Questions & Answers: Advance Directives and End of Life Decisions
Common Terms Used In Talking About End-of-Life
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
"I'm sorry, but there's nothing more we can do."
No patient wants to hear that. No doctor wants to say it. And with good reason: It isn't true.
It is true that in the course of many illnesses, cure ceases to be an option.
But no hope of a sure cure does not mean no hope at all. It certainly does not mean there is nothing more to be done.
When you receive the information that your illness is serious, a palliative care team can help you handle the news and cope with the many questions and challenges...
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.
Law that is based on a judge's decision in a court case, rather than by
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.
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.