BIOGRAPHY

Since completing his professional training as a General Physician, Mark has held positions at Middlemore, North Shore, Masterton, Kenepuru and Wellington Hospitals. For more than a decade he has pursued a parallel career as a photographer, writer and oral historian, pursuing postgraduate qualifications in Fine Arts and exhibiting and publishing on an ongoing basis while continuing to work part-time in hospital practice. Like many of his colleagues, for years he experienced a nagging cognitive dissonance between the technologically-focussed, often aggressive curative treatment offered to (or imposed upon) the frail elderly patients admitted to hospital wards, and the philosophical belief that for many people in declining health at the end of their natural life a timely death is the best outcome of an acute illness. This led to an interest in the concept of Goals of Care, the recognition that it is important to distinguish between curative treatment, palliation, and care of the dying, and to determine which is appropriate for any individual patient in a way that honours their autonomy as an active participant in medical decision-making. He is now leader of a working party at CCDHB working towards integrating the concept of Goals of Care into routine clinical practice.

ABSTRACT

Goals Of Care: Choosing The Best Medicine

‘To cure sometimes, to relieve often, to comfort always.’ Frequently attributed to Hippocrates, this oft-quoted phrase was understood for centuries as summing up the aims of medical treatment. But during the 20th century, advances in medical technology led to a shift in emphasis such that ‘To cure always’ became the default position for all patients admitted to hospital. However, cure is not always a realistic option, and prolongation of life is not the only reason for seeking or offering medical treatment.  The ‘Goals of Care’ framework adopted in Tasmanian hospitals divides such treatment into three phases: the curative, or restorative phase, aiming to reverse the course of an illness; the palliative phase, aiming at relief of symptoms; and the terminal phase, offering comfort while dying. Working within such a framework, clinicians can make treatment decisions that are appropriate within the overall context of a patient’s life trajectory, and honour the patient’s own beliefs and wishes in a way that is respectful of their autonomy.