• R J Jox, H-J Hessler, and G D Borasio.
• Interdisziplinäres Zentrum für Palliativmedizin, Klinikum der Universität München, Marchioninistrasse 15, Munich, Germany. ralf.jox@med.uni-muenchen.de
• Nervenarzt. 2008 Jun 1;79(6):729-37; quiz 738-9.

AbstractIn modern medicine, decisions about the kind of treatment at life's end are often inevitable. According to German law, powers of attorney and advance directives can be of help in these decisions. When a patient in a state of competence has issued a lasting power of attorney, there is no need for courts to appoint a proxy, and physicians immediately have a legally empowered decision-maker they can address. According to current German law, advance directives are legally valid and binding expressions of a patient's will. They are, however, more powerful when issued after consultation with a physician. If treatment at life's end no longer complies with the patient's will or loses its medical indication, the goal of treatment should be redirected towards palliation. This implies that life-sustaining treatment may be withdrawn or withheld, which is best accomplished with sensitivity to the needs of patients, relatives, and health care professionals.

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