Professionalität der Gesprächsbegleitenden und Freiwilligkeit der Teilnehmenden als ethische Herausforderungen von Advance Care Planning

Patients have the right to be treated according to their own wishes even if they are currently unable to form their own will. Advance care planning (ACP), as a special procedure for advance healthcare planning, aims to resolve this dilemma by determining the patient’s wishes in advance. Specially trained facilitators can offer help to determine, formulate and document such a will that takes the individual’s health situation into account. Loved ones closely involved with the person’s situation should be involved in the discussion process and it should be organisationally ensured that their wishes are actually accessible to those currently treating them if necessary. The procedure therefore combines a communicative element with an institutional element.

From an ethical perspective, this poses two main challenges. Firstly, counselling with such a complex objective requires skills and presupposes certain attitudes that are typical of professions in the strict sense. Secondly, despite its institutionalised form, the procedure must be voluntary for those involved. This is crucial for the validity of the process, but also for its outcome.

To address the first, it would be important to make corresponding professional standards explicit, for example in the form of a professional code of conduct. For the result of an ACP process to be legally binding, the persons concerned must be able to act freely, i.e. without any so-called lack of will. In keeping with the nature of ACP, voluntariness is also central for authentic determination of personal preferences. Therefore, it is an ethical duty to ensure that counselling is voluntary both at the outset and during the course of counselling.