What is a living will?

Doctors are only allowed to treat you if you agree to be treated. But if you’re unable to give your consent, someone else can do that on your behalf if they’ve been authorized to do so. This may be a relative or caregiver, for instance.

A living will can make decisions easier for them. The idea is that they can make decisions in line with your wishes if you have put down in writing what treatment you want and when treatment should stop.

Living wills are legally binding for everyone involved. That includes doctors, nurses, caregivers, health care proxies (agents), relatives, and courts. In unclear situations, a court can decide.

Your attitude toward illness, death and dying may change over time, so it’s a good idea to go back to your living will on a regular basis and make any changes you feel are necessary.

Your living will should include your full name, date of birth, address, the date and your signature.

It is important to give a precise description of the situations you want it to apply to. You should also describe what medical interventions you want or don’t want in those situations. Examples include being fed by tube or put on a breathing machine when you are dying.

If a medical situation that’s not covered in the living will happens, a legal guardian or other person authorized to represent you has to decide what action should be taken.

Your living will can also include brief information about your values, your thoughts on life and death, and your religious beliefs. This can be very useful to doctors, legal guardians and health care proxies because it can help them to make decisions in line with your wishes.

There are various places you can turn to for advice and assistance if you’re not quite sure what you want to put in your living will and how you should word it. In Germany these include doctors, Verbraucherzentrale consumer advice centers, the independent patient counseling service Unabhängige Patientenberatung Deutschland (UPD), counseling centers run by welfare organizations and churches, Pflegestützpunkt nursing care support centers and, in many cases, hospices.

Yes, special templates are available. But you can also just write your own living will. The only rule is that it must be in writing and you must have signed it yourself.

Sample living wills can help you decide what to include. Templates and samples are available from various places. They tend to be worded differently and it can be difficult to work out which one is best for you.

Germany’s Federal Ministry of Justice has published a guide (in German) with information, examples of specific sections, and examples of full living wills. It can be downloaded here.

Living wills never lose their validity. But you can easily change or cancel yours at any time, as long as you’re still able to make decisions. If you're unable to write, you can tell someone what you would like to change (give oral instructions). Depending on the impact of these instructions, it’s best to have them witnessed and, if possible, recorded in writing by the person who is authorized to represent you.

Doctors have to make sure that your living will still reflects your current wishes. So it's a good idea to discuss this matter with your family and friends every now and again. That way they can tell the doctors if they need to.

You should keep your living will somewhere where your doctors, legal guardian or other people authorized to represent you can get to it quickly and easily. One idea is to keep a note in your wallet, letting people know you have a living will and where to find it. You can also give your loved ones and doctors copies of the living will to look after.

In Germany, the Federal Chamber of Notaries (Bundesnotarkammer) has a central register where your living will can be kept, along with your health care proxy document if you have one. If need be, courts can consult the register, enabling them to quickly contact the person you have appointed. You have to pay a one-off fee for this registration.

A health care proxy document (also called a durable power of attorney for health care) enables you to specify who you want to make decisions for you if you’re ever unable to do so yourself. This ensures that someone you trust makes the decisions even in situations not covered in precise detail in your living will. It is a good idea to discuss your living will with the person who you appoint to act on your behalf.

It is important to be aware that even close relatives aren't automatically authorized to represent you. That means that even your (marriage) partner or children can only make decisions on your behalf if you have specified that they should do so in a health care proxy document (Vorsorgevollmacht).

If you haven't appointed anyone in this way, the guardianship court (Betreuungsgericht) can appoint a legal guardian to make all the necessary medical decisions for you.

Detailed information about health care proxies in Germany – including what has to be in them and when they apply – is available from the Federal Ministry of Justice.