The patient's right of self-determination:
A trustworthy relationship between doctor and patient also includes a consultation on the following subject: How should the doctor deal with the dying patient? This topic is generally avoided in the doctor-patient relationship. If a doctor addresses this issue on his own, the patient might get the impression that his situation is worse than the doctor admits. I would like to take the opportunity to make all my patients aware of this difficult topic.
The necessity to discuss this issue can be illustrated by an example: 90% of people want to die in their own home surrounded by their family. The facts are exactly the opposite. Approximately 90% of people die in hospitals and old people's homes or nursing homes. The problem is often not of medical but of legal nature, because if you don’t write down your will and discuss it with your family, things may turn out differently than you originally wanted.
Here some general information on this topic:
What is a living will?
During severe diseases, the patient’s ability to understand and to decide may be compromised or even eliminated. Then the doctor needs a previously written statement of intent in the form of a living will. The more specific a living will is written, the more likely the implementation is ensured. For example, if a terminally ill patient desperately wants to die at home surrounded by his family, even though in the hospital or the intensive care unit his life could be extended, this should definitely be put down in writing.
What is power of attorney for health care?
Should you be temporarily or permanently no longer able to attend to your own health affairs, you can appoint a representative (usually the spouse or next of kin). That person will then be the contact person of the physician in all medical issues.
How to proceed?
Documents for living wills and power of attorney for health care are available from church representatives as well as from the General Medical Council, but can also be drawn up individually.
The family doctor needs a copy of these documents. It is of utmost importance that you discuss your living will with your family. Often the next of kin want that everything possible should be done for the dying person (e.g. intensive care). Therefore, all close relatives should be informed about your living will so that there is no conflict with attending physicians. In case you live alone, it is also advisable to tell your doctor, who should be informed in a health crisis.