Germany needs to learn from Schiavo case

24th March 2005, Comments 0 comments

24 March 2005, WASHINGTON/BERLIN - The uproar over Terri Schiavo and whether the brain damaged woman should continue to receive food and water through a tube has triggered discussion and contemplation in other countries, too.

24 March 2005

WASHINGTON/BERLIN - The uproar over Terri Schiavo and whether the brain damaged woman should continue to receive food and water through a tube has triggered discussion and contemplation in other countries, too.

Eugen Brysch, the executive director of Germany's Hospice Foundation, spoke with Deutsche Presse-Agentur during a professional and private visit to the United States.

"We need legal clarity about how one handles patient directives" about end-of-life issues, said Brysch, who happened to be in Florida, the same state where Schiavo, 41, is being cared for in a hospice.

Brysch called for a law in Germany that would allow a written directive from the patient to be recognised in decisions about cutting off life-prolonging measures.

But he said "presumed intentions" similar to those that Schiavo's husband, Michael, says his wife expressed before she had a heart attack at age 26, should not "lead to death".

Schiavo's husband insists she would have wanted her feeding tube to be removed and not to have been maintained any longer in her current state, but her parents believe otherwise, and have carried the case to Congress and the White House. The parents have had a series of legal setbacks over the past seven years, including two at the federal level on Wednesday.

Schiavo has received no nourishment or hydration since Friday, and is expected to die within the next 10 days.

"The Schiavo case shows where this can lead: there are different interpretations of a presumed intention. Such desolate situations must be avoided," Brysch said. "It would be horrible if judges were to make the life and death decisions."

The Schiavo case has been in US courts for seven years, and Florida state courts have backed the husband. But the parents and the conservative Christian movement got Congress to pass an extraordinary law over the weekend that allows federal courts to get involved. The US Supreme Court has indicated three times in past years that it is a state issue by rejecting the case.

Brysch said that in Germany, every judge has a different approach to interpreting patient directives. "There are legal loopholes," he said.

He said pressure should not be applied to anyone to prepare such a document if he or she has not taken the initiative in the first place. 'Living wills', as the directives are often called, which are written under pressure create "the danger, that machines will be turned off out of cost considerations," Brysch said.

The Hospice Foundation says it has 55,000 members. It serves to support seriously ill and dying patients who have signed such directives when they come into conflict with their family and physicians.

Brysch said that US hospice facilities were a role model for Germany. The number of dying who are looked after by US hospices - either at home or in a special facility - ranges from 62 percent in Oregon down to 29 percent in New York.

But even that 29 percent is far and beyond the 2 percent in Germany who are cared for by hospices, Brysch said.

The example of Oregon shows that the consideration of assisted suicide drops among the seriously ill and dying when they are well cared for by a hospice.

"When well looked after, the dying person senses that he or she is well cared for, and is not only a burden," Brysch said.

In Oregon, the only US state that allows assisted suicide, 37 people requested the measure in 2004, compared to 42 in the year before. Oregon has 3.5 million residents.

Meanwhile Germany's Justice Minister Brigitte Zypries has said that she believes a right-to-die case similar to that now stirring up emotions in the United States would not be possible in Germany.

"In this form, this would not be possible in Germany," Zypries said on Wednesday evening in the ZDF daily journal programme. "The woman would probably continue to be cared for in our country."

She said she could not predict exactly how such a case would be handled in Germany. In Germany, relatives in a similar case would have to convince the doctors with documented evidence of the patient's directives. The minister recommended that such a directive should be "as precise and all-encompassing as possible" in describing exactly which treatments one would want.

"One should put it in writing, and also discuss it with a physician beforehand," Zypries said.

Such a directive should be constantly updated, and discussed with relatives, "exactly how one envisions the treatment", she said.


Subject: German news

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