Choosing Physician-Assisted Death

When American Terry Schiavo died in March after years in a permanent vegetative state and a fierce legal controversy, the question of living wills entered many people minds. But the process of producing one is not easy.

The living will provides guidelines for relatives, legal guardians or even friends to stop providing medical assistance for a loved one who has been in an accident or is suffering a terminal illness and can no longer express their wishes.

The possible ease provided by the document for those who may ever face that decision cannot be underestimated.

Yet when two German friends in their 60s, Renate and Johanna, decided to tackle the issue, they found it was not a matter that they could complete overnight.

For Renate, her mother's long battle with throat cancer forced her to deal with the subject. The illness had shaken her to the bone. Strapped to machines in the final years of her life, Renate's mother had lost her voice after six operations. She had become emaciated and Renate wondered if her mother could have died a more dignified death.

Johanna was there when her friend wanted to discuss the uncomfortable subject.

"We always talked about it, said to each other 'I have to make a living will, I want to take care of it'," she said.

Making deeds out of words

Facing one's own death and the possible consequences of not being able to decide about continuing one's life does not lend itself to quick action. For a year, the two worked and fine-tuned their living wills. Affected by her mother's death, Renate wanted to avoid being kept alive artificially.

"I didn't want to be kept on a resuscitator. Nor did I want to be fed intravenously," she said. When her time had come, others should let her go peacefully, she said.

But in Germany physician-assisted death is illegal. German Justice Minister Brigitte Zypries' plans to loosen the restrictions were scrapped in February. The country's highest court recognized the binding nature of a living will for doctors and caregivers. But the wills can only be implemented if the the patient's true desire can be determined without doubt, which can be an impossibility.

Relatives and guardians may have a different opinion, as in the case of Terry Schiavo in Florida.

Renate asked her daughter and her long-time friend Johanna to be responsible for carrying out her living will, her legal guardians.

"I chose as legal guardians people I have known a long time," Renate explained. "I asked them if they would be ready to do so (let me die), and they quickly said 'yes'."

Yet no matter what the circumstances, many things depend on the doctors on duty. After all, their job is to extend life, and the decision as to when to stop life-preserving measures can be difficult. The doctors' power is what scares Johanna the most.

"I am afraid that I won't be strong enough. That I won't have the resolve to stand up for her will," she said with a sense of trepidation.

Exactly the trepidation that those have who decide to go ahead and write their living will.