[Advance Directives in Exceptional Situations]

Advance Directives in Exceptional Situations Abstract. Advance directives are an important instrument to support the autonomy of patients in clinical settings. However, when the will documented in an advance directive is at odds with the current preferences of an incompetent or partially competent patient, particularly challenging decision-making situations arise for all involved. These will first be illustrated by means of a case example and then analyzed in terms of the most important ethical lines of argumentation. The expected duration of the patient's incapacity to make decisions is an important parameter from an ethical point of view. If the incapacity is permanent or increasing, as in the case of dementia, for example, attention should be paid to supporting the patient's remaining self-determination in the best possible way. This means that current preferences and statements of the partially or no longer competent patient must also be taken into account when interpreting an advance directive and planning the next steps.