Right to die

The German Medical Association has presented new guidelines for physician-assisted suicide, allowing greater leeway for doctors to rely on their own conscience when deciding whether to help ill patients die.

The new text, presented on Thursday, reads: "The doctor's assistance with suicide is not a medical duty." Previous guidelines stated that assisted suicide was in strict violation of medical ethics.

Rather than justifying or endorsing assisted suicide, the association said it was simply allowing doctors to decide for themselves whether helping a patient die is justifiable.

"When doctors themselves have a clear conscience, we will not condemn them," said Dr. Jörg-Dietrich Hoppe, the association's president.

Every third doctor for new rules

The change is a reflection of growing acceptance among German doctors of assisted suicide in certain situations.

A survey published last summer found that one in three doctors supported rules allowing physicians to support the suicide of patients with terminal illnesses.

The medical community last made a significant change to its position on assisted suicide in 1998, when it revised its stated concept of how to handle life and death. It then said that a doctor's mission was not just to heal and alleviate pain, but that allowing patients to die could in some cases take precedence over the obligation to sustain life.

No change in law

Suicide itself is not illegal in Germany, nor is it illegal to take patients off life support or a feeding tube when they have explicitly stated that such treatment should be terminated. However, killing a person who explicitly asks to be killed can carry jail terms of up to five years.

The German Medical Association is planning to continue discussing the issue at its annual convention in May. Text in the association's professional code of conduct, stating that doctors may not "actively shorten" the life of a dying patient, is under review.

The professional code of conduct is the binding document which regulates medical ethics, although it technically has no legal value. Any change to it by the country-wide association would also have to be approved by the regional branches.

More ethics training

The German Hospice Association, which considers itself an advocate for patients' rights, criticized the revised guidelines as simply removing the ethical component to the issue of assisted suicide.

"The doctor is now in a dilemma," said Eugen Brysch, head of the German Hospice Association. "How should he, as a practicing physician, decide when the suffering is so unbearable that he should help his patient commit suicide?"

Brysch said there is no way to objectively or scientifically measure the suffering of a patient, and that the German Medical Association needs to give doctors more qualitative guidance on how to make ethical decisions with terminally ill patients.

Much of the discourse on assisted suicide in Germany has been shaped by the euthanasia program of the Nazis, which killed more than 100,000 disabled and sick people who were deemed to be "unworthy of life."

Author: Andrew Bowen
Editor: Nancy Isenson