Table 2 Summary of country-specific conditions for existential decisions

Communication about treatment options and advance care planning

Patient and physician agree on a treatment plan and determine a treatment goal.

Agreement on a treatment plan and a treatment goal is not obligatory, and no standard practice.

Patient and physician agree on a treatment plan and determine a treatment goal.

The patient may draft an advance directive, esp. a living will detailing his or her wishes concerning life-sustaining treatment, ideally, but not necessarily, after consultations with the physician.

Advance directives have no legal status in health care law.

The patient may draft an advance directive, esp. a living will detailing his or her wishes concerning life-sustaining treatment, ideally but not necessarily after consultations with the physician.

Withholding or implementing life-sustaining measures

The physician proposes only those therapeutic measures that he/she considers to be medically indicated with regard to the treatment goal of the patient.

The physican proposes all available threapeutic measures that evidentially enhance quality of life and/or prolong life and that he/she considers to be medically indicated with regard to the disease stage.

The physician proposes only those therapeutic measures that he/she considers to be medically indicated for a particular need and that are approved by the clinic’s county.

In the absence of a clearly stated treatment goal, the physician determines the medical indication of a life-sustaining measure in view of the concrete situation of the individual patient.

The patient decides which option is implemented. He/she can choose an intense and risky option even if it is not the one recommended by the physcian.

Withdrawing life-sustaining measures

Withdrawal of life-sustaining measures accompanied by palliative sedation are allowed if:

Withdrawal of life-sustaining measures is regarded as an illegal act of “assisted suicide”.

Withdrawal of life-sustaining measures accompanied by palliative sedation are allowed if:

1. a competent patient revokes the consent to continue a life-sustaining measure,

1. a competent patient revokes the consent to continue a life-sustaining measure,

2. the physician determines a lack of medical indication due to the deteriorated condition of an incapacitated patient.

2. the physician determines a lack of medical indication due to the deteriorated condition of an incapacitated patient.

Palliative sedation for symptom control and alleviation of suffering is allowed.

“Terminal sedation” accompanying the withdrawal of life-sustaining treatment is illegal. Palliative sedation for symptom control and alleviation of suffering is allowed for imminently dying patients (“lethal analgesia”).

Palliative sedation for symptom control and alleviation of suffering is allowed.

In case of an incapacitated patient, the decision about the termination of treatment and palliative sedation has to conform to the living will of the patient or be made in agreement with the patient’s surrogate decision maker.

In case of an incapacitated patient, the decision for palliative sedation (“lethal analgesia”) has to be made in agreement with the patient’s surrogate decision maker.

In case of an incapacitated patient, the decision about the termination of treatment and palliative sedation has to conform to the living will of the patient or be made in agreement with the patient’s surrogate decision maker.