Collaboration between various disciplines is a key aspect of palliative care. Approaches and methods from various professions and disciplines are employed in order to provide the best possible medical management, care and support. Successful collaboration is based on a common understanding of palliative care, an open and interested attitude towards other professional groups and coordinated communication and cooperation. Organisation of the multiprofessional collaboration depends on the context in which it occurs. It is important to create clarity on this point according to the specific situation.

Advance directive (Patientenverfügung)

A written advance directive specifies what measures should be taken or omitted in the event of illness or accident, when the person is no longer able to make decisions on their own. The advance directive regulates situations at the end of life.

Power of attorney (Vorsorgeauftrag)

The power of attorney is a written declaration of intent relating to personal, financial and legal matters. It takes effect when a person is no longer able to make decisions on their own as a result of illness or an accident. 

ACP (Advance Care Plan)

Advance planning for health according to an ACP allows a patient to specify in writing their personal values and wishes in relation to illness and dying if they are no longer capable of making their own decisions. The inability to give consent can arise during an acute emergency situation, or may last for a prolonged period or even be permanent. An ACP is more differentiated and more detailed than an advance directive. An advance directive and ACP are often drawn up beforehand and do not necessarily relate to a specific illness situation.

Emergency plan (Notfallplan)

An emergency plan regulates the approach in the event of a deterioration in health or in an emergency situation and relates to a specific illness. It enables foreseeable complications to be discussed with the patient and their relatives and corresponding measures to be determined. The patient should keep the emergency plan in an emergency box together with their medicines.

Remarks:

• The Law on the Protection of Adults states that advance directives are legally binding. If the will of the patient is not known or is unclear, in emergency situations doctors may decide on medical measures according to their best medical judgement.
• Whether the document being drawn up is an advance directive or ACP, patients should always receive support from professionals who are well informed on medical, legal and ethical aspects. The process in each case should be managed professionally in the context of a discussion.
• Advice provided by professionals is subject to a fee, and it is advisable to clarify beforehand who will be responsible for the costs incurred.