A decision on end-of-life treatment in Germany is sending confusing signals about the state of the law there. An appeals court has struck down the conviction of a lawyer, Wolfgang Putz, who had advised his client to cut a feeding tube which was keeping her elderly mother alive.

Erika Küllmer had been in a vegetative state for five years and was being poorly cared for. Apparently her gangrenous arm had to be amputated at one stage after it had been neglected by nursing home staff. Relations between the woman’s daughters and the nursing home staff had broken down completely.

Germany's highest criminal court has ruled that withdrawal of treatment is legal if the patient has explicitly expressed a wish to avoid burdensome treatment. "Turning off a ventilator or cutting a feeding tube fall under the category of permissible forms of terminating treatment," declared a judge in the Federal Court of Justice.

Because – on top of a language barrier -- most newspaper accounts have confused euthanasia, assisted suicide and refusal of burdensome treatment, it is difficult to determine the significance of the case. But an opinion piece in Die Zeit described it as ground-breaking. Although German courts have dealt with similar cases, this case clarifies that a “living will” need not be written. Her daughter said that Mrs K. had expressed a wish not to be kept alive in such circumstances and this verbal request was sufficient, the court decided.

This was criticised by Eugen Brysch, the director of the German Hospice Foundation. “The verdict transmits a fatal signal that does not comply with the critically sick people’s fundamental right to self-determination and care,” he said. Mr Brysch was particular critical of an unwritten living will. “If, as in this case, a casual private conversation without sufficient witnesses is enough to determine the patient’s wishes, then the floodgates for misuse are wide open.” ~ New York Times, June 26