Self-determination, privacy, and the right to die. A comparative law analysis (Germany, United States of America, Japan)

European Journal of Health Law

Volumn 4, Issue 2, 1997, Pages 127-143

  Koch, Hans Georg ^a   Bernat, Erwin ^a   Meisel, Alan ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

COMPARATIVE STUDY; GERMANY; JAPAN; LAW; LIVING WILL; PRIVACY; REVIEW; SELF EVALUATION; UNITED STATES;

EID: 0030738895     PISSN: 09290273     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (103)

1. Cf. Act no. 351 of 14 May 1992 and Regulation no. 782 of 18 Sept 1992, bothreprinted (in English) in: Int'l Dig. Hlth Leg. (43), 1992: pp. 767 ff.
2. Cf. section 450 para 3 of the Dutch Civil Code, inserted by the Law of 17 Nov. 1994 (Medical Treatment Contracts Act) and entered into force on 1 April 1995, reprinted (in English) in: Int'l Dig. Hlth Leg. (46), 1995: pp. 196 ff.
3. Cf. § 10 para. 1 no. 7 of the Austrian Public Hospital Act (1958) as amended by Act no. 801 of 26 Nov. 1993.
4. Physicians, ethicists, and jurists worked together to explore the relationship between legal norms on the one hand and moral and professional behavior on the other with respect to advance directives and surrogate decision making.
5. The project was led by Professors H.-M. Sass (Bochum) and R.M. Veatch (Washington, D.C.) and funded by the Volkswagen Foundation (grant number II/68-273 and II/68-274).
6. Regarding methodological questions concerning comparative law, see A. Heldrich, Profane Gedanken über die Hintergründe der Rechtsvergleichung, in:Leser H.G. & Isomura T. (eds.), Wege zum Japanischen Recht, Festschrift für Zentaro Kitagawa zum 60. Geburtsgag, Berlin (Duncker & Humblot) 1992, pp. 157 ff.,
7. and (from an American perspective) R.B. Schlesinger, H.W. Bade, M.R. Damaska, P.E. Herzog, Comparative Law, 5th ed., 1988 Mineola (Foundation Press), pp. 868 ff.
8. Regarding these problems of methodology in comparative law, see H. Neumayer, Grundriβ der Rechtsvergleichung, in: David R.& Grasmann G. (eds.), Einführung in die groβen Rechtssysteme der Gegenwart, 2d ed., 1988 Munich (C.H. Beck), pp. 1-78.
9. See T.L. Beauchamp, "The promise of the beneficence model for medical ethics", in: J. Contemp. Health L. & Pol'y (6), 1990: pp. 145 ff.;
10. Veatch R.M., 1981 A Theory of Medical Ethics, New York (Basic Books Inc.) , pp. 145 ff.
11. Beauchamp T.L., "Paternalism", in: Reich W.T. (ed.), Encyclopedia of Bioethics, 1978 New York/London (The Free Press & Collier Macmillan), pp. 1194 ff.;
12. Brody, H., "The physician/patient relationship", in: Veatch R.M. (ed.), Medical Ethics, 1989 Boston/Portola Valley (Jones & Bartlett), pp. 65 ff., 68 ff.
13. On this subject, see also the essay of H.-L. Günther, "Voluntas aegroti suprema lex - juristische Erwägungen", in: Koslowski L. (ed.), Maximen in der Medizin, 1992 Stuttgart/New York (Schattauer) , pp. 124 ff.
14. For leading works on patient consent and the physician's duty to inform according to German law, see, e.g., A. Laufs, Arztrecht, 5th ed., 1993 Munich C.H. Beck, pp. 86 ff.;
15. H.-G. Koch, "Rechtfertigung und Entschuldigung bei medizinischer Tätigkeit - Ein Kommentar aus deutscher Sicht", in: Eser, A. Nishihara, H. (eds.), Rechtfertigung und Entschuldigung IV. Ostasiatisch-deutsches Strafrechtskolloquium 1993, Freiburg i. Br. (Published by the Max Planck Institute for Foreign and International Criminal Law) 1995, pp. 213 ff., pp. 218-243; on the effects of constitutional law on physician's liability, see the important German Supreme Constitutional Court decision BVerfGE 52, 131 ff.
16. Meyer v. Nebraska, 262 U.S. 390 (1923); Pierce v. Society of Sisters, 268 U.S. 510 (1925).
17. Griswold et al. v. Connecticut, 381 U.S. 479 (1965).
18. See In re Guardianship of Browning, 543 So.2d 258, 267 (Fla. Dist. Ct. App. 1989): 'In Florida, however, the right of privacy is specifically guaranteed by [the state] ... A recent Missouri decision which prohibited the removal of a gastrostomy tube is distinguishable because that state relied upon the absence of a state right of privacy to reach its result.'
19. See R. Kimura, "Fiduciary relationships and the medical profession: A Japanese point of view", in: Pellegrino, E.D. Veatch, R.M. Langan, J.P. (eds.), Ethics, Trust and the Professions, 1991,Washington, D.C. (Georgetown University Press), pp. 235 ff.
20. See K. Yamanaka, "Rechtfertigung und Entschuldigung medizinischer Eingriffe im japanischen Strafrecht", in: Eser, A. Nishihara, H. (Fn. 11), pp. 189 ff., 195 s.
21. See F. J. Illhardt, Medizinische Ethik. Ein Arbeitsbuch, 1985, Berlin Springer, pp. 2 ff.;
22. H.G. von Manz, "Typen medizinischer Ethik", in: Amelung, E.(ed.), Ethisches Denken in der Medizin - Ein Lehrbuch, 1992,Berlin/Heidelberg/New York/Tokyo (Springer) pp. 76 ff., 77-81.
23. According to H. Kawaguchi, Sterbehilfe im japanischen Strafrecht, Medizinrecht 1996 (in press).
24. For a recent survey see A.E. Meisel, "Barriers to forgoing nutrition and hydration in nursing homes", in: L. Med. & Health Care (20), 1995: pp. 335 ff.
25. als well as L. Kass, "Is there a right to die?" in: Hastings Center Report (23/1), 1993: pp. 34 ff.
26. See especially Mitchell v. Fleming, 741 P.2d 674 (Arizona 1987); Bouvia v. Superior Court, 225 Cal. Rptr. 297 (California 1986); Bartling v. Superior Court, 209 Cal. Rptr. 220 (California 1984); Superintendent of Belchertown State School v. Saikewicz, 370 N.E.2d 417 (Massachusetts 1977); Matter of Quinlan, 355 A.2d 647 (New Jersey; cert. denied 429 U.S. 922, 1976); In re Colyer, 660 P.2d 738 (Washington 1983).
27. Cruzan v. Director, Missouri Department of Health et al., 497 U.S. 161 (1990). For an evaluation of this case, see G.J. Annas, Nancy Cruzan in China, in: Hastings Center Report 20/5, 1990: pp. 39 ff.;
28. A. Meisel, 'A retrospective on Cruzan', in: L. Med. & Health Care (20), 1990: pp. 340 ff;
29. J.A. Robertson, "Cruzan and the constitutional status of nontreatment decisions for incompetent patients", in: Ga. L. Rev. (20), 1991: pp. 1139 ff.
30. See J.A. Robertson, "Cruzan: no rights violated", Hastings Center Report (20/5) 1990, pp. 8 s.
31. BGHSt 11, 111 ff.
32. High Court of Nagoya, decision of 12.12.1962; on this (unpublished) case see K. Yamanaka, in: A. Eser, H. Nishihara (Fn. 11), p. 200.
33. See The Japan Times of 29 March 1995, pp. 1 s.
34. See K. Kai, "Die Lehre vom menschenwürdigen Sterben in der Bundesrepublik Deutschland (Japanese)", in: Jurist 1995, Nr. 1601, pp. 61 ff., 69.
35. German decisions include BGHSt 32, 367 ff; LG Ravensburg NStZ 1987, pp. 229 s.; BGH NStZ 1987, p. 365; BGHSt 40, 257 ff.; AmtsG Neukölln, NJW 1987, 2933 (the only civil decision published in the FRG). For Japanese decisions, see III. 3, supra.
36. In re Conroy, 486 A.2d 1209 (N.J. 1985); for comments on this decision, see N.L. Cantor, "Conroy, best interests, and the handling of dying patients", in: Rutgers L. Rev. (37), 1985: pp. 543 ff.;
37. D.I. Droege, "In re Conroy: New Jersey's attempt to clarify the right to die", in: Adelphia L.J. 4, 1985/86: pp. 203 ff.;
38. L. Gostin, "A right to choose death: the judicial trilogy of Brophy, Bouvia and Conroy", in: L. Med & Health Care (14), 1986: pp. 198 ff.;
39. N.J. Moore, "Two steps forward, one step back": an analysis of New Jersey's latest "right to die decisions", in: Rutgers L.J. 19, 1988: pp. 955 ff.;
40. J.K. Weinberg, "Demystifying the right to die: the New Jersey experience", in: Med. & Law (7), 1988: pp. 323 ff.
41. BGHSt 40, 257 ff. = BGH, in: NJW 1995, 204 ff. - See also the comments of E. Bernat, "Behandlungsabbruch und (mutmaßlicher) Patientenwille", in: RdM 1995, pp. 51 ff.;
42. E. Bernat, idem, Antezipierte Erklärungen und das Recht auf einen selbstbestimmten Tod, Bochumer Medizinethische Materialien, Heft 104, Bochum (Zentrum für Medizinische Ethik) 1996;
43. M. Deichmann, "Vormundschaftsgerichtlich genehmigtes Töten durch Unterlassen?" in: MDR 1995, pp. 983 ff;
44. R. Helgerth, case comment, in: Juristische Rundschau 1995, pp. 338 ff;
45. R. Merkel, "Tödlicher Behandlungsabbruch und mutmaßliche Einwilligung bei Patienten im apallischen Syndrom", in: ZStW 107, 1995: pp. 544 ff;
46. H. Lilie, "Hilfe zum Sterben", in: Deutsch E. , Klingmüller E., Kullmann H.J. (eds.), Der Schadensersatz und seine Deckung, Festschrift für Erich Steffen zum 65. Geburtstag, Berlin/New York (de Gruyter) 1995, pp. 273 ff.;
47. H. Schöch, "Beendigung lebenserhaltender Maßnahmen", in: NStZ 1995, pp. 153 ff;
48. T. Verrel, "Selbstbestimmungsrecht contra Lebensschutz", in: JZ 1996, pp. 224 ff;
49. J. Vogel, "Die versuchte 'passive Sterbehilfe' nach BGH MDR 1995, 80", in: MDR 1995, pp. 317 ff;
50. W. Weißauer, H.W. Opderbecke, "Behandlungsabbruch bei unheilbarer Krankheit aus medikolegaler Sicht", in: MedR 1995, pp. 456 ff;
51. D. Zielinski, "case comment", in: Arztrecht 1995, pp. 188 ff.
52. BGH, in: NJW 1995, 204 ff., 205 (sub 2 a) with references to earlier decisions of the court.
53. BGH, in: NJW 1995, 204 ff, 205 (sub 2 a, at the end).
54. LG Kempten, decision of 7 June 1995, 2 Ks 13 Js 13155/93 (slip opinion - unpublished).
55. BGH, in: NJW 1995, 204 ff, 205.
56. Therefore, R. Merkel's (Fn. 29, supra, pp. 545 ff., 563 ff.) extensive criticism of the applicability of presumed consent in cases of patients who suffer from longterm unconsciousness ultimately misses its mark. In any case, it does not conflict with the legal instrument of presumed consent and the legal figure of presumed will to assume that, during periods of competence, a person could come to certain conclusions and could agree that should, on account of longterm unconsciousness, a determination later become necessary, the most recently expressed (and evidently not transient) statement made while lucid should be taken into consideration and, indeed, respected. Additionally, without saying so directly, Merkel's criticism would, in the final analysis, apply even to advance directives, a result that this author does not consider desirable.
57. Cf. E. Deutsch, "Sterbehilfe und Euthanasie als rechtliches Problem", in: Arztrecht 1981, pp. 125 ff.;
58. M. Harder, "Voluntas aegroti suprema lex - Bemerkungen zum sogenannten "Patiententestament"", in: Arztrecht 1991, pp. 11 ff.;
59. W. Uhlenbruck, "Der Patientenbrief - die privatautonome Gestaltung des Rechts auf einen menschenwürdigen Tod", in: NJW 1978, pp. 566 ff.
60. In Germany, the law of guardianship was restructured by a recent amendment of the Civil Code (Official Gazette 1990 I, pp. 2002 ff, in force since 1 Jan. 1992).
61. 'The guardian must comply with the wishes of the person under care, as long as they are not contrary to his best interests and can be expected of the guardian. This also applies to wishes that the person under care expressed before the guardian was appointed, unless it is clear that he does not want to adhere to such wishes.'
62. The LG Kempten's second decision (of 7 June 1995, 2 Ks 13 Js 13155/93) is unappealable.
63. BGH, in: NJW 1995, pp. 204 ff., 205.
64. See M. Deichmann, "Vormundschaftsgerichtlich genehmigtes Töten durch Unterlassen", in: MDR 1995, pp. 983 ff., correctly emphasizing that criminal liability for a homicide offense cannot depend upon whether or not the approval of the court of guardianship was expressed as a formal act (p. 984)
65. Cf. F. Rouse, "The role of the state legislatures after Cruzan: What can - and should - state legislatures do?" in: L. Med. & Health Care (19), 1991: pp. 83 ff.
66. According to M. Deichmann, MDR 1995, pp. 983 ff., 984 'mis puts the judge of the guardianship court into the position of a God over life and death.'
67. E. Bernat, for example, points this out in: "Antezipierte Erklärungen und das Recht auf einen selbstbestimmten Tod" (Fn. 29), pp. 1 s.
68. See note 28, supra.
69. Other decisions also articulated 'substituted judgment standard', see, e.g., In re Quinlan, 355 A.2d 647 (N.J. 1976); Superintendent of Belchertown State School v. Saikewicz, 370 N.E.2d 417 (Maff. 1977). For explication of the aforementioned decisions, see G.J. Annas, "Reconciling Quinlan and Saikewicz: decision making for the terminally ill incompetent" in: American Journal of Law & Medicine (4), 1979: pp. 367 ff.;
70. A.E. Buchanan, Medical paternalism or legal imperialism: not the only alternatives for handling Saikewicz-type cases, in: American Journal of Law & Medicine (5), 1979: pp. 97 ff.
71. 486 A.2d 1209, 1232.
72. See E. Bernat (Fn. 25), p. 164
73. Of the American literature in this area, especially noteworthy is the central work by L. Kutner, "Due process of euthanasia: the living will, a proposal", in: Ind. L. Rev. (44) 1969, pp. 539 ff.
74. See also J. Areen, "Advance directives under state law and judicial decisions", in: L. Med. & Health Care (19), 1991: pp. 91 ff;
75. N.L. Cantor, Advance Directives and the Pursuit of Death with Dignity, Bloomington,Indiana, Indiana University Press 1993;
76. M. A. Chapman, "The Uniform Rights of the Terminally Ill Act: too little, too late?" in: Ark. L. Rev. (42), 1989: pp. 319 ff;
77. Ch.J. Condie, "Comparison of the living will statutes of the fifty states", in: J. Contmp. L. (14), 1988: pp. 105 ff.;
78. G. Gelfand, "Living will statutes: the first decade", in: Wis. L. Rev. 1987: pp. 737 ff.
79. E.g.,: California Natural Death Act, Health and Safety Code §§ 7185-7195; cf. E. Deutsch, Gesetzliche Regelung des Rechts auf einen natürlichen Tod in Kalifornien, in: NJW 1977, pp. 1096 s.;
80. D.L. Redleaf, S.B. Schmitt, W.Ch. Thompson, "The California Natural Death Act: an empirical study of physicians' practices", in: Stan. L. Rev. (31) 1979: pp. 913 ff.
81. The fact that an academic conference on the subject of advance directives (Evangelische Akademie Bad Boll, January 22, 1996 was partially supported by a state ministry is remarkable. Lower level political authorities are apparently ready to enter the discussion, at least at the brain-storming stage.
82. In re Estate of Greenspan, 558 N.E.2d 1194 (III. 1990).
83. Illinois Living Will Act, III. Ann. Statch. 110 1/2 § 702(d), last sentence.
84. See II.2, supra.
85. For Germany see W. Gropp, "Suizidbeteiligung und Sterbehilfe in der Rechtsprechung", in: NStZ 1985, pp. 98 ff;
86. for the U.S. see G.P. Smith II, "All's well that ends well: Toward a policy of assisted rational suicide or merely enlightened self-determination?" in: U.C. Davis L. Rev. (22) 1989, pp. 275 ff
87. A detailed discussion of the myriad issues surrounding assisted suicide as a special form of euthanasia cannot be entered into here. Nevertheless, foregoing the initiation takes into consideration a decision of the Nevada Supreme Court (McKay v. Bergstedt, 801 P.2d 617 (1990), see E. Bernat, "Die rechtlichen Grenzen der Sterbehilfe: gezeigt am Beispiel der amyotrophen Lateralsklerose", in: Wiener Medizinische Wochenschrift 146 (1996), pp. 195-198.
88. For very recent comments on this topic see the articles of F.G. Miller, H. Brody, St.H. Miles, H. Hendin; T. Tomlinson & D. Czlonka; C.S. Campbell, J. Hare &P. Matthews and D.C. Saunders, in: Hastings Center Report (25/3) 1995, pp. 8 ff.
89. The activities of a certain Dr. Kevorkian have attracted considerable media attention even in Europe. See J. Persels, "Forcing the issue of physician assisted suicide. Impact of the Kevorkian case on the euthanasia debate", in: J. Legal Med. 14 (1993), pp. 93-124.
90. As of yet, this issue does not seem to have attracted much attention in Japan.
91. In the meantime, the U.S. Congress has taken up the subject. The Patient Self-Determination Act (Pub. Law No. 101-508, 5 Nov. 1990 §§ 4206, 4751 codified at 42 U.S.C. §§ 1395cc, 1396a) deals not only with living wills but also with health care proxies. Certain public health institutions are required to inform patients about their subjective rights under state law to determine the medical procedures to be carried out in the event of a terminal illness. For comprehensive comments, see the essays of J.D. Moreno, Ch.P. Sabatino, M. Mezey, B. Latimer, and J. Lynn, J.M. Teno, in: Hastings Center Report 23/1 (1993), pp. 5 ff.
92. Obviously, active euthanasia cannot be legitimated in this way.
93. See Restatement (Second) of Agency, § 122.
94. For critical comments, see, e.g., A. Laufs, "Der Arzt - Herr über Leben und Tod?", in: D. Schwab, D. Giesen, J. Listl & H.-W. Strätz (eds.): Staat, Kirche, Wissenschaft in einer pluralistischen Gesellschaft, Festschrift zum 65. Geburtstag von Paul Mikat, 1989, Berlin Duncker & Humblot, pp. 144 ff. 156. -
95. For comments in support of the statements made here, see, e.g., H.-G. Koch, "Die Wertigkeit der prospektiven Dokumentation", in: F. Anschütz & H.-L. Wedler (eds.), Suizidprävention und Sterbehilfe, 1996 Berlin/Wiesbaden, Ullstein Mosby , pp. 227 ff. 232;
96. A. Langenfeld, Vorsorgevollmacht, Betreuungsverfügung und Patiententestament nach dem neuen Betreuungsrecht, 1994, Konstanz, Hartung-Gorre, p. 108.
97. According to German law, a legal guardian need not be appointed to make a decision regarding the termination of treatment if the patient has named a proxy for this purpose. See § 1896 para. 2 sentence 2 Civil Code; M. Deichmann (Fn. 29), MDR 1995, pp. 983 ff, 985.
98. Cf., e.g., H.-G. Koch, Rechtsfragen des Patiententestaments, in: M. Oehmichen (ed.), Lebensverkürzung, Tötung und Serientötung - eine intesdisziplinaire Analyse der "Euthanasie", Rechtsmedizinische Forschungsergebnisse (Research in legal Medicine), Volume 15, 1996, Lübeck, Schmidt-Römhild pp. 131-144.
99. T. Kinoshita, "Japanese law and western law", in: H.G. Leser & T. Isomura (eds.), Wege zum japanischen Recht (Fn. 6), pp. 199 ff. 208.
100. See I. Morikawa, "Patient's rights in Japan: progress and resistance", in: Kennedy Institute of Ethics Journal (4) 1994, pp. 337 ff.
101. Cf. A. Meisel, The right to die, 2nd ed., Vol. 2, 1995, New York, Wiley Law Publications, 1995, p. 3 ff.
102. As expressed, for example, in the "Guidelines for Medical Aid in Dying", issued by the German Federal Association of Physicians (printed in: Dt. Arztebl. [C] 90 [1993], p. 1628 f.).
103. See, e.g., § 10 para. 1 no. 7 of the Austrian Public Hospital Act (1958) as amended by Act no. 801 of 26 Nov 1993. This provision enables the hospitalized patient to attach a living will to his medical record.