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
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.
"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 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.
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
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.
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, and grief support after death.
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.