What is a patient decree? What are the advantages of preventive care?

A living will affects everyone. It is not only in old age that you should draw up a living will: Accidents or serious acute illnesses can also put young people in situations in which they can no longer demand treatment themselves, but can also refuse it. In such situations, the question arises as to whether life should be prolonged by any means. With a living will, you can specify in which situations you want which treatments and which you refuse.

What is a patient decree?

Section 1827 of the German Civil Code defines what a living will is. Paragraph 1 states: “If an adult capable of giving consent has stipulated in writing whether he or she consents to or prohibits certain examinations of his or her state of health, medical treatment or medical interventions that are not yet imminent at the time of the stipulation (living will), the guardian shall check whether these stipulations apply to the current life and treatment situation of the person being cared for. If this is the case, the guardian must ensure that the wishes of the person being cared for are expressed and enforced. A living will can be revoked informally at any time.”

In concrete terms, this regulation means that doctors are bound by the provisions in an advance directive. However, this presupposes that the living will specifies in sufficient detail which situations it should apply to and which specific treatments should or should not be carried out. A further requirement is that the person making the living will must be “capable of giving consent”. Both points, the specific formulation of the areas of application of the living will and the question of capacity to consent, can be controversial in acute cases. If this is the case, a living will is not binding for medical practitioners. Rather, the “presumed will” must be investigated, as regulated in Section 1827 (2) of the German Civil Code.

If you decide to draw up a living will, it should fulfill all of the above requirements. Only then can you be sure that your living will serves to implement your wishes and ideas.

What is the difference between a living will, care directive and health care proxy?

The terms living will, care directive (LINK to further article: must be added later) and health care proxy (LINK to further article: must be added later) are often used interchangeably. It is true that all documents aim to regulate a person’s important affairs if they are no longer able to do so themselves. A living will exclusively regulates the question of which treatments a person should receive or not receive in specific situations. A health care proxy and a care directive, on the other hand, stipulate who should generally manage a person’s most important affairs if the person concerned is no longer able to do so themselves. Spouses or partners in a registered partnership and children are not automatically authorized. A regulation is always required that the person concerned has written down before a situation arises that makes a care directive or health care proxy necessary.

Contents of a living will: How do I make a living will?

In principle, any person over the age of 18 who does not have any mental limitations that affect their decision-making capacity can draw up a living will. It is not necessary to consult a specialist lawyer or a notary. The living will must be drawn up in writing. It refers to a moment in the future when the person is no longer able to express their will.

Formal requirements for a living will

The following information should be included in the living will:

• Names: with first and last name
• Date of birth
• current home address
• Date of the exhibition
• handwritten signature

You should also regularly update your living will. Above all, this means that you should sign and date the living will again at least every two years. The reason for this rule is that your wishes and ideas about how to deal with a serious illness and your own death can change over time. You should therefore read through your living will regularly and make changes if necessary. This can be done by hand. It is not necessary to draw up a new living will.

Content requirements: What should you pay attention to when drawing up a living will?

In order for a living will to take effect in an emergency, high content-related hurdles must be met. This is because in a living will you can specify that, under certain conditions and in specific situations, certain treatments should not be carried out. As this can result in death, the content of the living will must be very specific. Only then will doctors be able to act in your best interests. And only if the provisions of a living will apply to the specific life or treatment situation is it binding. Otherwise, your presumed will and your presumed treatment wishes must be researched.

In the living will, you must therefore specify as specifically as possible the medical situations in which the living will should apply. These could be the following situations and conditions, for example:

• Terminal illness, such as cancer
• irreversible (non-reversible), massive brain damage
• Waking coma
• Brain deterioration (dementia) with indication of the stage
• specific indications of illnesses already existing at the time the living will is drawn up, which could lead to conditions in which a living will should apply. (For example, multiple sclerosis)

It is also important that the medical measures that should or should not be taken are described as precisely as possible. This is because medical professionals and relatives have to make decisions based on your living will, which can make the difference between life and death. Formulations such as “I do not wish any life-prolonging measures” are not sufficiently specific according to the case law of the Federal Court of Justice.

In the living will, you should specifically address the following questions:

• Should resuscitation measures be taken (in the event of cardiac arrest)?
• Should artificial respiration be performed?
• Should artificial nutrition be started?
• You should also clarify further details if you already have serious illnesses for which certain life-prolonging treatments are possible in the terminal stage of the illness.

Important additions: What additional information should be included in a living will?

If a situation arises that is not covered by the living will, you can make it easier for relatives and doctors to research your presumed wishes by providing further information. In this way, you can also ensure that your values are taken into account. It is about questions like these:

• What are your religious views?
• What morals are important to you?
• What are you afraid of in terms of old age and illness?
• Who do you trust?

Who can help you draw up a living will?

In principle, it is possible to use a living will to print out. Corresponding templates based on the modular principle can be found at the Federal Ministry of Justice or the consumer advice center, among others. You can also find numerous other printable living wills on the internet. It is important that you pay attention to the reliability of the provider. It is also important that you read all text passages carefully and compare them with your own wishes and ideas. You can also amend or add to the components of the living will yourself. If you have any questions, it is important that you seek advice. This can be done with specialist lawyers, notaries or doctors.

Drawing up a living will: Who can help?

If you would like advice on drawing up your living will, you have various options:

• Specialist lawyer or notary: They can advise you on legal matters in particular.
• Medical professionals: Seek advice from your family doctor. They know your state of health best. They will provide you with support when it comes to formulating medical issues as specifically as possible.
• Advice centers: Some legal expenses insurance companies, Caritas and the German Foundation for Patient Protection offer advice by telephone or online on the subject of living wills.

Information on how to find a living will

In an emergency, the living will may need to be ready very quickly. Therefore, if you have drawn up a living will, you should bear the following things in mind:

• Always carry a piece of paper with a reference to your living will. The note must also state where the living will is located.
• You can leave the living will with a family member or another trusted person.
• Notaries and specialist lawyers can deposit the living will with the Central Register of Lasting Powers of Attorney of the Federal Chamber of Notaries on request.