Surgery and Palliative Care: Is There Common Ground or Simply a Clash of Cultures?

Abstract

The goal of clinical medicine is to improve or maintain the best possible health and well-being. An intervention is “palliative” when the primary aim is to optimise function or comfort without an expectation that the course of the illness will be changed. The philosophy of surgery is predicated on a localised, biomechanical intervention at a single point in time, often with an optimism focusing on what could be achieved. Conditions with potential surgical interventions that develop in advanced disease have widely varying manifestations and progression, making studies difficult, leading to greater reliance on clinical intuition for decision-making.

The person’s premorbid level of function, and the likelihood that any intervention will help them to return to, or maintain, better function, becomes the measures for decisions when considering palliative interventions. Principles include:

• Do no harm as surgery is trauma and, in someone with progressive, irreversible cachexia, anything that accelerates his/her deterioration is likely to compound disease progression even when minimally invasive.

• Just because something could be done does not mean that it should be done.