Questions & Answers: Advance Directives and End of Life Decisions

Glossary

Common Terms Used In Talking About End-of-Life Care

Advance Directive

A general term that describes two kinds of legal documents, living wills and medical powers of attorney. These documents allow you to give instructions about future medical care and appoint a person to make healthcare decisions if you are unable to make them yourself. Each state regulates the use of advance directives differently.

Benefits and Burdens

A commonly used guideline for deciding whether or not to begin or stop medical treatments. A benefit can refer to the successful outcome of a medical procedure or treatment. Outcomes can be medical (e.g., the heart beats again) or functional (e.g., the person is able to walk to the bathroom after being incapacitated by a stroke), or one that supports the patient's values (e.g., the patient is able to die at home as wished).

However, a benefit from one point of view can be experienced as a burden from another and might be viewed differently by doctors, patients and families. For example, if a patient's heart stops, is resuscitated and starts beating again, this is a successful outcome from a medical point of view, and a doctor may consider it a benefit. To the patient who is dying from a serious illness or disease, resuscitation may cause further injury and may contribute to the overall experience of suffering. This success, from the doctor's point of view, might actually be experienced as an additional burden by the patient. Discussions of the benefits and burdens of medical treatments should occur within the framework of the patient's overall goals for care.

Case Law

Law that is based on a judge's decision in a court case, rather than by legislation.

Capacity: In the healthcare context, the ability to understand and appreciate the nature and consequences of health care decisions and to make an informed decision. ?e term competent is also used to indicate ability to make informed decisions.

Do-Not-Resuscitate Order (DNR)

A DNR order is a physician's written order instructing healthcare providers not to attempt cardiopulmonary resuscitation (CPR) in case of cardiac or respiratory arrest. A person with a valid DNR order will not be given CPR under these circumstances. Although the DNR order is written at the request of a person or his or her family, it must be signed by a physician to be valid.

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Euthanasia

Based on a term meaning "good death." ?e term traditionally has been used to refer to the hastening of a suffering person's death. "Mercy killing" is another term often used. Voluntary Active Euthanasia involves a physician engaging in an act to cause a patient's death, such as by giving a lethal injection, with the patient's full informed consent. Involuntary or Non-voluntary Active Euthanasia refers to an act to end a patient's life, without that patient's full informed consent.

Hospice Care

A program to deliver palliative care to individuals who are in the final stages of terminal illness. In addition to providing palliative care and personal support to the patient, hospice includes support for the patient's family while the patient is dying as well as bereavement support to the family.

Life-Sustaining Treatment

Treatments (medical procedures) that replace or support an essential bodily function (may also be called life support treatments). Life-sustaining treatments include cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition and hydration, dialysis, and certain other treatments.

Living Will

A type of advance directive in which an individual documents his or her wishes about future medical treatment should he or she be at the end of life and unable to communicate. It may also be called a "directive to physicians," "healthcare declaration," or "medical directive." ?e purpose of a living will is to guide family members and doctors in deciding how aggressively to use medical treatments to delay death.

Medical Power of Attorney

A document that allows an individual to appoint someone else to make decisions about his or her medical care if he or she is unable to communicate. It may also be called a healthcare proxy, medical power of attorney or appointment of a healthcare agent. ?e person appointed may be called a healthcare agent, surrogate, attorney-in-fact, or proxy.

Palliative Care

A comprehensive approach to treating serious illness that focuses on the physical, psychological, spiritual, and social needs of the patient. Its goal is to achieve the best quality of life available to the patient by relieving suffering, controlling pain and symptoms, and enabling the patient to achieve maximum functional capacity. Respect for the patient's culture, beliefs, and values are an essential component. Palliative care is sometimes called comfort care.

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Physician-Hastened Death

Sometimes referred to as Physician-Assisted Suicide

A physician supplies the means, usually a prescription for a lethal dose of medication, which a terminally ill individual can use to end his or her own life.

Surrogate Decision-Making Laws

Refers to laws that allow an individual or group of individuals to make decisions about medical treatments for a patient who has lost decision making capacity and did not prepare an advance directive. Some state advance directive laws also refer to the designated healthcare agent as the surrogate.

Surrogate Decision-Making Laws

Refers to laws that allow an individual or group of individuals to make decisions about medical treatments for a patient who has lost decision making capacity and did not prepare an advance directive. Some state advance directive laws also refer to the designated healthcare agent as the surrogate.

Withholding or Withdrawing Treatment

Not beginning life-sustaining measures or stopping them after they have been used for a certain period of time.

WebMD Medical Reference from the National Hospice and Palliative Care Organization

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