How strictly should advance decisions be followed? The patients' opinion Sir-Advance treatment decisions for the case of decisional incapacity are increasingly being used by German citizens. 1 The federal parliament (Bundestag) is currently debating bills on the issue, but the members of parliament struggle with the question how much legally binding force an advance decision (AD) should have on physicians. 2 Although there have been many surveys among health care professionals, we could not find any survey which asked the authors of ADs themselves how much binding force they want these documents to have. As there is evidence that a terminal illness changes people's attitudes and may weaken advance refusals of treatment, 3 we aimed to compare the terminally ill and the nonterminally ill.

No abstract

In modern medicine, decisions about the kind of treatment at life's end are often inevitable. According to German law, powers of attorney and advance directives can be of help in these decisions. When a patient in a state of competence has issued a lasting power of attorney, there is no need for courts to appoint a proxy, and physicians immediately have a legally empowered decision-maker they can address. According to current German law, advance directives are legally valid and binding expressions of a patient's will. They are, however, more powerful when issued after consultation with a physician. If treatment at life's end no longer complies with the patient's will or loses its medical indication, the goal of treatment should be redirected towards palliation. This implies that life-sustaining treatment may be withdrawn or withheld, which is best accomplished with sensitivity to the needs of patients, relatives, and health care professionals.

No abstract

No abstract