Glossary of Terms related to Advance Directives and End of Life Planning
Advance directive - A general term that describes two kinds of legal documents, living wills and medical powers of attorney. These documents allow a person to give instructions about future medical care should he or she be unable to participate in medical decisions due to serious illness or incapacity. Each state regulates the use of advance directives differently.
Artificial nutrition and hydration: Artificial nutrition and hydration replaces eating and drinking by giving a balanced mix of nutrients and fluids through a tube placed directly into the stomach, the upper intestine or a vein.
Capacity - In relation to end-of-life decision-making, a patient has medical decision-making capacity if he or she has the ability to understand the medical problem and the risks and benefits of the treatment options. The term is frequently used with competency but is not the same. Competency is a legal status imposed by the court.
Cardiopulmonary Resuscitation - (CPR) CPR is used to try to restart the heart and breathing. It may consist only of mouth-to-mouth breathing or it can include pressing on the chest to mimic the heart’s function and cause blood to circulate. Electric shock and drugs also are used frequently to stimulate the heart.
Do-Not-Resuscitate (DNR) order - A DNR order is a doctor’s written order instructing the healthcare team not to attempt cardiopulmonary resuscitation (CPR) when the heart or breathing stops. A person with a DNR order will not be given CPR when this happens. The DNR order is written at the request of a person or his or her family; it must be signed by a doctor to be valid. A non-hospital DNR order is written for people who are at home and do not want to receive CPR.
Emergency Medical Services (EMS) - A group of governmental and private agencies that provide emergency care, usually to persons outside of healthcare facilities; EMS personnel generally include paramedics, first responders and other ambulance crew.
Healthcare agent - The person named in an advance directive or as allowed under state law to make healthcare decisions for a person who is no longer able to make medical decisions for themselves.
Hospice – Hospice is care for the terminally ill patient in the last 6 months of life when the goal of care changes from cure to comfort. Hospice is a team approach to expert medical care, pain management, and emotional and spiritual support tailored to the person's needs and wishes. Most of the care is provided in the patient’s home or the place they call home (nursing home, assisted living or independent living).
Intubation - Refers to "endotracheal intubation" the insertion of a tube through the mouth or nose into the trachea (windpipe) to create and maintain an open airway to help the patient breathe.
Life-sustaining treatment - Treatments (medical procedures) that replace or support a vital body function (may also be called life support treatments). Life-sustaining treatments include CPR, breathing tubes, nutrition and hydration through tubes and IV’s, kidney dialysis, and other treatments.
Living will - A type of advance directive in which a person writes dow his or her wishes about 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.”
Mechanical Ventilation - Mechanical ventilation may be known as a ‘breathing machine’. A ventilator forces air into the lungs through a tube that is inserted into the nose or throat. The machine does the breathing work for the lungs to keep oxygen moving that is necessary for life.
Medical Power of Attorney - A document that names someone else to make decisions about his or her medical care if he or she is unable to communicate. This type of advance directive may also be called a healthcare proxy, durable power of attorney for healthcare or appointment of a healthcare agent. The person named may be called a healthcare agent, surrogate, attorney-in-fact or proxy.
Palliative Care – A way of treating serious illness that focuses on the physical, psychological and spiritual needs of the patient. The goal of Palliative Care is to reach the best quality of life available to the patient by relieving suffering and controlling pain and symptoms. Palliative Care may be offered at any point during a chronic or terminal illness. You do not need to be in hospice to receive relief of symptoms of pain, nausea, shortness of breath, anorexia, fatigue and the like—due to your illness. Palliative Care may be offered in the hospital or at times in an outpatient care setting.
Power of Attorney - A legal document allowing one person to act in a legal matter on another's behalf about financial or real estate business.
Respiratory arrest –An event in which an individual stops breathing. If breathing is not restored, the persons heart will stop beating, resulting in cardiac arrest.
Surrogate Decision-Making - Surrogate decision-making laws allow a person or group of people (usually family) to make decisions about medical treatments for a patient who is unable to make their own decisions and did not prepare an advance directive. Most states have passed laws that permit surrogate decision making for people without advance directives.
Ventilator - A ventilator, also known as a respirator, is a machine that pushes air into the lungs through a tube placed in the trachea (breathing tube). Ventilators are used when a person cannot breathe on his or her own or cannot breathe effectively enough to circulate oxygen to the cells of the body or rid the body of carbon dioxide, which is vital for life.
Withholding or Withdrawing Treatment – To stop life-sustaining treatments or discontinuing them after they have been used for a certain period. This is generally done when treatments are no longer helping to improve a patient’s health, or the treatment is causing more symptom