Medical Goals of Care Plan Tasmania: What It Is and How It Works
The Document Your Doctor Uses When You Cannot Speak
When you are admitted to a Tasmanian hospital — whether through the emergency department, a planned surgery, or an aged care transfer — your treating doctor does not pull out your Advance Care Directive and follow it line by line. Instead, they translate your documented wishes into a clinical order that the nursing team, specialists, and after-hours staff can execute: the Medical Goals of Care (GOC) Plan.
The GOC Plan is an internal Tasmanian Health Service document (Form S97748) that standardises patient care into four clinical phases. It is the bridge between the legal language in your ACD and the minute-by-minute clinical decisions made on the ward. The GOC Plan operationalises your ACD in a clinical order; the ACD remains the legal record of your treatment directions.
The Four GOC Phases
Phase A: Curative and Restorative (Full Active Treatment)
Phase A means everything is on the table. The clinical team will use all available interventions to treat your condition and restore your health:
- Cardiopulmonary resuscitation (CPR) — including chest compressions, defibrillation, and emergency medications
- Code Blue activation (the hospital-wide emergency response for cardiac or respiratory arrest)
- Endotracheal intubation and mechanical ventilation
- Transfer to Intensive Care Unit (ICU)
- Emergency surgery
- Artificial nutrition and hydration
Where no ACD or GOC plan applies, Phase A is the default. If you have no ACD and no GOC plan, you receive Phase A care.
Phase B: Curative with Limitations
Phase B provides active treatment aimed at recovery, but with specific interventions excluded. The most common limitation is "Not for CPR" — meaning the clinical team will treat your condition aggressively but will not attempt resuscitation if your heart stops.
Other Phase B limitations might include:
- Not for intubation or mechanical ventilation
- Not for ICU transfer
- Active treatment of infections with intravenous antibiotics, but not for escalation to invasive procedures
Phase B is appropriate when a patient wants treatment for their current condition but has decided — through their ACD or in conversation with their treating team — that resuscitation beyond a certain point is not consistent with their wishes.
Phase C: Palliative Care
Phase C shifts the primary goal from cure to comfort. Life prolongation is a secondary consideration. Phase C care is automatically "Not for CPR or intubation" and focuses on:
- Pain management and symptom control
- Emotional and psychological support
- Maintaining dignity and comfort
- Allowing natural disease progression
A Phase C designation does not mean "doing nothing." It means reorienting treatment toward quality of life rather than life extension. Patients on Phase C still receive medications for symptom relief, wound care, physiotherapy for mobility and comfort, and nutritional support if they can eat and drink.
Phase D: Comfort During Dying
Phase D applies when death is imminent and expected — typically within hours to days. All active treatment stops. The sole focus is:
- Pain relief (opioid analgesics, sedation if necessary)
- Comfort measures (mouth care, repositioning, skin care)
- Family presence and support
- Dignity and privacy
Phase D is never a starting position on admission. It is a transition from Phase C (or occasionally Phase B) when the clinical trajectory becomes clearly terminal.
Who Completes the GOC Plan
The GOC Plan is authored and signed by the treating medical practitioner — your admitting doctor, your specialist, or the senior medical officer on the ward. It is a clinical order, not a patient form. You do not fill it out yourself.
However, the treating doctor should consider several inputs when completing the GOC Plan:
- Your Advance Care Directive — if you have one, the doctor should use your documented treatment consents and refusals to determine the appropriate GOC phase
- Your Enduring Guardian's input — if you lack capacity and the ACD does not directly address the current clinical scenario, the guardian can provide direction
- Your own wishes (if you have capacity) — if you are conscious and capable, you can discuss the GOC phase directly with your doctor
- Clinical assessment — the doctor considers your prognosis, the nature of your condition, and the realistic outcomes of different intervention levels
The GOC Plan is reviewed and updated throughout your admission. As your condition changes — improving or deteriorating — the treating team may adjust the phase.
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Why Your ACD Language Needs to Map to GOC Phases
This is the critical connection that most self-drafted ACDs miss. Your ACD is a legal document; the GOC Plan is a clinical order. If the language in your ACD does not clearly translate into one of the four GOC phases, the treating doctor has to interpret — and interpretation under time pressure defaults to Phase A (full active treatment).
Vague ACD language and its GOC consequences:
| What Your ACD Says | What the Doctor Hears | Likely GOC Assignment |
|---|---|---|
| "No extraordinary measures" | Undefined — what is extraordinary? | Phase A (default) |
| "No life support" | Ambiguous — does this include oxygen therapy? IV fluids? | Phase A or B, depending on interpretation |
| "I refuse CPR" | Clear | Phase B at minimum |
| "I refuse CPR, intubation, and mechanical ventilation. Prioritise comfort care." | Clear and specific | Phase C |
| "Comfort measures only during the dying process" | Clear and specific | Phase D |
The clearer your ACD language, the more confidently your doctor can set the GOC phase that matches your actual wishes — without defaulting to full intervention out of caution.
How to Ask Your Doctor About GOC
If you are currently under the care of a Tasmanian hospital or specialist, you can discuss the GOC framework directly:
- Before a planned admission: "Can we discuss which Goals of Care phase would be appropriate given my condition and my Advance Care Directive?"
- During a current admission: "I have an ACD that specifies [your refusals]. Has this been translated into a Goals of Care plan on my chart?"
- As a family member or Enduring Guardian: "My parent has a registered ACD. Can you confirm which GOC phase has been documented and whether it aligns with the ACD's instructions?"
You have the right to know your GOC designation and to discuss it with your treating team. The GOC Plan is a medical order — it is not made in secret — and your input (or your guardian's input) should be part of the process.
Getting the Alignment Right
Writing ACD refusal clauses that map cleanly to GOC phases is the most technically demanding part of advance care planning in Tasmania. Generic templates and interstate forms do not account for this clinical-legal alignment.
The Tasmania Advance Directive & Living Will Kit includes a GOC alignment worksheet that walks you through each phase, helps you draft refusal language that a treating doctor can translate directly into the correct GOC designation, and flags the clinical contradictions (like requesting CPR while refusing intubation) that force doctors to override directives.
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