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.

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.