Articles

Important Terms to Know

What are advance directives?
Increasingly, end of life issues are gaining public attention. This evolution of awareness has brought with it a whole new vocabulary that often is misunderstood. In order to make informed choices, we need to educate ourselves. Below are some of the terms and their definitions important for you to know.

Patient Self Determination
Enacted into Federal Law in 1990, this refers to the right of competent adults to make their own medical treatment decisions, and includes the right to complete advance directives, saying how and/or by whom decisions should be made in the event a person becomes incapacitated.

Informed Consent
Under state law, this includes the right to be informed of one’s medical condition and prognosis, the risks and benefits associated with a procedure or course of treatment and what alternatives exist.

Advance Directives
Advance directives include living wills and medical powers of attorney and are considered clear and convincing evidence of your preferences and values for end-of-life treatment in the event you are terminally ill and incapacitated.

• Living Will -- This is a legal, written document in which you specify the kinds of life-saving or life-sustaining care and treatment you do or do not wish to receive.
• Health Care Agent -- This is a person you appoint to convey your decisions about withholding or withdrawing life support systems.
• Attorney-In-Fact For Health Care Decisions/Health Care Power of Attorney -- This is someone whom you appoint to make various health care and treatment decisions. These might include decisions regarding the administration of medications, the provision of therapies, admission to a skilled nursing facility or instituting homecare services. It excludes any decisions regarding life or death or withholding or withdrawing life support systems.
  

What are some of the terms I need to know in order make decisions about how I want to be cared for at the end of my life?

Incapacitated
Someone is incapacitated when, in the opinion of the attending physician, he/she is unable to understand the nature and consequence of health care decisions and is unable to communicate an informed decision.

Persistent Vegetative State
When a person is not aware of self or the environment, is unresponsive, unable to eat or drink and the condition is irreversible, he/she is in a Persistent Vegetative State.

Life-saving/Life sustaining Interventions

• Cardiopulmonary Resuscitation (CPR)
  CPR is used when a person’s heart and/or breathing stops. This may include applying force to the chest with the hands, electrical shock to the heart, injection of medications and the use of a mechanical respirator. Upon admission to a medical facility, it is assumed that every patient whose heart stops will receive CPR unless a “do not resuscitate” (DNR) order is present. To resuscitate under these circumstances may represent a violation of person’s right to die with dignity.
• Artificial Hydration and Nutrition
  When a person can no longer take food or fluid by mouth these nutrients can be administered artificially.
  
  - Nasogastric Tube: The tube is inserted through the nose, down the esophagus and into the stomach.
  
  - Gastrostomy Tube: The tube is inserted surgically through the skin into the stomach wall. Liquid nutrition, water and medication are administered through the tube.
  
  - Intravenous (IV) Hydration: Through a needle in the arm, an IV line is inserted through which fluids and medications are received.
  
  Whether to withhold or withdraw artificial nutrition and hydration certainly is one of the most painful decisions one could ever expect to make. The question becomes whether or not the absence of artificial nutrition or hydration causes suffering as a result of starvation and dehydration. Towards the end of life the body requires little or no food. Research has shown that prolonged use of intravenous fluids or artificial nutrition is usually not effective and can even complicate a patient’s care. The medical evidence regarding dehydration in the end stage of a terminal illness indicates that it is a very natural and compassionate way to die. In fact the patient may experience the following benefits:
  
  - Less fluid in the lungs, making breathing easier
  - Less fluid in the throat and therefore less need for suctioning
  - Less pressure around tumors and therefore less pain
  - Less urination and less risk of bedsores