AMA Journal of Ethics

Word usage and intentional clarity will influence how patients feel about that Whipple pancreaticoduodenectomy surgery.

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

Some clinicians offering image-guided procedures have little training in palliative medicine, which is both a clinical and an ethical problem.

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

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.

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.

Clinician-family communication in surgical intensive care units should focus on reducing value incongruence and nonbeneficial operations.

Differentiating between best palliative care options and the curative and palliative potential of surgery is key to developing dual intentional clarity.

For some patients whose survival is extended by disease-modifying interventions, little guidance about clinical and ethical complexities exist.

Priorities far beyond generating morbidity or mortality data are needed to improve patients’ experiences, innovate metrics, and advance surgical palliation as a field.