Rethinking the central dogma of palliative care

Palliative care defines itself as complementary to life-prolonging therapy. Consideration should be given instead to viewing palliative care as the gold standard for all patients with progressive, life-threatening illness. The dichotomy between cure on the one hand and palliation on the other reflects the oncologic roots of palliative medicine, as well as the widespread societal view of medical treatment as overwhelmingly focused on cure. Because the treatment of patients with serious and complex illness is seldom curative, it makes more sense to think of the care of such patients as inherently palliative. Patients must choose among various forms of potentially life-prolonging therapies, each with its own side-effect profile and likelihood of success, depending on how they prioritize their goals of care. From this perspective, palliative care, an interdisciplinary approach that attends to advance care planning, psychosocial issues, and management of symptoms, should be the standard of care for these patients. Palliative care physicians can either provide primary care to patients with serious illness or can serve as consultants in the care of particularly challenging cases.