Until the mid nineteen-nineties, the greatest scepticism towards advance decisions came from within the medical profession itself. Many doctors were concerned about the fact that advance decisions were frequently made by people still enjoying robust health who could not know what illnesses may be awaiting them. Under these circumstances a serious danger was perceived that the person could refuse certain kinds of measures which, when treatment became acutely necessary, he or she would perhaps wish to accept after all.
In recent years, this antagonistic attitude has radically changed. For instance, the 'Principles of the German Medical Association in respect of terminal care' (Grundsätze der Bundesärztekammer zur ärztlichen Sterbebegleitung) published in 1998 describe advance decisions as being of "significant help as a guideline for action to be taken by the medical practitioner".
Amongst other factors, it may be assumed that decisions taken by the Federal Supreme Court contributed to the shift of opinion in the medical profession. Significant examples of this are to be seen in the Kempten Verdict and the Lübeck Case.
In September 2003 the Federal Ministry of Justice inaugurated an interdisciplinary working group entitled 'End of Life Patient Autonomy', whose brief it was to discuss the binding nature of advance decisions and to elaborate a draft for a possible amendment to the current legal situation. The working group presented its report in June 2004, recommending the adoption of the advance decision as an instrument to form part of guardianship legislation. In addition, the working group proposed further enquiries in the area of criminal law to clarify the circumstances under which the implementation of or the refrainment from a medical intervention is permissible or not as the case may be.
Consequent to the working group’s report, the 'Study Commission on Law and Ethics in Modern Medicine' which had been commissioned by the Federal Parliament in September 2004 published its interim report entitled 'Patientenverfügungen' ('Advance Decisions'). Amongst other things, the report contains a warning concerning the consequences of placing too much emphasis on the right to self-determination.
Another milestone marking the progress of the reform movement leading towards legislation on advance decisions can be seen in the expertise published in June 2005 by the National Ethics Council (Nationaler Ethikrat). The majority of its members spoke out against limitation of scope for advance decisions. The debate was also influenced by the 66th German Jurists’ Forum held by the Association of German Jurists, by an interdisciplinary working group from the Academy for Medical Ethics as well as by the Bioethics Commission of the Federal State of Rhineland-Palatinate.
Finally, three different draft bills were brought forward in the German Parliament by the Members Bosbach, Zöller and Stüncker. All three drafts included the requirements that those wishes and decisions contained in an advance decision are to be taken into account and implemented by a guardian or attorney, that an advance decision may be revoked at any time and that the wish to receive active euthanasia is not permissible in an advance decision. The drafts differed from each other mainly in respect of the limitation of scope of advance decisions and the role to be played by the guardianship court: Whereas the draft brought forward by Zöller and Stüncker included the rejection of limitation of scope, the Bosbach draft was in favour of it. On 18 June 2009, the Stüncker draft was adopted by majority vote.