Care for dying patients--German legislation

Caring for dying patients appears to be one of the most difficult challenges in modern medicine. Apart from respective medical standards, such care is influenced by legal stipulations, economic resources, societal values, and ethical principles. In Germany, legal provisions prohibit actively hastening a patient's death. Although passive and indirect means of assistance to die are permitted for terminally ill patients, they appear to be implemented only with hesitation. Probably, the authority of advance directives needs further clarification. More importantly, however, physicians' deficits in knowledge as well as their conceptual and psycho-emotional barriers need comprehensive improvement in order to foster end-of-life care.