What options for assisted dying are available in Germany?
When it comes to assisted suicide and its legality in Germany, a distinction must be made between various forms:
“Active” euthanasia (the deliberate causing of death in accordance with the patient’s wishes) is not permitted in Germany. “Indirect” euthanasia (improving quality of life while accepting that it may shorten life) and “passive” euthanasia (allowing a person to die by withholding or discontinuing life-sustaining measures) are permitted in Germany and are established practices in medical ethics.
The public and, at the same time, controversial debate on euthanasia mostly centers on “active” euthanasia. It is carried out by administering an overdose of morphine, benzodiazepines, anesthetics, muscle relaxants, insulin, or potassium. Active euthanasia is prohibited in Germany.
In Germany and in most nation-states, there is no social consensus in favor of active euthanasia. The opposition to active euthanasia is a complex issue that can only be briefly addressed here. The ban on active euthanasia prevents the suicide of people with disabilities from becoming a social “norm.” This counters the implied expectation that patients whose illness imposes significant caregiving and financial burdens on others will alleviate this burden through suicide.
When it comes to the ban on active euthanasia, additional cultural, social, ethical, and religious considerations must be taken into account. The options of “indirect” and “passive” euthanasia have been socially accepted in Germany since the 1990s.
In the case of ALS, the focus is on “indirect” euthanasia, which is carried out through the “double effect” of morphine and benzodiazepines. With these medications, symptom relief may be associated with a shortening of life (depending on the underlying symptoms and the intensity of the medication regimen).
“Passive” euthanasia occurs when patients refuse or discontinue life-sustaining measures (such as a PEG tube, mask ventilation, a cough assist device, or invasive ventilation).