A critical review of advance directives in Germany: Attitudes, use and healthcare professionals' compliance

Patient Education and Counseling

Volumn 87, Issue 3, 2012, Pages 277-288

  Evans, Natalie ^a,b   Bausewein, Claudia ^c,d   Meñaca, Arantza ^a   Andrew, Erin V W ^a   Higginson, Irene J ^c   Harding, Richard ^c   Pool, Robert ^a,e   Gysels, Marjolein ^a,c  

^a CENTRE FOR RESEARCH IN ENVIRONMENTAL EPIDEMIOLOGY CREAL   (Spain)

^b VU UNIVERSITY MEDICAL CENTER   (Netherlands)

^c KING'S COLLEGE LONDON   (United Kingdom)

^d German Association for Palliative Medicine   (Germany)

^e UNIVERSITY OF AMSTERDAM   (Netherlands)

Author keywords

Advance directive; End of life; Europe; Germany

Indexed keywords

AWARENESS; CULTURAL FACTOR; GERMANY; HEALTH CARE NEED; HEALTH CARE PERSONNEL; HEALTH CARE UTILIZATION; HUMAN; LEGAL EVIDENCE; LEGAL PROCEDURE; LIVING WILL; MAJOR CLINICAL STUDY; MEDICAL DECISION MAKING; MEDICAL PRACTICE; PATIENT ASSESSMENT; PHYSICIAN ATTITUDE; PRIORITY JOURNAL; SHORT SURVEY; TERMINAL CARE;

ADVANCE CARE PLANNING; ADVANCE DIRECTIVE ADHERENCE; ADVANCE DIRECTIVES; ATTITUDE OF HEALTH PERSONNEL; COMMUNICATION; DECISION MAKING; GERMANY; HEALTH KNOWLEDGE, ATTITUDES, PRACTICE; HUMANS; PHYSICIANS;

EID: 84861226671     PISSN: 07383991     EISSN: 18735134     Source Type: Journal    
DOI: 10.1016/j.pec.2011.10.004     Document Type: Short Survey

References (62)

1. Robertson G.S. Making an advance directive. Brit Med J 1995, 310:236.
2. Andorno R., Biller-Andorno N., Brauer S. Advance health care directives: towards a coordinated European policy?. Eur J Health Law 2009, 16:207-227.
3. Eisemann M., Richter J. Relationships between various attitudes towards self-determination in health care with special reference to an advance directive. Brit Med J 1999, 25:37.
4. Singer P.A., Martin D.K., Kelner M. Quality end-of-life care: patients' perspectives. J Amer Med Assoc 1999, 281:163-168.
5. Voltz R., Akabayashi A., Reese C., Ohi G., Sass H.M. End-of-life decisions and advance directives in palliative care: a cross-cultural survey of patients and health-care professionals. J Pain Symptom Manage 1998, 16:153-162.
6. Fissell R.B., Bragg-Gresham J.L., Lopes A.A., Cruz J.M., Fukuhara S., Asano Y., et al. Factors associated with " do not resuscitate" orders and rates of withdrawal from hemodialysis in the international DOPPS. Kidney Int 2005, 68:1282-1288.
7. Nys H. Emerging legislation in Europe on the legal status of advance directives and medical decision-making with respect to an incompetent patient (living-wills). Eur J Health Law 1997, 4:61-71.
8. Sehgal A., Weisheit C., Miura Y., Butzlaff M., Kielstein R., Taguchi Y. Advance directives and withdrawal of dialysis in the United States, Germany, and Japan. J Amer Med Assoc 1996, 276:1652-1656.
9. May A.T. Physician-assisted suicide, euthanasia, and Christian bioethics: moral controversy in Germany. Christ Bioeth 2003, 9:273-283.
10. Burchardi N., Rauprich O., Hecht M., Beck M., Vollmann J. Discussing living wills. A qualitative study of a German sample of neurologists and ALS patients. J Neurol Sci 2005, 237:67-74.
11. Schicktanz S., Raz A., Shalev C. The cultural context of patient's autonomy and doctor's duty: passive euthanasia and advance directives in Germany and Israel. Med Health Care Philos 2010, 13:363-369.
12. Beck C. Provisions for accident, sickness and old age by power of attorney, living wills, guardianship. Auflage 2009, 11. ISBN 978-3-406-59511-02009.
13. Wiesing U., Jox R., Heßler H., Borasio G. A new law on advance directives in Germany. J Med Ethics 2010, 36:779.
14. Teno J., Lynn J., Wenger N., Phillips R.S., Murphy D.P., Connors A.F., et al. Advance directives for seriously ill hospitalized patients: effectiveness with the patient self-determination act and the SUPPORT intervention. J Amer Geriatr Soc. 1997, 45:500.
15. Goodman M.D., Tarnoff M., Slotman G.J. Effect of advance directives on the management of elderly critically ill patients. Crit Care Med 1998, 26:701.
16. The SUPPORT Principal Investigators A controlled trial to improve the care for seriously ill hospitalized patients. J Amer Med Assoc 1995, 274:1591-1598.
17. Tonelli M.R. Pulling the plug on living wills. Chest 1996, 110:816.
18. Jox R., Krebs M., Bickhardt J., Hessdorfer K., Roller S., Borasio G. How strictly should advance decisions be followed? The patients' opinion. Palliat Med 2008, 22:675.
19. Sahm S., Will R., Hommel G. Attitudes towards and barriers to writing advance directives amongst cancer patients, healthy controls, and medical staff. J Med Ethics 2005, 31:437-440.
20. Harding R., Higginson I. PRISMA: a pan-European co-ordinating action to advance the science in end of life cancer care. Eur J Cancer Care 2010, 46:1493-1501.
21. Meñaca A., Evans N., Andrew E.V.W., Toscani F., Finetti S., Gómez-Batiste X., et al. End-of-life care across Southern Europe: a critical review of cultural similarities and differences between Italy, Spain and Portugal. Crit Rev Oncol Hematol 2011, http://www.sciencedirect.com/science/article/pii/S1040842811001600, [Epub ahead of print].
22. Glaser B.G., Strauss A.L. The discovery of grounded theory: strategies for qualitative research 2007, Aldine Transaction, Piscataway.
23. Strauss A., Corbin J. Grounded theory methodology-an overview. Handbook of qualitative research 1994, 273-285. Sage Publications, Thousand Oaks, CA. N.K. Denzin, Y.S. Lincoln (Eds.).
24. Flemming K. The synthesis of qualitative research and evidence-based nursing. Evid Based Nurs 2007, 10:68.
25. Becker G., Sarhatlic R., Olschewski M., Xander C., Momm F., Blum H. End-of-life care in hospital: current practice and potentials for improvement. J Pain Symptom Manage 2007, 33:711-719.
26. Borasio G., Weltermann B., Voltz R., Reichmann H., Zierz S. Attitudes towards patient care at the end of life. A survey of directors of neurological departments. Der Nervenarzt 2004, 75:1187.
27. Eisemann M., Richter J., Bauer B., Bonelli R.M., Porzsolt F. Physicians' decision-making in incompetent elderly patients: a comparative study between Austria, Germany (East, West), and Sweden. Int Psychogeriatr 1999, 11:313-324.
28. Justinger C., Richter S., Moussavian M.R., Serrano Contreras T., Schilling M.K. Advance health care directives as seen by surgical patients. Chirurg 2009, 80:455-461.
29. Kuhnlein P., Kubler A., Raubold S., Worrell M., Kurt A., Gdynia H.J., et al. Palliative care and circumstances of dying in German ALS patients using non-invasive ventilation. Amyotroph Lateral Scler 2008, 9:91-98.
30. Lang F.R., Wagner G.G. Living will incidence in non-clinical population samples: conditions and reasons for refusal. Dtsch Med Wochenschr 2007, 132:2558-2562.
31. Lang F., Baltes P., Wagner G. Desired lifetime and end-of-life desires across adulthood from 20 to 90: a dual-source information model. J Gerontol B Psychol Sci Soc Sci 2007, 62:P268.
32. Lang-Welzenbach M., Rodel C., Vollmann J. Advance directives in radiation oncology: attitudes of patients, physicians and nurses. Ethik Med 2008, 20:300-312.
33. Lang-Welzenbach M., Fasching P.A., Vollmann J. Advance directives and therapy decisions in gynecological oncology-qualitative interviews with patients, physicians and nursing staff. Geburtsh Frauenheilk 2005, 65:494-499.
34. Paul N.W., Fischer A. Advance health care directives: perception and reality results of a random survey. Dtsch Med Wochenschr 2008, 133:175-179.
35. Richter J., Eisemann M.R. The compliance of doctors and nurses with do-not-resuscitate orders in Germany and Sweden. Resuscitation 1999, 42:203-209.
36. Richter J., Eisemann M.R. Attitudinal patterns determining decision making in the treatment of the elderly: a comparison between physicians and nurses in Germany and Sweden. Intensive Care Med 2000, 26:1326-1333.
37. Richter J., Eisemann M.R. Attitudinal patterns determining decision-making in severely ill elderly patients: a cross-cultural comparison between nurses from Sweden and Germany. Int J Nurs Stud 2001, 38:381-388.
38. Richter J., Eisemann M., Bauer B., Porzsolt F. Physicians' attitudes toward treatment of incompetent patients-a comparison between East- and West-Germany. Med Klin 1997, 92:255-259.
39. Richter J., Eisemann M., Bauer B., Kreibeck H. Decisions and attitudes in the treatment of incompetent, chronically ill, elderly. A comparison between nurses and doctors, or why no one asks the nurse?. Z Gerontol Geriatr 1999, 32:131-138.
40. Richter J., Eisemann M., Zgonnikova E. Doctors' authoritarianism in end-of-life treatment decisions. A comparison between Russia, Sweden and Germany. J Med Ethics 2001, 27:186-191.
41. Richter J., Eisemann M.R., Bauer B., Kreibeck H., Astrom S. Decision-making in the treatment of elderly people: a cross-cultural comparison between Swedish and German physicians and nurses. Scand J Caring Sci 2002, 16:149-156.
42. Richter J., Eisemann M.R., Zgonnikova E. Doctors' attitudes and end-of-life decisions in the elderly: a comparative study between Sweden, Germany and Russia. Arch Gerontol Geriatr 2002, 34:107-115.
43. Sahm S., Will R., Hommel G. Would they follow what has been laid down? Cancer patients' and healthy controls' views on adherence to advance directives compared to medical staff. Med Health Care Philos 2005, 8:297-305.
44. Sahm S., Will R., Hommel G. What are cancer patients' preferences about treatment at the end of life, and who should start talking about it? A comparison with healthy people and medical staff. Support Care Cancer 2005, 13:206-214.
45. Sahm S., Will R. Relatives as standard surrogate decision-makers for incompetent patients: an empirical study about preferences for persons as proxies amongst cancer patients, healthy controls, nursing staff and physicians. Ethik Med 2005, 17:7-20.
46. Schroder C., Schmutzer G., Brahler E. Representative survey of German people concerning enlightenment and patient directive in a case of terminal illness. Psychother Psychosom Med Psychol 2002, 52:236-243.
47. Van Oorschot B., Simon A. Importance of the advance directive and the beginning of the dying process from the point of view of German doctors and judges dealing with guardianship matters: results of an empirical survey. J Med Ethics 2006, 32:623-626.
48. Van Oorschot B., Hausmann C., Köhler N., Leppert K., Schweitzer S., Steinbach K., et al. Patients as partners. Tumor patients and their participation in medical decisions. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2004, 47:992.
49. van Oorschot B., Hausmann C., Köhler N., Leppert K., Schweitzer S., Steinbach K., et al. Patientenverfügungen aus Patientensicht. Ethik Medizin 2004, 16:112-122.
50. Voltz R., Akabayashi A., Reese C., Ohi G., Sass H.M. Attitudes of healthcare professionals toward clinical decisions in palliative care: a cross-cultural comparison. J Clin Ethics 1999, 10:309-315.
51. Wiese C.H.R., Bartels U., Ruppert D., Marung H., Graf B.M., Hanekop G.G. Treatment of palliative emergencies by paramedics. Wien Klin Wochenschr 2008, 120:539-546.
52. Sahm S. Palliative care versus euthanasia. The German position: the German general medical council's principles for medical care of the terminally ill. Med Health Care Philos 2000, 25:195-219.
53. Federal Department of Justice and Police. Revision of guardianship legislation. Swiss Federal Department of Justice and Police; 2011. Available at: (accessed June 2011). http://www.ejpd.admin.ch/ejpd/en/home/themen/gesellschaft/ref_gesetzgebung/ref_vormundschaft.html.
54. Walter T. Historical and cultural variants on the good death. Brit Med J 2003, 327:218.
55. DeLuca Havens G.A. Differences in the execution/nonexecution of advance directives by community dwelling adults. Res Nurs Health 2000, 23:319-333.
56. Ott B.B. Advance directives: the emerging body of research. Amer J Crit Care 1999, 8:514.
57. van Wijmen M., Rurup M., Pasman H., Kaspers P., Onwuteaka-Philipsen B. Advance directives in the Netherlands: an empirical contribution to the exploration of a cross-cultural perspective on advance directives. Bioethics 2011, 24:118.
58. CIS [Care for Patients with Terminal and Illness] Estudio 2803 2009, CIS, Madrid.
59. Simon Lorda P., Tamayo Velazquez M.I., Barrio Cantalejo I. Advance directives in Spain. Perspectives from a medical bioethicist approach. Bioethics 2008, 22:346-354.
60. Héon-Klin V., Sieber E., Huebner J., Fullilove M.T. The influence of geopolitical change on the well-being of a population: the Berlin Wall. Am J Public Health 2001, 91:369.
61. Kopetsch T. The migration of doctors to and from Germany. J Public Health 2009, 17:33-39.
62. McCloskey E.L. The patient self-determination act. Kennedy Inst Ethics J 2009, 1:163-169.