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Questions and Answers: Artificial Nutrition and Hydration and End of Life Decision Making

Glossary of Terms

The following terms are commonly used in discussion about end-of-life decision-making.

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 health care decisions if you are unable to participate in medical decisions because you cannot speak for yourself. Each state regulates the use of advance directives differently.

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Benefits And Burdens
A commonly used guideline for deciding whether or not to withhold or withdraw 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 it supports the patient's values (for example, the patient is able to die at home as he 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 is resuscitated and the heart 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 only 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.

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

Do-Not-Resuscitate (DNR) Order
A DNR order is a physician's written order instructing health care 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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