Background To date, ACP has taken place at Agaplesion Markus Hospital in three stages: (1) seminars for the general public prior to disease onset, (2) individual consultations following diagnosis, and now (3) palliative care consultations. The hospital has one of the largest palliative wards in Germany (20 beds).
Aim In contrast to preventive seminars for members of the “healthy” general public, the situation surrounding patients having to cope with the onset of an actual disease is very different. The disease-related decision-making process is often emotionally very stressful. From an ethical standpoint, the decision-making process needs to be limited to the clinical picture in question and its expected course. Experience has shown that extended occupation with abstract scenarios often overtaxes patients and/or their next of kin, also putting them on the defensive.
Methods In order to realise our aims, we incorporate studies providing specific information about procedures and methods which are able to help hospital patients experience extreme situations in a less stressful manner.
Results A comprehensive ACP concept, if it is to be developed successfully, requires the acknowledgment and provision of different ethical and medical consultation constellations, corresponding to the different (disease-related) situations and emotional burdens facing directly or indirectly affected parties.
Conclusion In the special context of palliative medicine, it is particularly important to speak not only about the usual issues concerning procedure regulation and proxy decisions, but also about key lifetime events and positively experienced situations. Autobiographical memories generate positive emotions and encourage a congruent experiencing of identity, which can be used as an important orientation when navigating the last phase of life.
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