Many definitions rightly emphasise that the core element of ACP is a continual communication process between patients, their family, and a qualified facilitator that may but does not have to find its expression in written advance directives (ADs). Under certain circumscribed conditions, the presence of such a process alone may suffice to provide care for an individual patient in accordance with his or her wishes. At the same time, with view to reliably honouring patient choices in diverse situations and settings, there are good reasons to make an effort at optimal documentation of individual preferences. Optimal documentation will attempt to reflect the patients’ views, and to capture the patients’ specific treatment wishes in a way that will be directly applicable in typical (frequent) scenarios, and provide best possible guidance even under atypical (rare) circumstances. This requires a written clarification of goals and acceptable outcomes in the first place, and with regard to the documentation of preferences for concrete treatment scenarios, it implies striking a balance between medical differentiation on the one hand and validity on the other since the two can be viewed as inversely related.

In this workshop, participants will be introduced to the detailed documentation developed for the German ACP program beizeiten begleiten, including a POLST (physician orders for life-sustaining treatment) equivalent focusing on medical emergencies, a detailed AD, and an AD by proxy. There will then be opportunity to compare these documents with other available examples of international ACP programs, and to discuss their different rationales, foci, strengths and weaknesses.