Dr. Jox, let’s imagine I am a physician in a hospital. I struggle with caring for a critically ill patient, who asked me to help him die. What should I do?
Ralf Jox: It is important to talk with the patient, if that’s possible. This is initially the most important aspect for physicians. Then you discuss whether there are medical measures to prolong the patient’s life with the patient and possibly the family members. The patient needs to subsequently decide whether he or she wants to take advantage of this option and whether this is a therapeutic goal for him or not. I strongly advise to enter a dialogue.
People sometimes have a different perception of what makes life worth living or not. How do I act as a physician, if my patient refuses a treatment suggestion that I deem desirable?
Jox: Every person has the right to have a different opinion of course. This actually happens a lot, because by nature, physicians often have a different view of the situation, since they have an appreciation of specific treatments for instance. However, they need to be ready to engage with the patient and accept that therapies they deem worthwhile and useful are being rejected. There are limits when the patient no longer has the ability to judge or make decisions. Other conditions apply when you are therefore dealing with a patient, who is not able to make judgments due to a severe mental illness or delirium. As soon as a patient is competent however and able to review the consequences of the choice and reach a decision, he or she is allowed to decide against any type of treatment, even against life-sustaining measures.
But what should I do as a physician when the patient actively asks me to help him for instance by administering a painkiller overdose?
Jox: Euthanasia and physician-assisted suicide by directly ending a life are to be assessed differently by law. The request for euthanasia is illegal in Germany. However, assisted suicide is currently being strongly debated. Your question also touches on so-called indirect euthanasia. When a patient suffers from severe pain or severe shortage of breath at the end of his or her life for instance and already needs very high doses of pain medicine or sedatives, physicians can sometimes not rule out that the last phase of life is shortened by the high doses of drugs. This is permitted in Germany as long as the primary goal is pain relief and not the patient’s death.
You already mentioned that there are discussions on assisted suicide. What is the current state?
Jox: The current legal position on physician-assisted suicide is that it is not illegal in Germany. However, the legal admissibility for physicians depends on which German state they reside in. Approximately half of German Medical Associations prohibit physicians from it, while the other half allows it. Many patients rightly don’t understand this confusing situation. Added to this is the fact that there are also non-physician practitioners that offer suicide assistance, for instance within the realm of an association in Hamburg, by organizations in Switzerland or private individuals. These are all reasons why the German parliament (Bundestag) is now going to discuss a statutory rule over the next few months.