The Federal Court of Justice (BGH) has decided in the event of a long-standing dispute over a living will that the woman lying in wait coma may die. The Karlsruhe judges dismissed a complaint of their husband against a corresponding decision of Landshut Landshut in the last instance (Az. XII ZB 604/15). Thus, the son of the woman prevailed: He took the position that his mother would have wanted an end to the artificial diet and hydration.

The case has a fundamental meaning: It was essentially about how concrete people need to hold for the emergency, when they want to continue to live and when not, so their wishes are taken into account. For example, the statement "not wanting to sustain life" is usually not enough because it is too general.

Since 2009, citizens have been able to stipulate in writing in a living will whether and how they wish to receive medical treatment in certain situations. In order to facilitate the interpretation, the document may also contain personal information, for example on one's own values ​​or on religious questions. The German Foundation for Patient Protection assumes that every third person in Germany now has a living will.

"Life-prolonging measures should be avoided" is not enough

A first BGH ruling in another case in 2016 had unsettled many people, according to the patient advocates. It had a woman decree that in a permanent damage to the brain "life-prolonging measures should be omitted." After a stroke, the daughters argued about whether the mother wanted to continue to be fed artificially. The BGH was too weak to use the wording as a basis. It does not contain a sufficiently specific treatment decision, it was said at that time.

Read here: Which questions your living will should answer.

In the current case of the woman born in 1940, who had suffered a stroke more than ten years ago, the Federal Court of Justice had raised doubts in early 2017 as to whether the lower courts had not requested too much from the living will.

In her living will, the patient expressed similar views to the patient from the 2016 judgment. In addition, she specifically opposed life-prolonging measures in the event of "no prospect of regaining consciousness." Prior to her stroke, she had witnessed two cases of coma in the area and several times told relatives and acquaintances that she did not want to pretend that she did not want to be artificially fed, rather die her. Luckily, she provided with her living will. Once she was able to talk to her therapist after the stroke, then she said, "I want to die."

Artificial nutrition was already initiated

The district court initially held that it can not be clearly deduced that the woman also wanted to stop an already initiated artificial diet. The Federal Court of Justice answered this in 2017 and clarified that even if medical measures are not described in detail, a living will can be concrete enough if specific illnesses or treatment situations are mentioned. Whether there is still a chance that the woman regains consciousness, can be clarified by an expert.

The district court has meanwhile made up for this and subsequently declared the document to be sufficiently precise and effective - according to the expert, the functions of the cerebrum are completely wiped out in women. With the decision of the BGH is now to implement what the woman has wished for this case. Family and doctors have to stick to it.

For the Foundation for Patient Protection, the resolution makes it clear once again: "The more specific a living will is, the better - if there are no possibilities for interpretation, quarrels become superfluous", explained CEO Eugen Brysch. "Therefore, it should always be clearly stated in the living will in which illness which medical measures are desired or rejected."