The rush was huge when the Christophorus Hospice Association invited to a lecture on the current topic of "assisted suicide" in the Franzmühle in Bad Tölz.
Bad Tölz
- Assisted suicide: This is obviously a topic that moves many people.
At a lecture in the hall of the Franzmühle parish home in Tölz, no seat was left empty.
Some of the 200 listeners even sat down on the window sills to listen to the speaker Prof. Claudia Bausewein.
There was only standing room for dozens.
The Federal Constitutional Court overturned stricter rules for assisted suicide
The Director of Palliative Medicine at the LMU-Klinikum in Munich criticized the injustices in access to palliative medicine: "There are weaknesses in the care system and in people's minds." She considers the three draft laws currently being discussed in the Bundestag to be "not practicable".
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Prof. Claudia Bausewein, who heads palliative medicine at the LMU-Klinikum in Munich, has a lot of experience in talking to seriously ill people.
In the Franzmühle parish home in Tölz, she gave a lecture on "assisted suicide" to an audience of around 200 people.
© Patrick Star
Assisted suicide is a highly topical issue since the Federal Constitutional Court overturned the stricter rules for assisted suicide in early 2020.
The Bundestag wants to vote on it again this spring.
Two cross-party groups of deputies with liberal ideas want to join forces to stand up to a restrictive draft law.
Liberal approach versus restrictive approach
The liberal regulation, which is supported by Federal Health Minister Karl Lauterbach (SPD), among others, provides for regulations outside of criminal law.
The establishment of state-approved counseling centers is planned here, which will provide open-ended information to those who wish to die and point out alternatives to suicide.
On the other hand, a draft law by the members of parliament around Lars Castellucci (also SPD) provides that the aid should only be allowed in exceptional cases.
"We went through the draft laws with the managing director and doctors," said Bausewein at the event to which the Christophorus Hospice Association had invited.
"The liberal drafts are not practicable because you can't find a psychiatrist, let alone an expert." In her view, the restrictive draft law suffers from the fact that it is too closely based on the law that the Federal Constitutional Court overturned.
"It will be exciting to see how this turns out." Bausewein believes that the liberal approach will prevail.
The palliative care physician described in detail her work with seriously ill patients.
The goal is to keep them at home for as long as possible.
She deliberately does not say that the goal is for patients to be able to die at home: "A kind of fetish has developed around dying at home, and it is often presented as the gold standard." It is often ignored the needs of the family and relatives: "The burden is sometimes greater for them than for the patients themselves."
Great ambivalence is quite normal at the end of life
It is very important that the hospice associations get to know the patients as early as possible and not just before the end of their lives.
In fact, palliative care in Germany begins on average 13.2 days before death.
"That's alarming, those are frightening numbers," said the clinic director.
She often has to do with people who express the wish to die faster or to be dead: "We are experienced in having such conversations and dealing with the wishes." A great ambivalence at the end of life is completely normal: "If it's It's about dying, most people think one way or another.
Desires change.”
It also happens that these people say in the same breath that they want to die and look forward to the birth of their grandchild.
It's about taking people with a suicidal wish seriously in their distress and finding out what makes their life so unbearable: "Suicidal people often have tunnel vision.
They see in death the only chance and the only way out.
They are often surprised at the additional support options that are available.”
Doctor feels in a legally uncertain position
She described the case of a 73-year-old single man with lower lip cancer.
The senior felt pain while eating and was disgusted with food.
However, he refused treatment.
Bausewein said he had had a longing for death for many years.
"The cancer was almost welcome for him."
He was only afraid of being socially isolated because of his physical disfigurement, the doctor said.
"We did pain therapy in the palliative care ward, treated the wound and had a lot of conversations," Bausewein recalled.
She also offered the man to support him in everything if "the need was too great".
“He was able to come to terms with that.
He went home and only came back three months later.”
As feared, the cancer had completely disfigured his lower jaw.
Bausewein offered him sedation.
In other words, drugs could calm him down and take away his pain.
His answer: "Not today, but tomorrow." He repeated this answer for three weeks.
"He was very surprised that we didn't let that stop us from lovingly caring for him despite his disfigurement.
After three weeks he died of natural causes.”
In the discussion that followed, one doctor said that he was in a legally uncertain position if he was assisting in suicide.
If he puts an infusion, he is doing active euthanasia, which is forbidden in Germany.
"Also, I would have to start resuscitation immediately."
Difficult access to palliative care for the chronically ill
If a doctor puts an infusion but does not start the process, the control of the action remains with the person concerned, Bausewein replied: "Only putting infusions is nothing active." Doctors are not obliged to provide resuscitation in such a case and cannot be reported for failure to provide assistance become.
Since "unnatural death" is stated on the death certificate, it automatically goes to the police and the public prosecutor's office.
"But they are now better prepared for the situation." She is not aware of any case in which a doctor has had problems because of the aid.
Accurate documentation is important.
Another listener spoke out in favor of assisted suicide being part of a living will.
He found: "One should be able to determine that an assisted suicide should be carried out if one is no longer able to make decisions oneself." Bausewein saw this suggestion critically: "How do you want to decide with a person suffering from dementia whether he actually wants to commit suicide?" It I don't give a black-and-white diagnosis, the disease can drag on for many years, and some patients still have a good quality of life: "I don't want to talk about the day on which the assisted suicide is performed."
A nurse reported that it was more difficult for the chronically ill to get palliative care than for cancer patients, for example: "You put your finger in a wound," replied Bausewein.
“The health insurance companies usually reject palliative care for lung or kidney patients.
That is a weakness in the insurance system.”