Precautionary planning includes all planning in advance for situations in which you can no longer make important decisions yourself for health reasons. Such reasons could be, for example, prolonged unconsciousness or advanced dementia.
In an emergency situation, all necessary medical measures may be carried out first. If it becomes apparent that a patient will be unconscious or unable to make decisions for themselves for a longer period of time, a proxy is appointed to make decisions on their behalf. In a power of attorney , you can specify who this proxy should be and what they are allowed to decide. The proxy is therefore a personal trusted person, usually from the family.
If there is no lasting power of attorney, from 1.1.2023 the spouse can take over the legal representation for matters of health care via the so-called spouse representation right, for a maximum of 6 months (see also the video of the Clinical Ethics Committee of the University Medical Center Göttingen)
The prerequisite is
- that the spouses are not separated
- there are no indications that the spouse will refuse representation
- that there is no care directive for another person
- that there is no court-appointed guardianship by another person
If the spouse is unable or unwilling to act as a legal representative, the guardianship court will appoint a guardian. If possible, a suitable family member will be appointed. You can specify who should be your guardian in a care directive .
The spouse, caregiver or authorized representative makes decisions on further medical treatment based on the patient's wishes. He/she is obliged to determine the patient's wishes as well as possible. This may be set out in a living will, or the topic of "what if..." may have been discussed at some point. The proxy must therefore decide as the patient would have decided for themselves if they were currently capable of giving consent.
The patient's wishes may be set out in writing in a living will. If there are no written provisions, other verbal statements are used. Has the subject of "what if..." ever been discussed? It is problematic if the legal representative does not know the patient's wishes and cannot obtain any information, e.g. because there are no relatives.
A living will or a detailed discussion with the patient's social environment about the desired extent of treatment can therefore be helpful.