Advance Health Care Directive (AD) / Definition of Terms
- Advance Health Care Directive: Is a legal document, varying to some extent from state to state, which helps guide patients, families and physicians regarding our values and wishes at the end of life.
- Capable: Able to understand, communicate in some way, and in the opinion of an appropriate doctor, decide with reasonable thought process.
- 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.
- 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.
- 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.
- End of life: There is no agreement about the amount of time in which life can continue, but generally up to 6 months. Life prolongation in these terms may mean life support on a respirator, on dialysis or artificial feeding. “Quality of life” is a separate issue which the patient or proxy evaluates.
- 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.
- 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.
- Ombudsman: A “neutral” advocate appointed usually by a government entity who is expected to protect the interest of the patient vs. the medical care system.
- 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."
- 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.
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