Capacity, advance directives and patients' preferences one year after Germany's law on advance directives and lasting power of attorney

In September 2009 Germany's new law on advance directives came into effect with new regulations on capacity and on medical treatment for those lacking capacity, not only for end of life decisions but for any decisions on medical treatment ( 1901 aAbs. 1 BGB). The discussion since the change in legislation is reviewed. The new law sets out conditions for advance directives, how to determine a patient's will and in the absence of a clear will how to determine a presumed will. The implications of the patient's will for the legal guardian, for the appointed proxy and the treating physician are reviewed and discussed, also the legal provision to enforce the patient's will.