Abstract
During the last two decades, various options have been developed to enable competent persons to influence, in advance, the decision-making process concerning their medical treatment in case they become incompetent. At the same time, this raised the question about the legal status of such statements, asking if they are fundamentally different from actual consents or refusals to consent regarding medical treatment. The Act that has come into force on September 1st, 2009, regulates living wills and the duties and role of surrogate decision-makers in the scope of civil law, but leaves quite a lot of questions unanswered.
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Notes
- 1.
“Basic Law for the Federal Republic of Germany” (Grundgesetz für die Bundesrepublik Deutschland—GG) of 23 May 1949 (Federal Law Gazette p. 1), in the revised version published in the Federal Law Gazette, part III, class. no. 100-1, as last amended by Art. 1 of the Law of 11 July 2012 (Federal Law Gazette I p. 1478)”, English unofficial translation available at http://www.gesetze-im-internet.de/englisch_gg/index.html (Last accessed: 1 October 2013).
- 2.
“Criminal Code” (Strafgesetzbuch—StGB) of 15 May 1871, in the version promulgated on 13 November 1998 (Federal Law Gazette, part I, p. 3322), last amended by Art. 1 of the Law of 24 September 2013 (Federal Law Gazette, part I, p. 3671). Unofficial English translation available at http://www.gesetze-im-internet.de/englisch_stgb/index.html (Last accessed: 1 October 2013).
- 3.
“Civil Code” (Bürgerliches Gesetzbuch—BGB) of 18 August 1896, in the version promulgated on 2 January 2002, last amended by Art. 1 of the Law of 20 September 2013 (Federal Law Gazette I p. 3642); unofficial English translation available at http://www.gesetze-im-internet.de/englisch_bgb/index.html (Last accessed: 1 October 2013).
- 4.
Repeated judicial decisions of the German Federal Court of Justice (BGHSt 11, 111; 16, 309; 35, 246; BGHZ 29, 33; 106, 153) based on judicial decisions of the Imperial Court of Justice dating back to 1894 (RGSt 25, 375; 38, 34).
- 5.
In order to improve readability, only the male form is used in the text; nevertheless, all data apply to members of both genders.
- 6.
Section 630 d BGB. For further information on informed consent, see Parzeller et al. (2012), pp. A576–586.
- 7.
Taupitz (2000a), pp. A28 et seq.
- 8.
Taupitz (2000a), p. A28.
- 9.
For an overview of exceptions to the physician's duty of informing the patient, see Parzeller et al. (2012), p. A581.
- 10.
Compare: BVerfG decision from 25 July 1979 no. 2 BvR 878/74 = BVerfGE 52, 131; BGH decision from 5 July 2007 no. 4 StR 549/06 = MedR 2008, 158.
- 11.
BGH decision from 5 December 1958 no. VI ZR 266/57 = BGHZ 29, 33.
- 12.
Taupitz (2000a), pp. A60 et seq.
- 13.
BGH, decision from 10 February 1959 no. 5 StR 533/58 = BGHSt 12, 379.
- 14.
More information: Taupitz (2000a), pp. A58 et seq.
- 15.
See LG Oldenburg decision from 16 March 2010 no. AZ 8 T 180/10; crit. remark on the decision from Tolmein (2010).
- 16.
- 17.
- 18.
The parliamentary debate started back in 1985, after a publicity campaign of assisted suicide proponents. Accordingly, the public hearing held by the Committee on Legal Affairs of the German Bundestag focused mainly on criminal law provisions. For more information on this initial debate, see Stenographisches Protokoll über die 51. Sitzung des Rechtsausschusses des Deutschen Bundestages (1985), protocol no. 51.
- 19.
“3rd Act Changing the Custodianship Law” (3. Gesetz zur Änderung des Betreuungsrechts—3. BtÄndG”) of 29 July 2009 (entered into force on 1 September 2009), in: Federal Law Gazette I, p. 2286.
- 20.
This law was supported by different members of all parties, even though mainly by members of the Social Democrats, the Greens, and the Liberals. In this case, the usual practice to vote in line with their own party was skipped, since this issue was considered to be a matter of conscience.
- 21.
Nevertheless, an indirect impact on criminal law occurred due to the recognition of the primacy of the patient’s will over the physician’s position as the guarantor of life (sec. 323c of the Criminal Code). See also BGH decision from 25 June 2010 no. 2 StR 454/09 = NJW 2010, 2963 (2966).
- 22.
- 23.
There are different such orders or requests, such as DNR (“do not resuscitate”), CPR (“cardiopulmonary resuscitation”), DNAR, (“do not attempt resuscitation”), AND (“allow natural death”), “comfort measures only”, “no tube feeding”, “no IV-fluids”, etc. For further information: Gillick (2006), p. 133; Burns et al. (2003), p. 1550; Mirachi (2007), p. 305; Schmidt (2009), p. A-1511/B-1292/C-1260; Rinofner-Kreidl (2010), p. 32; Schweizerische Akademie der Medizinischen Wissenschaften (SAMW) 2008, etc.
- 24.
Jox et al. (2008), p. 163.
- 25.
A bill presented to the German parliament regarding this issue and suggesting that relatives should be considered as standard surrogate decision-makers for incompetent patients was rejected at this point (Bundestag printed paper no. 15/4874 p. 26, in conj. with Bundestag printed paper no. 15/2494). For further information: Bundesrat printed paper no. 865/03; 2003, p. 97, http://www.dnoti.de/DOC/2005/abschlussbericht.pdf (Last accessed: 20 June 2012); crit. Strätling et al. (2003), p. 379; in favour of a default system, Sahm and Will, (2005), p. 20.
- 26.
Bundesamt für Justiz: Betreuungsverfahren—Zusammenstellung der Bundesergebnisse für die Jahre 1992 bis 2011, available online at: http://www.bundesjustizamt.de/DE/Themen/Buergerdienste/Justizstatistik/Betreuung/Verfahren__Betreuungsgesetz,templateId=raw,property=publicationFile.pdf/Verfahren_Betreuungsgesetz.pdf (Last accessed: 17 July 2012).
- 27.
Usually they cover property and financial or personal welfare matters, but they can also be more detailed like, e.g., “apartment clearing out” (BayObLG decision from 19 June 2001 no. 3Z BR 125/01 = NJW 2002, 381), etc.
- 28.
Compare sec. 276 I no. 2 of the Law on the Proceedings regarding Family Matters and Voluntary Jurisdiction (Gesetz über das Verfahren in Familiensachen und in den Angelegenheiten der freiwilligen Gerichtsbarkeit = FamFG).
- 29.
Bundestag printed paper no. 11/4528, p. 122; BayObLG decision from 3 June 2002 no. 3Z BR 94/02 = FamRZ 2002, 1225 et seq.; BGH decision from 4 August 2010 no. XII ZB 167/10.
- 30.
Compare: BayObLG decision from 3 August 1995 no. 3 Z BR 190/95 = BtPrax 1995, 218; BayObLG decision from 24 August 2001 no. 3 Z BR 274/01 = FPR 2002, 203.
- 31.
Diederichsen in: Palandt (2012), sec. 1897 BGB, recital 16.
- 32.
Bundestag printed paper no. 11/4528, p. 128.
- 33.
For more information see: Lipp (2007), p. 48.
- 34.
Bundestag printed paper no. 11/4528, p. 122; BayObLG decision from 3 June 2002 no. 3Z BR 94/02 = FamRZ 2002, 1225 et seq.; BGH decision from 4 August 2010 no. XII ZB 167/10.
- 35.
Roth 2010, part C, recital 2 et seq.
- 36.
Powers of attorney “are also in the public interest as they avoid costly guardianship proceedings as well as the appointment of guardians who, if the ward is poor, have to be paid for by the general public” (Lipp 2007, p. 30). See also Bundestag printed paper no. 11/4528, p. 122.
- 37.
More information: Lipp (2007).
- 38.
A legally incompetent person may apply to the custodianship court to appoint a trusted person as his custodian. For more information, see Taupitz (2000a), p. A 102; Roth 2010, part C, recital 125; partial legal capacity sufficient according to, e.g., Baltz (2009), p. 77, with further reference; capacity to give informed consent sufficient according to, e.g., Diederichsen in: Palandt (2012), sec. 1904, rectial 26.
- 39.
Information brochure on the custodianship law of the German Federal Ministry of Justice 2012, p. 31, http://www.bmj.de/SharedDocs/Downloads/DE/broschueren_fuer_warenkorb/DE/Das_Betreuungsrecht.pdf (Last accessed: 17 July 2012).
- 40.
Winterstein in: Jürgens (2010), sec. 167 BGB, recital 3; the content of such instruments is hardly provable and therefore cannot be verified; compare OLG Hamm decision from 12 May 2009 no. I-15 Wx 1-4/09 = FGPrax 2009, 217 (219). For this reason, some authors argue that a power of attorney for health care has to be in writing in any case; for example: Dodegge (2010a), p. 2630.
- 41.
Bundestag printed paper no. 16/13314, p. 4.
- 42.
LG Fulda decision from 30 April 2009 no. 16 Js 1/08 - 1 Ks = BeckRS 2010, 06420; LG Waldshut-Tiengen decision from 20 February 2006 no. 1T 161/05 = NJW 2006, 2270.
- 43.
Bundestag printed paper no. 16/8442, p. 13.
- 44.
Sec. 25 of the Certification Act (Beurkundungsgesetz) from 28 August 1969 (Federal Law Gazette I, p. 1513), as last changed by art. 2 of the Law of 22 December 2010 (Federal Law Gazette I, p. 2255).
- 45.
May (2012).
- 46.
- 47.
- 48.
- 49.
See above 1.2.
- 50.
BGH decision from 10 October 2006 no. VI ZR 74/05 = MedR 2008, 289, with a comment by Lipp. Providing parents with information required also by OLG Karlsruhe, decision from 07.04.2010 no. 7 U 114/09 = BeckRS 2010, 08386. Further crit. comments: Kern ((2007)), p. 220412. One part of the literature had already demanded a similar system of “co-consent” of the minor capable of consenting and his parents; see Taupitz (2000a), pp. A 63 et seq.
- 51.
More detailed: Taupitz (2000a), pp. A 58 et seq.
- 52.
Lipp (2009), sec. 17, recital 127.
- 53.
- 54.
LG Kleve decision from 31 May 2010 no. 4T 77/10 = NJW 2010, 2666 (2668). Accordingly, Diederichsen in: Palandt (2012), § 1901a, recital 18 with further references.
- 55.
Najdecki (2009).
- 56.
Schmitz (2009).
- 57.
Bundestag printed paper no. 16/8442, p. 13.
- 58.
During the parliamentarian debate, the German legislator relied on the number of 8.6 million living wills (ca. 10 % of the total population) that has been estimated by the German Hospice Foundation; compare Bundestag printed paper 16/8442, p. 8.
- 59.
The legislator explicitly recognised this risk in Bundestag printed paper no. 16/8442, p. 14. See also Albrecht and Albrecht (2009), p. 428.
- 60.
- 61.
Bundestag printed paper no. 16/13314, p. 20. Compare also: Taupitz (2000b), p. 116.
- 62.
Bundestag printed paper 16/13314, p. 5.
- 63.
Id. at p. 4.
- 64.
Seichter (2010), p. 162.
- 65.
See also Taupitz and Weber-Hassemer (2006), p. 1117.
- 66.
“Empfehlungen der Bundesärztekammer und der Zentralen Ethikkommission bei der Bundesärztekammer zum Umgang mit Vorsorgevollmacht und Patientenverfügung in der ärztlichen Praxis” 2010, p. A 882.
- 67.
- 68.
- 69.
Accordingly, Bundestag printed paper no. 16/8442, p. 11, 15.
- 70.
- 71.
Law of 20 February 2013 (Federal Law Gazette, part I, p. 277).
- 72.
Diehn and Rebhahn (2010), p. 331.
- 73.
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Taupitz, J. (2013). Patient’s Autonomy According to 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_4
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