Institut für Ethik und Geschichte der Medizin, Universität Tübingen, Gartenstr 47, D-72076 Tübingen, Germany.
J Med Ethics. 2010 Dec;36(12):779-83. doi: 10.1136/jme.2010.036376.
This article presents the new German law on advance directives from 1 September 2009. The history of the parliamentary process of this law is described, the present regulations are explained, their relevance for medical practice discussed and shortcomings are identified. Finally, the new law is compared with other regulations in the international context. Previously established legal practice in Germany has now become largely confirmed by the new law: An advanced directive must be respected in any decision concerning medical treatment, regardless of the stage of the illness. It can be informally revoked at any time, even with limited decision-making capacity. Nobody may be obliged to issue a directive in any way. Advance directives do not need notarisation or routine updating after certain time intervals. Provided that the patient, who is no longer mentally competent, has issued a lasting power of attorney (Bevollmächtiger), or provided that the patient has been appointed a healthcare proxy by the courts (Betreuer), this authorized surrogate must assert the patient's will. The role of the guardianship court is clarified: it only needs to be involved in cases of disagreement as to the patient's will. The new German law thus combines more legal certainty with a liberal emphasis on patient autonomy and flexible, adaptable regulations.
本文介绍了 2009 年 9 月 1 日生效的德国新的预嘱法。描述了该法律的议会程序历史，解释了现行规定，讨论了它们对医疗实践的相关性，并指出了不足之处。最后，将新法与国际背景下的其他法规进行了比较。德国以前的法律实践现在在很大程度上得到了新法的确认：无论疾病处于何种阶段，预嘱都必须在任何涉及医疗的决定中得到尊重。它可以随时被非正式撤销，即使在决策能力有限的情况下也可以撤销。任何人都不得以任何方式被强制发出指示。预嘱无需在经过一定时间间隔后进行公证或例行更新。只要不再具有精神能力的患者已经签发持久授权书（Bevollmächtiger），或者患者已被法院指定医疗代理人（Betreuer），该授权代理人就必须维护患者的意愿。监护法院的角色也得到了澄清：只有在对患者意愿存在分歧的情况下才需要涉及监护法院。德国新法因此在更具法律确定性的同时，强调了患者自主权和灵活、适应性强的规定。
