Key takeaways
- A living will is a written document specifying what medical treatments you wish. This document is referred by the doctors and the relatives when you are no longer capable of communicating your wishes.
- A living will is legally valid if it’s signed by you and is specific enough.
- You should review and update (if necessary) your living will every two years.
This is how you do it
- You can create a living will yourself using the free online tool by Verbraucherzentrale.
- You can also use paid online services to create a living will. These services offer reminders to update your will, emergency card, or sticker and keep your will up to date with changes in the law.
- It’s critical that your living will is accessible by the doctors. To do that, you can either register the living will in the central healthcare register or use paid online services.
- Lastly, you can avail services of a lawyer to create a living will.
Table of Contents
What is a living will (Patientenverfügung) in Germany?
A living will (Patientenverfügung) is written documentation specifying what measures your doctors and relatives should take if you are unable to communicate what you want (§ 1827 BGB). This could be due to a serious illness, accident, coma, etc.
The doctors are bound by your directives in the living will. They must choose the medical treatments accordingly.
NOTE: The living will only have a binding effect if it is sufficiently specific and applies to the living and treatment situation at hand.
You also specify an authorized person in the living will. This person ensures that your wishes are implemented (§ 1828 BGB). The doctors coordinate with the authorized person to make medical decisions.
Why should you have a living will?
It’s important that you draw up a living will for the following reasons.
- You relieve your relatives from the burden of making difficult decisions.
- The “living will” ensures that the choice of medical treatment is based on your wishes.
NOTE: Doctors can’t follow your living will in emergency siutuations. They must take the necessary measures to save you and don’t have enough time to examine your advance directives.
A case study of a patient to reiterate the importance of a living will
An 82-year-old dementia patient didn’t have a living will. As a result, he was kept alive for five years.
The man suffered from severe dementia from 2006 and was no longer able to move or have contact with those around him.
As he didn’t have a living will, the treating doctor decided to keep him alive on a life support machine (feeding tube to his stomach).
The man’s son sued the doctors after his father’s death. He claimed that the artificial life support from 2010 onwards only led to a senseless prolongation of the suffering caused by the illness.
He demanded compensation for the pain and suffering of his father. However, the Federal Court of Justice rejected it in a 2019 ruling.
The judges explained that continuing to live could not, in principle, be viewed as harmful and that no third party could judge whether a person should continue to live or not. If the patient had written a living will, his doctor could have acted according to his wishes. [1]
What happens if you don’t have a living will?
- If you don’t have a living will, a court-appointed guardian and the treating doctors will decide about your medical treatments. The same applies if the living will is not specific enough or is not applicable to the current living and treatment situation.
- In case of doubt, doctors and relatives assume that the patient wants to survive. They take every medically possible action to preserve the patient’s life. Even if it means complete dependence on life-support machines.
- If your family members and doctors have different opinions about your medical treatment, things may end up in court. In such cases, you might be kept alive for years, even though you might have refused it for yourself.
What should your living will contain?
- Personal information and declaration: You provide your personal information, such as name, date of birth, and address. You also declare that you are drawing up the living will in full mental capacity.
- Resuscitation: You can specify the situations in which you don’t want doctors to perform resuscitation. Some people don’t want resuscitation as they are old and terminally ill, or it’s already been more than 5 minutes since their heart stopped. No blood flow to the brain for more than 5 minutes leads to severe permanent brain damage.
- Place of treatment: Where would you like to be treated during your last days? In the hospital, at home (if possible), or in hospice.
- You don’t want to continue your life: There are diseases or medical conditions in which many people don’t want to continue living. You can specify such medical conditions in your living will.
- Refuse certain medical treatments: You can set general rules for medical conditions in which you refuse certain treatments. You can also specify which life-sustaining measures you want to forego.
- Organ donation or organ receiving: In your living will, you can specify whether you want to donate or receive organs.
- Authorized person: This is the person who ensures your wishes (as per the living will) are implemented.
- Waiver of medical confidentiality: Doctors in Germany cannot share your medical information with third parties. Thus, it’s critical that you expressly waive confidentiality when sharing information with the authorized person.
- Supplementary text: You can add your personal values to the living will. It helps doctors and relatives in ambiguous situations. For example, Suppose you are bedridden and will remain so for the rest of your life. Although your children would be happy to take care of you, but you don’t want to put them in this situation. So, you can mention it in your living will.
How do you create a living will in Germany?
You have three options to create a living will in Germany
- Use the online tool from the consumer advice center and create a living will for free
- Use paid online services
- Get services from a lawyer or a notary
Free online tools
The consumer advice center (Verbraucherzentral) offers a free tool for creating a living will. After you answer a few questions, the tool will create a living will for you.
The tool is in German only. We are in the process of creating an English tool to support expats. Subscribe to our newsletters to stay updated.
Once you have the living will, you should do the following.
- Sign the living will
- Register the living will in the central healthcare register (Zentralen Vorsorgeregister). It’s optional to register but highly recommended.
Doctors can access the central register and check if a living will exists. They cannot access the content of the living will as you don’t upload the document in the register.
However, doctors can find out who you named as an authorized person and contact them in emergency situations.
How to register in the Central healthcare register
- Go to the central healthcare register’s website.
- Click on new registration (Neue Registierung)
- Fill out the form with information about you and the authorized person.
- Select all the persons who have access to your living will.
- Pay the registration fee. It’s 23 € as of June 2024.
Paid online services
There are several paid online services that charge a one-time fee or a subscription to create a living will. Every online service offers a subscription model, as you should review your living will every two years.
The online service providers offer the following services to their customers.
- Reminders to review the will every two years.
- Keep the living will up to date with the changes in the law.
- Provide you with the emergency card or sticker. Doctors and emergency staff can use it to access your living will.
- Doctors can even access the content of the living will as the service provider stores your will with them.
Here are some of the online services you can use
- Patientenverfuegungplus
- 19.90 € (one time) or
- 19.90 to 29.90 € per annum (subscription)
- Afilio
- No one-time payment option
- 29 € to 72€ per annum (subscription)
Contact a lawyer
The third option is to contact a lawyer. It’s the most expensive option. Lawyers can charge you anywhere from 300 € to 500 € per hour for consultation.
The benefit of consulting a lawyer is that your “living will” won’t have any ambiguities.
If you have legal insurance, your insurer covers the costs of preparing precautionary documents. However, you must always confirm with the insurer before going to a lawyer.
In our comparison and test, we found that Arag*—Aktiv-Premium, WGV—Optimal PBV, and KS-Auxilia*—Jurprivat are the best legal insurance plans.
If you want an English service, check legal insurance from Feather* and Getsafe*. Feather and Getsafe are insurance agents and sell Roland’s legal insurance plans. Roland is rated very good by DISQ (rating agency).
When is a living will legally valid in Germany?
Your living will is legally valid if it satisfies the following conditions.
- It’s signed by you
- It’s sufficiently specific. This means you describe exactly in which situations the living will apply. You also specify the medical measures you don’t want.
NOTE: Certification in a notary’s office or by an authority is not required.
Your living will must also be accessible to doctors in an emergency situation. This is why you must at least register your living will in the Central Healthcare Register.
You can also use paid online service providers. They offer emergency retrieval services, which allow doctors to access your living will.
How often should you update your living will?
- You can change or revoke your living will at any time. You should do it if your life situation changes. For example, suppose the authorized person is suffering from a terminal illness. In this case, you must change the authorized person in your will.
- Experts recommend reviewing your living will every two years and confirming it with a new signature.
Is a living will enough, or do you need other documents?
A living will alone is not enough. You also need a power of attorney in which you declare one or more people as your authorized representatives.
Many people are under the impression that your partner or children have the right to make decisions in situations when you cannot communicate yourself. However, that’s not the case in Germany.
Without power of attorney, neither your life partner nor your children can make decisions for you. So, you must draw up this document in good time.
The court will appoint a legal representative if you don’t have a power of attorney. The representative can be a member of your family or a third-party professional guardian.
NOTE: Since Jan 2023, if you are married, your spouse can make decisions on your behalf if you are unable to make one. However, your spouse can make decisions only for six months and in health matters.
