Often overlooked, surgery can be a key element in palliative care

Palliative care medicine is a widely misunderstood discipline. While many physicians may regard it as being reserved for dying patients, it can benefit anyone living with a serious, complex illness. In addition, palliative interventions can be invasive and may even include surgical care.

But no matter the intervention, palliative care should be driven by intention—by patients, their family members and their physicians aiming not to cure disease or prolong life, but to improve quality of life at any given time.

The October issue of AMA Journal of Ethics^® (@JournalofEthics) investigates surgical palliation, paying particular attention to intention formation and trust preservation.

Articles include:

1. "Who Should Decide When Palliative Surgery Is Justifiable?"

   1. No single person should make decisions about for whom or according to which criteria palliative surgery is clinically and ethically appropriate.

2. "How Should Surgical Palliative Success Be Defined?"

   1. A surgeon’s duty is to identify goals of care, including those about quality of life, from a patient’s perspective and to consider how to achieve them.

3. "Teaching Palliative Care in Surgical Education"

   1. Calls to expand palliative care education have been explicit since the 1990s, but palliative care training in surgery remains too narrowly focused on end of life.

4. "AMA Code of Medical Ethics’ Opinions Related to Palliative Surgical Care"

   1. Guidance about sedation to unconsciousness and medically ineffective interventions can be applied to surgical palliation.

In the journal’s October "Ethics Talk" podcast, editorial fellow C. Alessandra Colaianni, MD, chief resident in the Department of Otolaryngology–Head and Neck Surgery at Harvard Medical School, describes the creation of this month’s issue on palliative surgery. In the same episode, Wynne Morrison, MD, MBE, director of the Justin Michael Ingerman Center for Palliative Care at Children's Hospital of Philadelphia, explains how to explore palliative surgical goal formation with children and their guardians.

The October issue also features six author-interview podcasts. Listen to previous episodes of the “Ethics Talk” podcast or subscribe in iTunes or other services.

These AMA Journal of Ethics CME modules are each designated by the AMA for a maximum of 1 AMA PRA Category 1 Credit™:

• Holding Curative and Palliative Intentions.
• How Should Surgical Palliative Success Be Defined?
• When Should Neuroendovascular Care for Patients With Acute Stroke Be Palliative?
• How Should Surgeons Communicate About Palliative and Curative Intentions, Purposes, and Outcomes?
• Where's the Value in Preoperative Covenants Between Surgeons and Patients?

Additionally, the CME module “Ethics Talk: Why 'Palliative Surgery' Is Not Like 'Jumbo Shrimp'” is designated by the AMA for a maximum of 0.5 AMA PRA Category 1 Credit™.

The offering is part of the AMA Ed Hub™, an online learning platform that brings together high-quality CME, maintenance of certification and educational content—in one place—with relevant learning activities, automated credit tracking and reporting for some states and specialty boards.

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

Upcoming issues of the AMA Journal of Ethics will focus on health care and homelessness, health justice and diversity, and disparities along the medical-dental divide. Sign up to receive email alerts when new issues are published.