What is a 'Goals of Care Designation' and why you and your family should have them
Imagine the following...
You're thirty years old and have never seen the inside of a Hospital. On your way home from work, you find yourself in a catastrophic motor vehicle collision. The damage to your heart and lungs is severe. After a short ambulance ride and emergency surgery, the Hospital moves you to the Intensive Care Unit, and the doctors hook you up to machines that support your heartbeat and breathing. Due to the medications required to keep your condition stable, you are unable to speak or even understand what is happening around you. Your physicians are not confident you will recover.
You're seventy years old and have had cancer for the past five years. You and your family have fought hard, and you've tried chemotherapy, radiation, and complimentary treatments. Nothing has worked, and you are now approaching the final stages of the illness - and your life.
In both of these circumstances, your family will have to make complex, ethically challenging decisions about your care, and in both of these circumstances a little green document could let them - and your medical team - know exactly what steps you want taken.
In Alberta, you can complete something called a "Goals of Care Designation" or a Greensleeve. No, not the super depressing recorder song that everyone tries to make you listen to at Christmas. It's a package of papers you complete with your family doctor, and it lives inside a nifty plastic green sleeve.
As a brief overview, the Greensleeve allows you to select from three levels of care:
- Medical Care
- Resuscitative Care
- Comfort Care
This replaces the one-size-fits-all "Do Not Resuscitate" Order that most people think of when conversations around the end of life care come up.
Resuscitative Care is the default treatment people receive when they arrive at the hospital. Every possible measure, including Intensive Care and life support, will be used to keep the patient alive. These actions can be useful, but are also traumatic and can actually harm the body. For example, an intubated patient is generally sedated and is unable to speak.
Medical Care is the next level down and includes any treatment that is likely to help the patient recover, excluding Intensive Care and life support. This can be a good option for patients with terminal illness, where treatment of infections and surgical interventions could help prolong their lives. In these situations, a patient has made the quality of life a priority but is still willing to receive treatment that cures or controls their condition.
Comfort Care is all about quality of life. This is the kind of care you would receive in a Hospice or Palliative Care Unit at a Hospital. All care is directed at maximum symptom control and maintenance of function. As death approaches, care is all about reducing suffering, even if such care hastens the moment of death.
Speak to your doctor about filling out a Goals of Care Designation.
Talk to a lawyer about completing a Personal Health Directive. This document is the legal companion of a Goals of Care Designation and can clarify exactly how you would like to receive treatment, and who should make medical decisions for you if you aren't able to make those decisions yourself. People frequently believe that a Personal Health Directive is something only the elderly should complete, but the truth is that people of any age or health status can find themselves unconscious, leaving the family to make impossible decisions about their care.