Definitions


Advanced Care Planning (ACP) 
“Issues relating to death and dying are commonly avoided until late in the illness, when suffering is common and patients no longer are competent to make their own decisions” (Davidson, 2007).  Effective ACP facilitation involves advocating for advance directives; initiation of conversations about ACP with all adults who need to plan; skillful facilitation with each individual; ensuring ACPs are clear and specific to each person; ensuring plans are available when needed; and following plans in a thoughtful and respectful way (Hammes, 2006).

Advance Directive:

A set of instructions, usually written, that allows you to specify the kind of treatment you would want if, in the future, you were very ill and unable to make decisions. Both the "living will" and the "durable healthcare power of attorney" are advance directives, and it is recommended people complete both.

Artificial Nutrition and Hydration:

  • A variety of therapies meant to prevent dehydration or malnutrition in a patient who cannot swallow. Most commonly this involves:
  • Intravenous (IV) therapy -fluids and medications go directly into the patients' blood stream.
  • Total Perental Nutrition (TPN) - nutrients are administered directly into the patients' bloodstream.
  • Naso-gastric (NG) tube feedings - liquid nutrition is administered through a tube placed in the patient's stomach through the nose.
  • Feeding tube (G-tube) - liquid nutrition is administered through a tube surgically placed in a patient's stomach.

Cardiopulmonary Resuscitation (CPR):
Procedures used when a person's heart stops beating or they stop breathing. It can include mouth-to-mouth breathing, chest compressions, electric shock, and drugs to stimulate the heart.

"Do Not Intubate Order" (DNI):

A physician's order to not pass a tube into a patient's windpipe to facilitate breathing. Intubation includes use of a ventilator.

"Do Not Resuscitate Order" (DNR) or "Do Not Attempt Resuscitation" (DNAR):

A physician's order dictating that you do not want to be resuscitated if your heart AND breathing stop. Also called "no code."

Durable Power Of Attorney:

A written authorization for someone, usually called an agent, to act on your behalf if you become incapacitated and are unable to make decisions for yourself.

Ethics Committee or Ethics Consult:
A group or individual that offers an opinion on cases in which providers, family members, and clients disagree about the best course of action.

Futile Care:

Treatment or therapy that will not cure the patient or increase his/her comfort, but will only prolong the vegetative or dying state. This treatment should be stopped as soon as its futility is realized. Also referred to as Medical Futility.

General Power of Attorney:
A document that grants broad power to an agent to carry out actions on your behalf. However, the power to make health care decisions is not presumed but must be specified in the document.

Health Care Power of Attorney:
A document that grants power to an agent to make medical decisions for you. A "durable" health care power of attorney allows the agent to continue to make medical decisions on your behalf if you become incapacitated. Ideally, the agent should know your wishes and agree to carry them out.

Hospice Care
Hospice care is similar to palliative care in that the goals are to alleviate symptoms and improve quality of life. In contrast to palliative care, however, hospice is appropriate when there is a life expectancy of six months or less. It is important to note that a life expectancy is never “by the book”. Some patients with a life expectancy of six months will live much longer and some will die much sooner than expected. It is generally accepted that the sooner a patient can access hospice services, the more they will benefit from the care received.

A patient is ready for hospice when they have decided to pursue treatments meant only to promote comfort, not cure the illness. Those treatments may include medications to relieve pain, nausea, shortness of breath, loss of appetite, muscle cramps, itching, hiccups, and many more. The mission of hospice is to affirm life and view death as a natural process. Hospice is not designed to hasten death or “help” someone die, but rather to help patients live the remainder of their lives as fully as possible. Hospice services are covered by Medicare and other private insurers.

Living Will:
A document regarding your wishes for medical treatment when you are in imminent danger of dying, including artificial nutrition and hydration. This is one part of the advance directive explained above.

Palliative Care:
Palliative care is specialized medical care for people with serious illnesses. This type of care is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness - whatever the diagnosis. 
 
The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, and other specialists who work with a patient's other doctors to provide an extra layer of support. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment. Definition in 2011 by the Center to Advance Palliative Care (CAPC)

Proxy:
An individual who has been granted the authority or power to act on another's behalf. Also known as an agent.

Ventilator:
A machine that helps a patient to breathe. It can be used temporarily until a person can breathe without assistance or as a permanent breathing aide.