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Archive for Saturday, September 8, 2001

Glossary of end-of-life terms

September 8, 2001

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If you were to become seriously ill, you and those around you could expect to hear the following terms used by health-care professionals:

  • Advance directive: Describes two kinds of legal documents, living wills and medical powers of attorney, which allow you to give instructions about future medical care and appoint a person to make health-care decisions if you are unable to make them yourself. (Each state regulates the use of advance directives differently.)

  • Benefits and burdens: Guideline for deciding whether to withhold or withdraw medical treatments for you. A benefit can refer to the successful outcome of a medical procedure or treatment. But a benefit from one point of view can be a burden from another and might be viewed differently by doctors, patients and families. For example, if you are resuscitated, this may be a benefit from your doctor's point of view. For you, though, resuscitation may be a burden if it causes unnecessary suffering.

  • Best interests: A standard for making health-care decisions based on what others believe to be "best" for you by weighing the benefits and the burdens of continuing, withholding or withdrawing treatment.

  • Brain death: The irreversible loss of all brain function. Most states legally define death to include brain death.

  • Capacity: A patient's ability to understand the nature and consequences of health-care decisions and to make an informed decision.

  • Clear and convincing evidence: A high measure of proof that may be required legally to prove your wishes if you are unable to express them. A few states require clear and convincing evidence that an incompetent patient would want to refuse life support before treatment may be stopped unless there is an advance directive authorized by the state's law.

  • Cardiopulmonary resusitation (CPR): An attempt to resuscitate the heart and lungs by compressing the chest and providing artificial breathing.

  • Do-not-resuscitate (DNR) order: A physician's written order instructing health-care providers not to attempt cardiopulmonary resuscitation in case of cardiac or respiratory arrest. Although the DNR order is written at the request of you or your family, it must be signed by a physician.

  • Double effect: Results that would be morally wrong if caused intentionally are permissible if foreseen but unintended. An example: Pain medication is administered with the intention of relieving pain but has the possible unintended secondary effect of hastening death.

  • Euthanasia: Traditionally used to refer to the hastening of death, or "mercy killing." In voluntary active euthanasia you have given your fully informed consent to an intervention administered to cause death, such as a lethal injection. Involuntary or nonvoluntary active euthanasia involves a physician engaging in an act to end your life without your fully informed consent.

  • Hospice care: A program that delivers palliative care to you in the final stages of terminal illness as well as support for your family.

  • Life-sustaining or life-support treatment: Medical procedures such as cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition and hydration and dialysis that replace or support an essential bodily function.

  • Living will: A type of advance directive that documents wishes about future medical treatment to guide your family members and doctors in deciding how aggressively to use medical treatments to delay your death. (Also called a "directive to physicians," "health-care declaration" or "medical directive.")

  • Medical power of attorney: Document that allows you to appoint someone else to make decisions about your medical care if you are unable to do so.

  • Palliative or hospice-type care: Care that focuses on your physical, psychological and spiritual needs. Its goal is to achieve the best quality of life available by relieving suffering by controlling pain and symptoms while enabling you to function. Respect for your culture, beliefs and values is an essential component.

  • Physician-assisted suicide (sometimes referred to as physician-hastened death): A physician supplies the means, usually a prescription for a lethal dose of medication, by which you can end your life.

  • Substituted judgment: Permits a relative, friend or doctor to make medical decisions for you when you are unable to communicate, basing those decisions on what you would have wanted.

  • Surrogate decision-making laws: Allow an individual or group to make decisions about medical treatments for you in the absence of an advance directive, once you have lost decision-making ability.

  • Withholding or withdrawing treatment: Discontinuing life-sustaining measures.

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