Palliative care aims to relieve physical pain and psychological, social, and spiritual suffering while supporting the patient's treatment goals and respecting the patient's racial, ethnic, religious, and cultural values. Like all good patient care, palliative care is based on the fundamental ethical principles of autonomy, beneficence, nonmaleficence, justice, and duty.
Although palliative care includes hospice care and care near the time of death, it also embraces the management of pain and suffering in medical and surgical conditions throughout life. If palliation is taken to apply solely to care near the time of death, or "comfort measures only," it fails to include the life-affirming quality of active, symptomatic efforts to relieve the pain and suffering of individuals with chronic illness and injury. In this respect, palliative care is required in the management of a broad range of surgical patients and is not restricted to those at the end of life.
The tradition and heritage of surgery emphasize that the control of suffering is of equal importance to the cure of disease. Moreover, by adhering to the standards of professionalism endorsed by the American College of Surgeons, the surgeon is positioned to take a leadership role in advocating for palliative care for all patients.
The Statement of Principles of Palliative Care is an evolutionary step beyond the American College of Surgeons' 1998 Statement of Principles Guiding Care at the End of Life. It describes extending palliative care to a broad range of patients receiving surgical care.
Statement of principles of palliative care
- Respect the dignity and autonomy of patients, patients' surrogates, and caregivers.
- Honor the right of the competent patient or surrogate to choose among treatments, including those that may or may not prolong life.
- Communicate effectively and empathically with patients, their families, and caregivers.
- Identify the primary goals of care from the patient's perspective, and address how the surgeon's care can achieve the patient's objectives.
- Strive to alleviate pain and other burdensome physical and nonphysical symptoms.
- Recognize, assess, discuss, and offer access to services for psychological, social, and spiritual issues.
- Provide access to therapeutic support, encompassing the spectrum from life-prolonging treatments through hospice care, when they can realistically be expected to improve the quality of life as perceived by the patient.
- Recognize the physician's responsibility to discourage treatments that are unlikely to achieve the patient's goals, and encourage patients and families to consider hospice care when the prognosis for survival is likely to be less than a half-year.
- Arrange for continuity of care by the patient's primary and/or specialist physician, alleviating the sense of abandonment patients may feel when "curative" therapies are no longer useful.
- Maintain a collegial and supportive attitude toward others entrusted with care of the patient.
