Bioethics: legitimate questions

After six years of discussion and polemics, on June 18, the Bundestag, Germany’s Federal Parliament, adopted a law regarding living wills. The Bundestag voted 320/566 in favour. According to the new law, patients’ living wills concerning medical treatment are binding for medical staff regardless of the patients’ health stage. Germany’s Catholic Church took a stand the very same day with a statement signed by Msgr. Robert Zollitsch, President of Germany’s Bishops’ Conference. Follows an excerpt of the statement.Today the Bundestag gave the final vote to the regulation on living wills. The draft submitted by Joachim Stünker (SPD) gained the needed majority, after a serious and responsible debate that lasted eight years. From now onwards, if it isn’t possible to establish the will of a patient in a given moment, the will expressed in an advanced directive will be considered as an effective declaration of will. We have legitimate questions regarding the equalization between the previously declared will and the present will of the patient, in case a decision is to be taken when the patient’s health condition prevents his consensus. The foundation of the will of the patient, based on his advanced directive, doesn’t repose in its existential experience but in its theoretical premise.Establishing the difference between these two aspects, from the viewpoint of the will of the patient, constitutes the particular responsibility of the persons of reference and of the medical staff, which include a guardian or a procurator in their capacities as legal representatives. Recent debates regarding the bearing and the binding effectiveness of living wills has shown that a number of aspects ought to be taken into account when the will is drawn up and implemented. These include the moment when the living will was issued, whether the will expressed in advance is compatible with the current state of health of the patient and whether before drawing up the declaration the patient had been informed by the medical staff. Patients’ living wills are certainly appropriate.They respond to the patients’ right to self-determination. On several occasions we said we are in favour of patients’ self- determination and also that self-determination be associated with medical care, in order to ensure the patients’ wholesome autonomy. However, we do believe that the legal regulation of living wills, that is the object of the current debate, which highlights the patients’ self-determination from one perspective only, ought to be accurately investigated in order to ascertain whether the initial will of the patients has been envisaged along with the deterioration of the patients’ state of health. We once again wish to point out that patients in a state of vigil coma and those affected by severe dementia are not in a terminal state. Along with the patients’ living wills there are other possibilities regarding the approach to this issue. In the living will drawn up by Germany’s Bishops’ Conference and by the Council of Germany’s Evangelical Church (EKD) in conjunction with other member Churches and members of the Community of Christian Churches (ACK), an option consists in appointing a person as the legal representative that can help the doctor address the patients’ life termination, whose intentions he has been made aware of. In our opinion this synergy of self-determination and assistance can best guarantee the welfare of any patient nearing life termination.