The regulation of the so-called living will in Section 1901a BGB is an important addition to the provisions concerning the persons who have to make decisions for the benefit and in place of persons unable to give their consent. A detailed presentation of the essential regulations as well as the history of the German Living Will Act is presented in the In Focus on Advanced Decisions. 

The core of the regulations, also known as the "Living Will Act", form Sections 1901a, 1901b, 1904 BGB. Section 1901a(1), sentence 1 BGB defines a living will as consent to or prohibition of  "specific tests of his state of health, treatment or medical interventions not yet directly immanent at the time of determination...". Living wills therefore enable patients to determine which medical measures should be taken or not taken in such cases before they become unable to give their consent. The order often includes statements on life-prolonging measures (see the In Focus on Euthanasia for further information). 

A living will is only binding if a person's wishes and expectations as set out in the living will apply to the person's current living and treatment situation (Section 1901a(1), sentence 1 BGB). If a living will has been drawn up lawfully and if the provisions apply to the current living and treatment situation,  custodians or authorized representatives must ensure that the will of the person in question is respected.

If a person is already suffering from dementia, the scope of the living will, which can then still be issued, is measured by the ability at that time to understand the content and scope of the respective decisions and to express a will in this regard (living wills: Section 1901a BGB). 

If there is no living will, or if the determinations of a living will do not correspond to the current situation, the presumed will of the person under custodianship must be determined and observed (Section 1901(2) BGB). The presumed will must be ascertained in accordance with Section 1901a(2), sentence 2 on the basis of concrete indications, taking into account in particular previous oral or written statements, ethical or religious convictions and other personal values of the person under custodianship (Section 1901a(2), sentence 3).