Press Release 03/2006
Berlin, 13 July 2006
The German National Ethics Council presents its Opinion on end-of-life care
After a period of intensive deliberation, the National Ethics Council is today
(Thursday) issuing its Opinion Self-Determination and Care at the End of Life.
This document continues the discussion of the themes addressed in the Council's
Opinion on the advance directive published in June 2005.
The Council has thoroughly discussed the issues involved in dealing responsibly with the
process of dying. It has perused a large volume of material, obtained expert opinions,
consulted with doctors and other medical specialists, and held meetings in Augsburg and
Münster at which it exposed itself to the ongoing vigorous public debate. The outcome is
enshrined in the recommendations now presented.
The National Ethics Council proposes that the current terminology of active euthanasia,
passive euthanasia and indirect euthanasia be abandoned on the grounds that it is not only
open to misunderstanding but also in certain respects misleading. Decisions and actions at
the end of life which directly or indirectly affect the dying process and the onset of
death can be appropriately described and distinguished by the use of the following
terms: end-of-life care; therapy at the end of life; letting die; assisted suicide;
and killing on demand.
With regard to end-of-life care and therapies at the end of life, the Council emphasizes
that everyone who is incurably ill and dying is entitled to be treated, nursed and cared
for in conditions of respect for his or her human dignity. All measures involved in end-of-life
care and therapies at the end of life must be subject to the wishes of the patient concerned.
Adequate palliative care must be provided for every incurably sick and dying individual.
For this purpose, doctors must be able without fear of prosecution to give priority to
the patient's quality of life over the maximum possible prolongation of life. Sufficient
provision of inpatient and outpatient care in nursing homes, palliative care wards and hospices
is urgently necessary, and the availability of interdisciplinary training and advanced training
for doctors and nurses who treat the seriously ill and the dying must also be increased on
an urgent basis. The role of the voluntary sector in end-of-life care should be actively
promoted and supported, and family members should have access to competent advice on the
availability of nursing and other care for the seriously ill. The employment laws should
provide for leave so as to allow close relatives to care for a dying person.
One aspect of "letting die" is that everyone has the right to refuse a medical measure
even if it has the potential to prolong his or her life. The same applies where a
patient is incapable of expressing his or her wishes provided that the refusal can be
inferred with sufficient certainty from an advance directive or other reliable indication.
In the absence of definite information on a patient's wishes or if the patient has been
unable to formulate such wishes, penal and professional sanctions should not be applied if,
having regard to the prospects of success, to the patient's suffering and to the patient's
probable life expectancy, a medical treatment is no longer indicated and is therefore withheld,
limited or withdrawn. The preservation of life must take precedence in cases of doubt.
With regard to suicide, suicide intervention and assisted suicide, both the law and social
practice should continue to be directed towards dissuading people, even if seriously ill,
from taking their own lives and towards offering them prospects for life. If, where a gravely
ill person attempts suicide, there are clear indications that the attempt is underlain by a
seriously considered decision and that the individual concerned does not wish to be rescued,
then, in the view of the majority of the members of the National Ethics Council, persons such
as doctors or family members who have a particular duty in relation to the welfare of that
individual should be allowed to desist from intervening without fear of prosecution. Some
Council members consider it necessary to restrict this possibility to situations in which
death from the serious illness is manifestly imminent.
Opinions within the National Ethics Council on the permissibility of physician-assisted
suicide and organized assisted suicide diverge. However, the Council unanimously declares
its opposition to the assistance of suicide for profit, which in its view should be a criminal offence.
Killing on request (Section 216 of the Penal Code) should remain a punishable offence.
The German text of the Opinion Self-Determination and Care at the End of Life can be
accessed online at:
http://www.ethikrat.org/stellungnahmen/stellungnahmen.html.
An English version will be available in due course.
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