What We Talk about When We Talk about Goals
What are the goals of medicine? Are they fixed and immutable? Is there consensus concerning them? Current thinking about the goals of medicine should guide health care delivery, research and medical education. The literature on the goals of medicine is sparse, however, and "issues of purposes and values tend to be crowded out by...technical questions"  related to science or the organization and financing of health care. Therefore, I wanted this issue of Virtual Mentor to focus on some of the
... ocus on some of the basic questions about medicine and its aims. I also wanted these discussions to be sufficiently concrete to have relevance for practicing physicians; for example, to what extent are physicians obligated to respond to patient demands? This collection of writings aims to link reflections on the goals of medicine with day-to-day decisions regarding patient care and with laws, policies and education methods that directly affect medical practice. The Hastings Center Goals of Medicine project articulated four goals: (1) the prevention of disease and injury and the promotion and maintenance of health; (2) the relief of pain and suffering caused by maladies; (3) the care and cure of those with a malady and the care of those who cannot be cured; and (4) the avoidance of premature death and the pursuit of a peaceful death  . Although we might squabble over wording, the substance of these intentions is difficult to dispute, and these goals provide a starting point for discussion. Writing for the Hastings goals project, Hanson and Callahan present three very compelling reasons why we-physicians, bioethicists and patients-should care about the goals of medicine. The first is that "it makes no sense to talk about the financing and organization of health care systems unless we understand the purpose of the enterprise" . The second is that "the rapid advances of twentieth-century medicine have generated enormous ethical, cultural, and legal problems-and a remarkable number of them turn on what it is thought right or wrong, good or bad, for medicine to do for people in the name of preserving or improving their health"  . The third is that "modern scientific medicine seems to have elevated some goals of medicine-its intent to save and extend life, for instance-over other important goals, such as the relief of suffering and the pursuit of a peaceful death. It is exceedingly helpful to realize or sense the ensemble of medical goals, and then ask how they should fit together"  . In addition to addressing specific medical goals, each article in this issue of Virtual Mentor demonstrates how discussion of ethical issues in medicine can always benefit from some thinking about basic goals.