Goals of Care
The world of modern medicine can be overwhelming and confusing. There are so many options, each of which comes with benefits and burdens and probabilities. Yet, just because something can be done doesn’t mean it should be done; the marvels of technology need to be balanced against the patient’s goals.
It’s therefore important to distinguish between goals of care and a plan of care. The goals of care are determined by a patient’s priorities and values, their hopes and fears. Goals can be described in plain language without reference to procedures or medical interventions. Possible goals include wanting to live independently, to be able to read books, to play with one’s grandchildren, to recognize the people one loves, or simply to live as long as possible. Goals often change over time and should be revisited regularly with one’s physician and loved ones.
Advance directives are an excellent format for communicating one’s general goals. Often, though, an advance directive can’t predict what situations may arise, and goals of care need to be interpreted in terms of ongoing developments. In such situations, effective communication of a patient’s goals and priorities will help the medical formulate a plan of care (e.g. whether to provide intensive interventions such as CPR or mechanical ventilation) that does honor to a patient’s values.