German court rules on euthanasia

BMJ 1994; 309 doi: (Published 01 October 1994) Cite this as: BMJ 1994;309:830
  1. H L Karcher

    Allowing a comatose patient to die by stopping medical treatment can be lawful even without the patient's written consent, if consent to stopping treatment can be sensibly assumed. This is the essence of a decision made by the German Federal High Court in Karlsruhe last month. The ruling has marginally extended the interpretation of existing German laws on the borderline between criminal homicide and legal passive euthanasia.

    The decision follows the case of a 72 year old woman who had irreversible brain damage after having been resuscitated from a cardiac arrest in 1990. Three years later the patient's family doctor proposed stopping artificial feeding, pointing out that this would not violate existing laws. The patient's son reluctantly agreed, although his mother had not written an advance directive. The son remembered that after watching a television programme on intensive care patients his mother had said that she did “not want to end up like that.”

    Unexpectedly, however, nurses in the nursing home refused to stop artificial feeding, and the woman lived for a further nine months. The case became public, and at a primary hearing in Kempten, Bavaria, the doctor was fined DM 6400 (pounds sterling 2600) and the patient's son DM 4800 (pounds sterling 2000) for violating the law at that time, which required a written advance directive.

    But the Federal High Court has now ruled that the evidence for the patient's wishes may have been sufficient to justify stopping treatment and referred the case back to the lower court. The judges in Kempten have been asked to review their first decision in the light of the high court's comments.

    Professional organisations have not yet responded to the judgement, but there is speculation that it will probably lead to a recommendation that everyone should draw up written advance directive.

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