Death directives surge as Vorarlberg plans patient advocate reform

The number of death directives for assisted suicide is rising in Vorarlberg as the state plans to reorganise its patient advocacy service, ORF reported. Critics fear that making the currently independent association a state body could affect its work.

Gerold Battlogg, 72, wants to end his life on his own terms after years of health problems following a prostate condition. He says neither surgery nor medication has helped him.

“I have lived my life. I do not necessarily want to depend on the pharmaceutical industry to keep living,” Battlogg told ORF. He said he wanted to die while he could still make the decision independently and was mentally clear.

The Vorarlberg patient advocacy service has drawn up around 10 death directives a year in recent years. This year, however, the number has risen sharply, patient advocate Alexander Wolf said. There had been 10 by June and around 15 by the time of the report, with about 10 more cases in preparation.

That would amount to a doubling, or more, he said. Wolf could not explain the increase, but suggested that people considering assisted suicide might simply want to keep the option open.

Assisted suicide has been legal in Austria under strict legal conditions since January 1, 2022. It is governed by the Death Directive Act, which was introduced after a ruling by the Constitutional Court and is being amended in 2026.

Battlogg’s death directive is due to take effect in a few weeks. He is concerned about the planned reform, under which the patient advocacy service would be placed under the state government rather than remaining an independent association.

He fears that doctors could try to persuade him to abandon his decision. “That really goes against the grain for me,” he said, adding that he had lost trust in doctors and was worried that the state could interfere in his decision.

The state government said those concerns were unfounded. Health Minister Martina Rüscher of the Austrian People’s Party said in a written statement to ORF Vorarlberg that the patient advocacy service would remain independent and free from instructions.

Its independence would be explicitly established in law, Rüscher said. The patient advocate and staff would be obliged to serve patients’ interests and would not be subject to instructions from the state or other legal entities.

She said this would ensure that neither the state nor a hospital or other institution could influence the service’s substantive work, including in the sensitive areas of patient directives and death directives. The organisational link to the state government would not affect its professional or substantive independence, she said.

Rüscher added that death directives were regulated under federal law through the Death Directive Act, which would not be changed by the proposed amendment. The patient advocate would remain responsible for them.

Wolf also does not share concerns about interference in death directives. He said the only question was whether the federal government would continue to cover the costs of drawing up a death directive through the patient advocacy service. Regardless, he said, the state could still decide that the patient advocate should carry out the task.