign was also supported by then Federal President Johannes Rau, Chancellor Helmut Kohl, and Federal Health Minister Horst Seehofer. See further Brenn (1998), pp. 18–19.
4.
See, for example, Bundestag printed paper no. 15/5858, p. 68.
5.
In Germany, many do not even translate the term palliative care but rather use it in its original English form. Others translate it as Palliativmedizin; Palliativversorgung, or (ehrenamtliche) Hospizarbeit. In Austria, the following terms are also being used: palliative Betreuung/Palliativbetreuung, Lindernde Fürsorge (relief and comfort). Besides the already mentioned terms, in Switzerland the term Palliative Betreuung exists (EAPC 2009, p. 281). Compare also Pastrana et al. (2008), p. 712.
6.
The film was later followed by another movie. In this second movie, Die letzte Station—Dreharbeiten in einer Sterbeklinik (The Last Station—Filming in a Dying Clinic), the members of the film crew reflected on their initial work and wondered if they themselves have changed due to their experiences in the London hospice. In 1972, the editorial team of the German state channel ZDF was awarded with the Adolf-Grimme-Prize for the production of this second movie.
7.
Historically, the hospice movement always regarded itself as a counterweight to the so-called euthanasia movement that advocates killing on request. Nevertheless, even prominent scientists perceived the dying clinics (Sterbekliniken) as belonging to the euthanasia movement (see for example: Tröndle 1987, p. 40).
8.
Godzik (1993), p. 27.
9.
Godzik (1993), p. 27; Oheim (2009), p. 42.
10.
More information with further references: Oheim (2009), p. 42.
11.
Pastoralkommission der Deutschen Bischofskonferenz (1993).
12.
Godzik and Jeziorowski (1989) and Godzik (1992).
13.
The Ministry initially funded 12, later 14, inpatient palliative care hospital wards in order to investigate the possibilities of improving care of dying cancer patients in hospitals. For more information, see further Bundesministerium für Gesundheit (1998).
14.
Nowadays, 60 % of the 3,800 members of the German Society for Palliative Medicine (Deutsche Gesellschaft für Palliativmedizin—DGP) are physicians, almost 30 % are involved in care services, and further 10 % work in other professions (among others are psychology, spiritual welfare, social work, physiotherapy, pharmacology, and law). For more information, see further http://www.dgpalliativmedizin.de. Accessed 23 September 2013.
15.
In 1992, the Federal association representing the interests of the 16 regional hospice organizations of the Länder (Landesarbeitsgemeinschaften—LAGs) was established as Bundesarbeitsgemeinschaft Hospiz (BAG). In 2007, this German umbrella hospice organization has been renamed to Deutscher Hospiz- und PalliativVerband e.V. (DHPV). See further http://www.dhpv.de. Accessed 23 September 2013.
16.
The German Palliative Care Society—Deutsche Gesellschaft für Palliativmedizin e.V. (DGP) was established in 1994, mainly representing physicians. See further http://www.dgpalliativmedizin.de. Accessed 23 September 2013.
17.
The association representing the interests of patients, Deutsche Hospiz Stiftung e.V., was founded in 1995. See further http://www.stiftung-patientenschutz.de. Accessed 23 September 2013.
18.
In 1990, six families with children who had life-shortening diseases joined together and founded the German Children’s Hospice Association (Deutscher Kinderhospizverein e.V.). See further http://www.deutscher-kinderhospizverein.de. Accessed 23 September 2013
19.
Recommendation Rec (2003) 24 of the Committee of Ministers to member states on the Organization of palliative care and explanatory memorandum (Adopted by the Committee of Ministers on 12 November 2003 at the 860th meeting of the Ministers’ Deputies), available at https://wcd.coe.int/ViewDoc.jsp?id=85719. Accessed 23 September 2013.
20.
Davies and Higginson (2004a, b).
21.
Barcelona Declaration on Palliative Care (1995), p. 15; Poznan Declaration (1998), pp. 61–65.
22.
The European Federation of Older People (EURAG) (2004), p. 16.
23.
Differing opinion regarding the Council of Europe: Rixen (2012), recital 1.
24.
Compare for example: German National Ethics Council (Nationaler Ethikrat) (2006), p. 52 et seq.
25.
Council of Europe, CM 2003, 130 Addendum/15 October 2003, paragraph 53; compare also EAPC (2009), pp. 285–286.
26.
Council of Europe, CM 2003, 130 Addendum/15 October 2003, paragraph 53.
27.
The Scottish Government (2008).
28.
Section 27 I 9 of the Approbationsordnung für Ärzte (ÄApprO).
29.
Bundestag printed paper no. 13/7264, p. 60.
30.
A comprehensive list of numerous German laws and regulations concerning palliative care is available at http://www.dhpv.de/service_gesetze-verordnungen.html. Accessed 23 September 2013.
31.
There are several different types of providers of palliative care, especially in the outpatient sector. For further information, see Bundestag printed paper no. 15/5858, p. 10 et seq.
32.
The current status of development is recorded in Sabatowski et al. (2013).
33.
An additional form of hospital-based palliative care includes palliative care consultancy services (Konsiliardienste). They are often connected to a palliative care ward. Their financial scheme is still unclear.
34.
For more information on financial schemes for hospital-based palliative care, see Maier (2011).
35.
A detailed list of 12 children’s hospices (last updated on 27 August 2013), available at http://www.bundesstiftung-kinderhospiz.de/fileadmin/dokumente/liste.pdf. Accessed 19 June 2013.
36.
For an overview of the development of inpatient hospices and palliative care hospital wards from 1996 to November 2011, see Sabatowski et al. (2013).
37.
German Bundestag printed paper no. 13/7264, p. 60; German Bundestag printed paper no. 16/3100, p. 105.
38.
Federal Gazette 1997, BGBl. I p. 1520; for current full English wording of this section, see Appendix.
39.
According to this new section and the relevant Framework Agreement, which was signed by the Bundesarbeitsgemeinschaft Hospiz (now: DHPV) and the Statutory Health Insurance Funds in 1998, the financing relied on multiple sources. See further Hoffmann et al. (2009).
40.
Rahmenvereinbarung nach § 39a Abs. 1 Satz 4 SGB V über Art und Umfang, sowie Sicherung der Qualität, der stationären Hospizversorgung from 13 March 1998, in its version from 14 April 2010, available at http://www.dhpv.de/tl_files/public/Service/Gesetze%20und%20Verordnungen/2009-07-23_RV-stationaer.pdf. Accessed 23 September 2013.
41.
Bundestag printed paper no. 13/11459, p. 37.
42.
Section 2 of the Pflegeleistungs-Ergänzungsgesetz from 14 December 2001 (Federal Gazette BGBl. I 3728); for full English wording of this section, see Appendix; for further explanatory information following the Draft, see Bundestag printed paper no. 14/7473, p. 22.
43.
Bundestag printed paper no. 14/7473, p. 13. Since 2009, the same counts for nursing homes, institutions for integration of disabled persons, or children and adolescents.
44.
Bundestag printed paper no. 14/7473, p. 22.
45.
Rahmenvereinbarung nach § 39a Abs. 2 Satz 7 SGB V zu den Voraussetzungen der Förderung
sowie zu Inhalt, Qualität und Umfang der ambulanten Hospizarbeit from 3 September 2002, in its version from 14 April 2010, available at http://www.dhpv.de/tl_files/public/Service/Gesetze%20und%20Verordnungen/amb_rahmen_p39a-sgb5.pdf. Accessed 23 September 2013.
46.
Bundesministerium für Gesundheit (2012), p. 2.
47.
Richtlinie des Gemeinsamen Bundesausschusses zur Verordnung von spezialisierter ambulanter Palliativversorgung (Spezialisierte Ambulante Palliativversorgungs-Richtlinie/SAPV-RL) from 20 December 2007, last amended on 15 April 2010, entered into force on 25 June 2010, available at http://www.dhpv.de/tl_files/public/Service/Gesetze%20und%20Verordnungen/2010-04-15-SAPV-RL.pdf. Accessed 23 September 2013.
48.
Empfehlungen des GKV-Spitzenverbandes nach § 132d Abs. 2 SGB V für die spezialisierte ambulante Palliativversorgung from 23 June 2008 in its version from 5 November 2012, available at http://www.dhpv.de/tl_files/public/Service/Gesetze%20und%20Verordnungen/Palliativ-Empfehlungen-nach-132d-Abs-2-SGB-V_05-11-20102.pdf. Accessed 23 September 2013.
49.
A list of present model contracts (Musterverträge), listed by individual German federal states (Länder), available at http://www.dgpalliativmedizin.de/allgemein/sapv.html. Accessed 23 September 2013.
50.
Jansky et al. (2011), p. 164.
51.
Wodarg (2008).
52.
LSG Nordrhein-Westfalen, decision from 30 March 2009, no. L 16 B 15/09 KR ER.
53.
Bundestag printed paper no. 16/3100, p. 145.
54.
A detailed list of their distribution and further information available at http://www.kbv.de/vl/36178.html. Accessed 23 September 2013. For more information, see also Dielmann-von Berg (2012).
55.
While, for example, in Berlin individual physicians who participate in the provision of SAPV have their own individual BSNR codes, elsewhere teams with more than ten physicians have one joint BSNR code. Because of specific regional developments, in the health care region Westphalia-Lippe, no such codes are necessary. In the health care region North Rhine, these codes are being provided by the regional association of SHI physicians (Kassenärztliche Vereinigung Nordrhein—KV Nordrhein). See further Melching (2011).
56.
A detailed map and further information available at Dielmann-von Berg (2012).
57.
Schneider et al. (2010), pp. 66–70
58.
2.2 II of the Empfehlungen des GKV-Spitzenverbandes nach § 132d Abs. 2 SGB V für die spezialisierte ambulante Palliativversorgung from 23 June 2008 in its version from 5 November 2012, available at http://www.dhpv.de/tl_files/public/Service/Gesetze%20und%20Verordnungen/Palliativ-Empfehlungen-nach-132d-Abs-2-SGB-V_05-11-20102.pdf. Accessed 23 September 2013.
59.
For further information, see Weihrauch (2012).
60.
For further information, see press releases from the patients’ organization IG SAPV ‘SAPV und Privatversicherungen’ (28 April 2012) and ‘SAPV und Privatversicherungen 2’ (11 June 2012), available at http://www.ig-sapv.de/IG-SAPV/Aktuelles.html. Accessed 23 September 2013.
61.
‘PKV übernimmt Kosten der SAPV’, in: Ärzte Zeitung from 25 June 2009, available at http://www.aerztezeitung.de/praxis_wirtschaft/aerztliche_verguetung/article/554612/pkv-uebernimmt-kosten-sapv.html. Accessed 23 September 2013.
62.
Schlingensiepen (2011).
63.
Vereinbarung zur Umsetzung der ambulanten palliativmedizinischen Versorgung von unheilbar erkrankten Patienten im häuslichen Umfeld, in the health care region Westphalia-Lippe in force since 1 July 2011, available at http://www.palliativ-portal.de/images/pdf/westfalen/sapv-nordrhein.pdf. Accessed 23 September 2013.
64.
This norm is directly applicable, and—which is even more important—the German Constitution specifically declares that an amendment affecting basic principles laid down in Article 1 GG is inadmissible (article 79 III GG).
65.
Jacobson (2007), p. 294.
66.
English translation available at http://www.landtag.brandenburg.de/sixcms/media.php/5701/Verfassung_englisch.pdf. Accessed 23 September 2013.
67.
For further information on previous and current attempts of a positive definition, see Herdegen (2013), recital 34 et seq.
68.
In so doing, the courts developed case groups of human dignity violations. For further information on these groups, see Hillgruber (2013), recitals 17-51.1
69.
Dürig (1956), p. 127; Herdegen (2012), recital no. 36. For more information and further references: Will (2011) and Enders (2010).
70.
German Constitutional Court’s decision from 15 December 1970, no. 2 BvF 1/69; 2 BvR 629/68; 2 BvR 308/69 = BVerfGE 30, 1 (26).
71.
For a general overview of different conceptions with further references, see Anderheiden (2012), p. 218 et seq. For a comprehensive overview of different worldwide conceptions and, in particular, in care settings, see Jacobson (2007), p. 298 et seq.
72.
German Constitutional Court’s decision from 15 February 2006, no. 1 BvR 357/05 = BVerfGE 115, 118 (153) with further references.
73.
For further references, see Jacobson (2007), p. 298 et seq.
74.
Enquete-Kommission des Deutschen Bundestages, Bundestag printed paper no. 15/3700, p. 10.
75.
Enquete-Kommission des Deutschen Bundestages, Bundestag printed paper no. 15/5858, p. 67 et seq.
76.
Ibid., p. 8.
77.
Ibid., p. 8.
78.
For current English translation of this section, see Appendix.
79.
Bundestag printed paper no. 16/3100, p. 105, referring to the mid-report of the Inquiry Commission from 2005 (Bundestag printed paper no. 15/5858, p. 67 et seq.).
80.
BGH decision no. 4 StR 129/95 from 20 July 1995 = NJW 1995, 3194; OLG Hamm decision no. 3 Ss 396/74 from 6 September 1974 = NJW 1975, 604 (605); OLG Düsseldorf decision no. 2 Ss 302/88—266/88 II from 10 January 1989 = NStZ 1989, 269.
81.
Compare for example: Großkopf and Schanz (2005), p. 138; German Federal Administrative Court’s decision from 19 May 2005, no. 3 C 17/04 = BVerwGE 123, 352.
82.
German Federal Administrative Court’s decision from 19 May 2005, no. 3 C 17/04 = BVerwGE 123, 352.
83.
Ibid.
84.
Report of the Special Rapporteur (2013), p. 9.
85.
For example: Zenz and Rissing-van Saan (2011), p. 384; Kutzer (2010).
86.
See for example: Kutzer (1991), p. 55; Kutzer (1994), p. 115.
87.
In the years before that, German criminal courts have of course many times recognized that wrongfully inducing, enhancing, or maintaining pain meets the offense of assault, which can also be committed by omission and negligence. However, they usually discussed it in the context of the criminal and tort law and not referring to human dignity as contained in article 1 I of the German Constitution.
88.
Kutzer (1994), p. 115; Kutzer (1991), p. 55.
89.
BGH decision from 15 November 1996, no. 3 StR 79/96 = BGHSt 42, 301 (305), referring to Kutzer (1994), p. 115. See also: German Federal Administrative Court’s (Bundesverwaltungsgericht = BVerwG) decision from 19 May 2005, no. 3 C 17/04 = BVerwGE 123, 352.
90.
Steiner (2011), recital 5, referring to judgments of the German Constitutional Court = BVerfGEn 115, 25 (43); 123, 186 (242).
91.
Ibid.
92.
BVerfG decision from 6 December 2005, no. 1 BvR 347/98 = BVerfGE 115, 25 with further references.
93.
Compare also BVerfG decision no. 1 BvL 28/95/1 BvL 29/95/1 BvL 30/95 from 17 December 2002 = BVerfGE 106, 275 (277, 303, 308).
94.
Compare ‘Ökonomie darf das Menschenrecht auf Schmerzfreiheit nicht aushebeln’, in: Medical Tribune Kolloquium no. 3/2010, pp. 6–7.
95.
BVerfG decision no. 1 BvR 347/98; from 6 December 2005. For further information on the case, see: Bohmeier and Penner (2009), pp. 65–77.
96.
Ibid.
97.
Ibid.
98.
Following this decision, in 2011 the G-BA changed its guidelines for medical diagnosis and treatment methods (Gemeinsamer Bundesausschuss (G-BA) 2011b); for further information, compare also BVerfG decisions no. 1 BvR 2496/07 from 29 November 2007 (supplementary to the BVerfG-decision from 6 December 2005, no. 1 BvR 347/98) and no. 1 BvR 3101/06 from 6 February 2007 (specifying the time proximity of the beginning of a life-threatening condition).
99.
Burkhard (2006), p. 181, with further references.
100.
BVerfG decision from 9 February 2010, no. 1 BvL 1/09, 1 BvL 3/09, 1 BvL 4/09 = NJW 2010, 505. See also the accompanying English press release no. 5/2009 of 9 February 2010, concerning this judgment, available at http://www.bundesverfassungsgericht.de/en/press/bvg10-005en.html. Accessed 23 September 2013.
101.
Neumann (2006), p. 393, with further references.
102.
Bundesministerium für Gesundheit (2012) p. 2.
103.
European Association for Palliative Care (EAPC), International Association for Palliative Care (IAHPC), Worldwide Palliative Care Alliance (WPCA), and Human Rights Watch (HRW) are working together to advocate for access to palliative care as a human right. Full text of the Charter and further information available at http://www.eapcnet.eu/Themes/Policy/PragueCharter.aspx. Accessed 23 September 2013.
104.
Compare also the Declaration of Montréal that Access to Pain Management Is a Fundamental Human Right from 2010, available at http://www.iasp-pain.org/Content/NavigationMenu/Advocacy/DeclarationofMontr233al/default.htm. Accessed 23 September 2013.
105.
Kutzer (2010), p. 12; Penner and Bohmeier (2011), pp. 526–535.
106.
Ibid.
107.
Penner and Bohmeier (2011), pp. 526–535
108.
Bundestag printed paper no. 17/3815, p. 178. See further: Goh (2012).
109.
BVerfG decision from 6 December 2005, no. 1 BvR 347/98 = BVerfGE 115, 25.
110.
May (2001), p. 257 et seq.; Friedrichsen (2009), pp. 52–54, with further references. For further information, see also the BtPRAX online lexicon, containing a comprehensive list of important judicial decisions regarding the withdrawal or withholding of nutrition and hydration and other end-of-life issues, available at http://www.bundesanzeiger-verlag.de/betreuung/wiki/Sterbehilfedokumente. Accessed 23 September 2013.
111.
BÄK (2011), p. A 346.
112.
Ibid., p. A 347.
113.
Borasio (2009) and de Ridder (2009).
114.
Müller-Busch (2004a), pp. 107–112; Müller-Busch (2004b), pp. 369–377; Strätling et al. (2005), pp. A-2153/B-1814/C-1718, with further references.
115.
Borasio (2009).
116.
Strätling et al. (2005), p. A-2153, with further references.
117.
Cherny et al. (2009), p. 581; EAPC (2010), p. 342.
118.
Sprung et al. (2008).
119.
For example: Cherny et al. (2009) and Neitzke et al. (2010).
120.
Neitzke et al. (2010), p. 141.
121.
Cherny et al. (2009), p. 586.
122.
For further information, compare also Beckmann (2009) and Salkic and Zwick (2012).
123.
Same doubt raised by Holtappels and Behringer (2012), p. 20.
124.
The German physician Mechthild Bach committed suicide in 2011 after being charged of murder in several cases. ‘Internistin Mechthild Bach ist tot – Suizid’, in: Ärzte Zeitung online 24 January 2011. http://www.aerztezeitung.de/panorama/article/638048/internistin-mechthild-bach-tot-suizid.html. Accessed 23 September 2013
125.
Schlingensiepen (2012) and Augstein (2012).
126.
Augstein (2012).
127.
Müller-Busch (2009), p. 308.
128.
Compare also Martin-Moreno et al. (2008).
129.
Charta zur Betreuung schwerstkranker und sterbender Menschen in Deutschland, available at http://www.charta-zur-betreuung-sterbender.de/tl_files/dokumente/Charta_Broschuere.pdf. Accessed 23 September 2013; for further information, see Nauck and Dlubis-Mertens (2011), pp. 176–178.
130.
It is a collaboration between the EAPC, the International Association for Hospice and Palliative Care (IAHPC), and the World Palliative Care Alliance (WPCA).
131.
European Association for Palliative Care (EAPC), International Association for Hospice and Palliative Care (IAHPC), Worldwide Palliative Care Alliance (WPCA) 2007: Budapest commitments—a framework for palliative care development. http://www.eapcnet.eu/Themes/Policy/Budapestcommitments.aspx. Accessed 23 September 2013.
132.
Budapest Commitments at the EAPC Congresses. Report from Trondheim, 29–31 May 2008, available at: http://www.eapcnet.eu/Themes/Policy/Budapestcommitments/BCatEAPCcongresses.aspx. Accessed 19 June 2013.
133.
A comprehensive list of institutions that have signed the Charter available at: http://www.charta-zur-betreuung-sterbender.de/tl_files/dokumente/Charta-Unterstuetzer-Institutionen.pdf. Accessed 19 June 2013.
134.
A comprehensive list of institutions that have signed the Charter available at: http://www.charta-zur-betreuung-sterbender.de/tl_files/dokumente/Charta-Unterstuetzer-Einzelpersonen.pdf. Accessed 19 June 2013.
135.
‘Sechster Bericht zur Lage der älteren Generation in der Bundesrepublik Deutschland – Altersbilder in der Gesellschaft’ (Bundestag printed paper no. 17/3815, p. 178 et seq.).
136.
BVerfG decision from 3 April 2001, no. 1 BvR 2014/95 = BVerfGE 103, 197 (221).
137.
More information on this program available at http://www.bosch-stiftung.de/content/language2/html/6780.asp. Accessed 19 June 2013.
138.
Robert Bosch Foundation. Palliative care curriculum 2010, http://www.bosch-stiftung.de/content/language2/html/13157.asp. Accessed 23 September 2013
139.
English wording available at http://www.pflege-charta.de/fileadmin/charta/pdf/Die_Charta_in_Englisch.pdf. Accessed 19 June 2013.
140.
Ibid.
141.
A detailed list with further references available at http://www.pflege-charta.de/umsetzung-der-pflege-charta/gesetzliche-bezugnahmen-auf-die-pflege-charta.html. Accessed 19 June 2013.
142.
For more information and further references, see http://www.pflege-charta.de/en/about-the-charter.html. Accessed 23 September 2013.
143.
Führer (2011), pp. 583–596.
144.
Gemeinsamer Bundesausschuss (G-BA) (2011a).
145.
In Germany, the first inpatient children’s hospice was founded in 1998. Detailed lists of existing children’s hospices and hospice services is available at http://www.deutscher-kinderhospizverein.de/verein/kinderhospizarbeit-in-deutschland/. Accessed 19 June 2013.
146.
See section 39a I 5 SGB V (inpatient children’s hospices), section 39a II 8 SGB V (outpatient hospice services) and section 37b I 6 SGB V (specialized outpatient palliative care—SAPV).
147.
World Health Organization (1998), p. 8.
148.
Preamble and section 2 I c of the Framework Agreement (Rahmenvereinbarung nach § 39a Abs. 1 Satz 4 SGB V über Art und Umfang, sowie Sicherung der Qualität, der stationären Hospizversorgung) from 13 March 1998, in its version from 14 April 2010, available at http://www.dhpv.de/tl_files/public/Service/Gesetze%20und%20Verordnungen/2009-07-23_RV-stationaer.pdf. Accessed 23 September 2013.
149.
Rahmenvereinbarung nach § 39a Abs. 2 Satz 7 SGB V zu den Voraussetzungen der Förderung
sowie zu Inhalt, Qualität und Umfang der ambulanten Hospizarbeit from 3 September 2002, in its version from 14 April 2010, available at: http://www.dhpv.de/tl_files/public/Service/Gesetze%20und%20Verordnungen/amb_rahmen_p39a-sgb5.pdf. Accessed 23 September 2013.
150.
Empfehlungen des GKV-Spitzenverbandes nach § 132d Abs. 2 SGB V für die spezialisierte ambulante Palliativversorgung from 23 June 2008 in its version from 5 November 2012, available at: http://www.dhpv.de/tl_files/public/Service/Gesetze%20und%20Verordnungen/Palliativ-Empfehlungen-nach-132d-Abs-2-SGB-V_05-11-20102.pdf. Accessed 23 September 2013.
151.
More on this: Gottschling (2012), p. 1.
152.
DGP (2011).
153.
Dielmann-von Berg (2013).
154.
Empfehlungen zur Ausgestaltung der Versorgungskonzeption der Spezialisierten ambulanten Palliativversorgung (SAPV) von Kindern und Jugendlichen from 12 June 2013, available at: http://www.dgpalliativmedizin.de/images/stories/Empfehlungen_zur_Ausgestaltung_der_Versorgungskonzeption_der_Spezialisierten_ambulanten_Palliativversorgung_von_Kin.pdf. Accessed 23 September 2013.

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Institute for German, European and International Medical Law, Public Health Law and Bioethics of the Universities of Heidelberg and Mannheim (IMGB), Mannheim, Germany
Amina Salkić

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Department of Legal Sciences School of Law, University of Salerno, Fisciano, Salerno, Italy
Stefania Negri
IMGB, University of Mannheim, Mannheim, Baden-Württemberg, Germany
Jochen Taupitz
IMBG, University of Mannheim, Mannheim, Baden-Württemberg, Germany
Amina Salkić
IMGB, University of Mannheim, Mannheim, Baden-Württemberg, Germany
Anna Zwick

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Salkić, A. (2013). Legal Rules on Palliative Care Under German Law. In: Negri, S., Taupitz, J., Salkić, A., Zwick, A. (eds) Advance Care Decision Making in Germany and Italy. Veröffentlichungen des Instituts für Deutsches, Europäisches und Internationales Medizinrecht, Gesundheitsrecht und Bioethik der Universitäten Heidelberg und Mannheim, vol 41. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40555-6_8

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