A GUIDE FOR CAREGIVERS AND FAMILIES

Talking about goals of care can feel daunting, but it’s one of the most important conversations you can have with your loved ones and care team. At Greendale House, we want to help you understand what these conversations mean, why they matter, and how to approach them with clarity and compassion.

What Does “Goals of Care” Mean?

Goals of care are conversations about:

• What matters most to this person

• What makes life meaningful for them

• What medical treatments align with their values

• What treatments may not

These conversations help us to have clarity when medical decisions or crises arise.

It is not a conversation about when to “give up.”

When Do These Conversations Matter?

These principles become critical when there is a serious medical event, and the likelihood of meaningful recovery is low.

Examples may include:

• Cardiac arrest

• Severe stroke

• Respiratory failure

• Advanced disease progression

Families are often consulted to help make decisions on their loved one’s behalf, and this is even harder when a goal of care conversation has never been discussed.

The 3 Big Questions Often Asked

Living Wills or Advance Directives are documents people can complete that often address 3 main questions:

• Would you want CPR?

• Would you want ventilation (a breathing machine)?

• Would you want artificial feeding via a feeding tube?

These are usually considered when recovery to prior function is unlikely.

Important in South Africa

Living Wills / Advance Directives do not carry binding legal weight.

Doctors and hospitals are not legally obligated to follow them.

However, they remain valuable because they guide the next of kin who will likely be consulted in a crisis.

Clarity reduces conflict and regret.

The 3 Big Questions Are Just the Tip of the Iceberg

Goals of care discussions should also include questions like:

• Where would you prefer to receive care?

• Would you want hospital transfers if very unwell?

• Would you treat infections aggressively?

• What level of dependency feels acceptable?

• Who should speak on your behalf if you cannot?

• What does a “good death” look like to you?

• How much information do you want about prognosis?

• How much intervention feels burdensome?

• Should we prioritise comfort over life prolongation?

The Most Important Question

Before asking about machines or procedures, ask:

What makes life worth living for you?

For some people, being alive at any cost is most important. For others, independence, awareness, and engagement matter more.

There is no right answer – only alignment with individual values.

How to Start the Conversation

It often feels awkward. Naming the awkwardness reduces it.

Sometimes people signal they are already thinking about it:

• “I might not be around next Christmas.”

• “I’ve lived a good life.”

• “I don’t want to be a burden.”

• “I wouldn’t want to live like that.”

Don’t shut these down. Instead, try asking more about what they mean.

These comments are invitations, not things to correct.

Why These Conversations Matter

Families are left making decisions in crisis.

Having these conversations ahead of time gives clarity so that:

• Decisions align with values

• Guilt is reduced

• Conflict is reduced

• Fear is reduced

• The person feels heard

It decreases isolation.

Goals of care are not about death.

They are about:

• Dignity

• Autonomy

• Relationships

• Respect

If you are unsure how to begin, ask for guidance.

Goals of care conversations are essential in ensuring that medical decisions reflect what truly matters to the person receiving care. They help families and caregivers navigate difficult moments with clarity, compassion, and respect. At Greendale House, we encourage you to start these conversations early, so you and your loved ones can face the future with confidence and peace of mind.