Behandlungswünsche

Behandlungswünsche describes the statements of an individual’s preferences for medical care in situations where they cannot communicate their decisions. They are rooted in the principle of patient autonomy and aim to ensure that treatment aligns with personal values, goals, and acceptable quality of life. In German-speaking contexts they are commonly implemented through advance directives, such as a Patientenverfügung, as well as care proxies (Vorsorgevollmacht) and accompanying explanations about treatment goals.

Contents often covered by Behandlungswünsche include preferences regarding life-sustaining interventions (for example cardiopulmonary resuscitation, ventilation), artificial nutrition and hydration, antibiotic use, pain management, and the overall aim of care (curative versus palliative). They may also indicate acceptable levels of risk, preferred place of care, and whether to participate in organ donation. Clarity and specificity in wording improve interpretability by clinicians.

Process and implementation emphasize preparation while capable, ideally in dialogue with physicians and relatives, and documentation in writing. It is important to designate a surrogate decision-maker if appropriate and to ensure the document is accessible within medical records. Behandlungswünsche should be reviewed and updated periodically, particularly after changes in health status or personal circumstances. When capacity is lost, clinicians refer to the expressed wishes; if instructions are unclear, substituted judgment or best-interest considerations guide decisions, balancing benefits and burdens.

Legal and ethical context highlights the protection of autonomy and the promotion of aligned care. Behandlungswünsche can vary in legal recognition by jurisdiction, but ethically they support informed consent, reduce unwanted interventions, and facilitate shared decision-making. Challenges include ambiguities, family disagreements, and the need for high-quality documentation.