glossary

GLOSSARY

Often the death with dignity debate becomes muddled due to confusion over terms. The following definitions are supplied to increase your understanding of a host of end-of-life care practices and vocabulary.

Advance Directives: a general term that describes two kinds of legal documents (see living wills and durable 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 has their own regulations concerning the use of advance directives.

Coma: "A coma is a profound or deep state of unconsciousness. An individual in a state of coma is alive but unable to move or respond to his or her environment," according to the National Institute of Neurological Disorders and Stroke (NINDS). Comas can be the result of illnesses or injuries.

Comfort Care: an approach to care of the dying that emphasizes the relief of discomfort rather than the cure of illness or prolongation of life. Physical, social and emotional needs are the first priority, even when treatment such as high dose pain medication may have the effect of hastening death. Also called palliative care.

Death with Dignity: legal in Oregon and known in the medical/academic literature as physician-assisted suicide, death with dignity allows mentally competent state residents with a terminal diagnosis and a prognosis of six months or less, to request a life-ending prescription from their physician. This prescription must be self-administered.

Do-Not-Resuscitate Order (DNR): also called a 'no code,' a DNR is usually placed on a patient's medical chart to indicate there should be no attempt to restart a failed heartbeat or apply cardiopulmonary resuscitation (CPR) to restore normal breathing. A DNR order can be changed and experts say it should be reviewed regularly. In a DNR situation, a patient is still provided comfort care. Without such an order, emergency medical technicians are legally required to perform CPR.

Double Effect: a doctrine established by St. Thomas Aquinas in the 13th Century that an action having two effects, one that is intended and positive and one that is foreseen but negative, is ethically acceptable if the actor intends only the good effect. The doctrine is often used to describe the impact of administering high doses of morphine or terminal sedation - treatments intended to relieve suffering but that will inevitably hasten death. Since the intention is comfort care, this is not considered euthanasia and is legal across the country.

Durable Power of Attorney: a document appointing someone to make medical decisions in the event that the individual becomes unable to make those decisions him/herself. Also called health care proxy.

Euthanasia: translated literally as "good death," euthanasia refers to the act of painlessly but deliberately causing the death of another who is suffering from an incurable, painful disease or condition. It is commonly thought of as lethal injection and it is often referred to as mercy killing. All forms of euathanasia are illegal throughout the U.S.

-Active/Passive Euthanasia: these terms indicate whether the treatment resulting in death was administered or withheld. In "active euthanasia," death is hastened by the treatment given to a patient. In "passive euthanasia," it is treatments that are withheld or withdrawn that hasten death.

-Involuntary/Voluntary Euthanasia: refer to whether or not euthanasia is intended by the patient. "Voluntary" indicates the person has consented; "involuntary" indicates the person has not consented.

Futile Measures: a general term often used in the medical care of seriously ill patients who are typically terminal ill, to describe interventions that will have little effect on outcome or prognosis.

Guardian Ad Litem: an individual appointed by a court to represent the interests of a minor or incompetent / impaired person in a legal proceeding.

Hospice: an organization offering comfort care for the dying when medical treatment is no longer expected to cure the disease or prolong life. The term may also apply to an insurance benefit that pays the costs of comfort care (usually at home) for patients with a prognosis of six months or less.

Life-Sustaining Treatment: any treatment that, if discontinued, would result in death. This includes technological interventions such as dialysis and ventilators and also simple treatments such as feeding tubes and antibiotics.

Living Will: a type of advance directive that contains instructions about future medical treatment in the event a person cannot communicate his or her wishes later. State law may govern a living will's effective date and the treatments it may cover.

Minimally Conscious: this state was described in the February 12, 2002, edition of Neurology and is qualitatively distinct from coma and vegetative states; People in this state are impaired, but have some capabilities. They may reach for and grasp things, track moving objects, locate sounds, process and respond to words. Patients may inconsistently verbalize or gesture to communicate. Patients may gain full consciousness but this state also exists as a permanent outcome.

Palliative Care: treatment for the dying that focuses on relieving pain and discomfort rather than on fighting disease. See also comfort care.

Patient Self-Determination Act: a 1991 federal law requiring health care facilities that receive Medicare and Medicaid funds to inform patients of their right to execute advance directives concerning their end-of-life care.

Persistent Vegetative State: Some people in comas lapse into a persistent vegetative state. The NINDS says: "Individuals in such a state have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function and normal sleep patterns. Even though those in a persistent vegetative state lose their higher brain functions, other key functions such as breathing and circulation remain relatively intact. Spontaneous movements may occur, and the eyes may open in response to external stimuli. They may even occasionally grimace, cry or laugh. Although individuals in a persistent vegetative state may appear somewhat normal, they do not speak and they are unable to respond to commands."

Physician Assisted Suicide/Physician Assisted Dying: a physician's response to a request from a mentally competent, terminally ill adult for the means to hasten death at a time of the patient's choosing. This takes the form of a prescription for lethal medication that the patient may obtain and self-administer. Within the United States, it is legal only in Oregon.

Refusal of Treatment: Mentally competent adults may refuse life-sustaining treatments such as a ventilator or feeding tube. See withholding/withdrawing treatment.

Surrogate Decision Making: a procedure allowing family members to make decisions about medical care in accordance to the wishes of the patient if they are known. If the patient's wishes are not known, the decisions are made in the patient's "best interests."

Terminal Sedation: a coma-like state induced when symptoms such as pain, nausea, breathlessness or delirium cannot be controlled while keeping the patient conscious. Patients die after a number of days of the secondary effects of sedation - dehydration or other intervening complications.

Withholding or Withdrawing Treatment: to omit or cease life sustaining treatment, such as a ventilator, feeding tube, or medication that, if used, would prolong the patient's life. This legal act may be upon a patient request, follow an advance directive, or be based on judgment of medical futility.

Email this page to a friend Share on Facebook Share on StumbleUpon Print this page