Advance care planning The process of discussing the type of treatment and care that a patient would or would not wish to receive in the event that he or she loses capacity to decide or are unable to express a preference, for example their preferred place of care and who they would want to be involved in making decisions on their behalf. It seeks to create a record of a patient’s wishes and values, preferences and decisions, to ensure that care is planned and delivered in a way that meets their needs and involves and meets the needs of those close to the patient.
Advance directives These directives pertain to treatment preferences and the designation of a surrogate decision-maker in the event that a person should become unable to make medical decisions on their own behalf. Advance directives generally fall into three categories: living will, durable power of attorney, and health care proxy.
Living will This is a written document that specifies what types of medical treatment are desired. A living will can be very specific or very general. The most common statement in a living will is to the effect that: If I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued. More specific living wills may include information regarding an individual's desire for such services such as analgesia (pain relief), antibiotics, hydration, feeding, and the use of ventilators or cardiopulmonary resuscitation. A Living Will is not legally binding in the state of Michigan. Michigan residents should choose a Durable Power of Attorney for Health Care form to ensure their choices are respected.
Durable power of attorney This is the third type of advance directive. Individuals may draft legal documents providing power of attorney to others in the case of incapacitating medical condition. This person is often referred to as the D.P.O.A. The durable power of attorney allows an individual to make bank transactions, sign Social Security checks, apply for disability, or simply write checks to pay the utility bill while an individual is medically incapacitated.
Health care proxy This is a legal document in which an individual designates another person to make health care decisions if he or she is rendered incapable of making his or her wishes known. The health care proxy has, in essence, the same rights to request or refuse treatment that the individual would have if capable of making and communicating decisions.
Artificial nutrition and hydration Clinically assisted nutrition includes nasogastric feeding (through the nose) and percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) feeding tubes through the abdominal wall. PEG, RIG and nasogastric tube feeding also provide fluids necessary to keep patients hydrated. Clinically assisted hydration includes intravenous or subcutaneous infusion of fluids (use of a ‘drip’), and nasogastric tube feeding or administration of fluid. The term ‘clinically assisted nutrition and hydration’ does not refer to help given to patients to eat or drink, for example spoon feeding.
Best practices A set of guidelines, ethics or ideas that represent the most efficient or prudent course of action. Best practices are often set forth by an authority, such as a governing body or management, depending on the circumstances. While best practices generally dictate the recommended course of action, some situations require that such practices be followed.
Cardiopulmonary resuscitation An emergency procedure that involves breathing for the victim and applying external chest compression to make the heart pump. It can include: breathing into the mouth and pressing on the chest, electrical shock and drugs to try to start the heart, and/or a tube to assist with breathing. Abbreviated CPR, it works best if a person is healthy with no illness and is administered within a few minutes of the heart or lungs ceasing to work. “Success” rate for the chronically ill, older or weak is approximately 17% in a hospital setting and less than 3% in those living in a nursing home.
Comfort care A model of end-of-life care, essentially synonymous with the hospice model, in which focus shifts away from life-sustaining treatment to a concentration upon relief of discomfort. In the context of comfort care, physical, emotional and spiritual needs are all given priority. As opposed to active treatment and care, a decision may be made in a comfort care situation to provide higher doses of pain medication, even if its use may accelerate approaching death.
DNR Abbreviation of ‘Do Not Attempt Cardiopulmonary Resuscitation’. These advance management plans may be called DNAR orders or Allow Natural Death decisions in some healthcare settings.
End stage The last phase in the course of a progressive disease. As in end-stage liver disease, end-stage lung disease, end-stage renal disease, end-stage cancer, etc. The term "end stage" has come to replace "terminal".
Futility of care AKA Non-beneficial Care, it is the belief that in cases where there is no hope for improvement of an incapacitating condition that no course of treatment is called for.
Futile medical intervention AKA Futility care or Terminal care. A medical intervention that does not lead to improvement in the patient’s prognosis, comfort, well-being, or general state of health.
Hospice The word “hospice” is used to describe both an institution providing care for people who are dying and an interdisciplinary model of care that focuses on relieving symptoms and supporting patients and their families at the end-of-life. Hospice care is generally offered to those with a life expectancy of 6 months or less and includes setting aside active and/or life prolonging treatment in favor of pain management and comfort care, with a focus on ensuring the best quality of life possible until the end of life. Hospice includes Palliative care for the incurably ill given in such institutions as hospitals or nursing homes, but also can be given in homes and includes support for those affected by the patient’s illness; patients, family, friends.
Heroic or extraordinary measures Generally understood as emergency interventions normally intended to save life and restore health but seen in the context of impending death as actions that just prolong the dying process. Such measures may include CPR, forced intubation and certain surgeries. These measures themselves cause pain and trauma and are often avoided, by order of the patient and/or attending physician, at the end of life.
Life support A therapy or device designed to preserve someone's life when an essential bodily system is not doing so. Life support may, for example, involve enteric feeding (by a tube), total parenteral nutrition, mechanical ventilation, a pacemaker, defibrillator, heart/lung machine, or dialysis.
Palliative care The holistic care of patients with advanced, progressive, incurable illness, focused on the management of a patient’s pain and other distressing symptoms and the provision of psychological, social and spiritual support to patients and their family. Palliative care is not dependent on diagnosis or prognosis, and can be provided at any stage of a patient’s illness, not only in the last few days of life. The objective is to support patients to live as well as possible until they die with dignity.