Common Terms & Definitions
An ongoing process that enables adults of any age or stage of health to make plans for their future health care. The process helps the individual reflect on and understand their personal wishes, values, goals, and treatment and care preferences, make decisions based on that understanding, and then share that information with family and healthcare providers who may be making those decisions on their behalf should they not be able to make them for themselves. The process may also include documenting those decisions in a legal document, such as an Advance Directive, Healthcare Power of Attorney and Living Will.
a general term referring to a written document directing future medical treatment and care in the event that a person loses the capacity to make or communicate for themselves. Some examples of advance directives are a healthcare power of attorney, a living will, and POLST and DNR forms.
also known as a proxy, surrogate, or attorney-in-fact, a person who is designated by another person, the principal, as their agent and legally authorized to act on that person’s behalf.
a medical treatment that supplements or replaces ordinary eating and drinking by providing a chemical mix of nutrients and fluids to the body through a tube, either into a vein (parenteral) or directly into the digestive tract (enteral).
see Medical Aid in Dying
a complete examination of the body after death by a doctor to determine the cause of death.
the right or condition of self-government, the capacity to make an informed, uncoerced decision; the exercise of self-determination and choice among alternatives, based on an individual’s values and beliefs.
in the context of an agent making decisions on behalf of a principal, a standard for decision-making based on what the agent believes to be “best” for the principal after weighing the principal’s wishes and values, stated directives, if any, and doing a comprehensive risk benefit analysis of possible outcomes
when a person has the ability to understand the matter, the associated risks and benefits of available options, and can make and communicate the decision for themself, they are determined to have capacity. If they are unable to make or communicate decisions for themself, they are determined to be incapacitated. Incapacity is generally used for medical decision-making whereas incompetency is a legal determination made by a court of law.
a person who provides physical and emotional support to someone who needs assistance. Generally care-givers are family or friends, but may also sometimes be professional care-givers, such as home healthcare aides.
a course of therapy during which a patient’s needs for comfort care and symptom relief is managed comprehensively and seamlessly. Hospice and palliative care professionals provide a continuum of care to patients with serious and terminal illness, and those at the end of life.
a state of unconsciousness where a person is alive but unable to communicate or respond to their environment. Comas may be temporary or permanent, as in a permanent vegetative state.
medical care provided with the primary goal of making a person as comfortable as possible at the end of life by relieving pain and other symptoms. Care is not focused on curing or prolonging life.
a person who has the ability to understand and engage in certain matters such as entering into a contract, or financial transactions, they are considered to be legally competent. If they are unable to understand the matter, they will be considered legally incompetent and any contract or transaction they enter into may be null and void. Incompetence is a legal determination made by a court of law.
medical procedures that attempt to restart the heartbeat and/or breathing of a patient who has no heartbeat or who has stopped breathing. Procedures may include intubation (insertion of a breathing tube), mouth-to-mouth or other mechanically assisted breathing, administration of drugs to stimulate the heart, and defibrillation (electric shock to the heart). While CPR is a life-saving measure for healthy people, it can be less effective and even harmful to people who have serious, chronic or terminal illness.
a person who is trained to guide and care for a person who is transitioning to death. The doula provides emotional, spiritual and physical support to everyone involved in the patient’s care during the death process. Their goal is to enable a dying experience that honors who the patient is and has been in their life, and help them live their best life up to their final breath.
refers to an individuals’ ability to make and communicate meaningful decisions about whether or not to participate in a matter. Generally, this includes understanding of the matter, appreciation of the potential risks and benefits, the ability to reason regarding the risks and benefits, and the ability to express a choice about whether or not to participate. Decision-making capacity should not be confused with competence. Incompetence is a legal determination made by a court of law. For example, a person who is legally judged unable to handle their financial affairs may still have decision-making capacity in other matters, such as healthcare.
a decline in mental and cognitive function that is more significant than is expected with the normal aging process.
the final disposal of a deceased personals body, whether by burial, cremation or any other means.
a medical order signed by a physician, nurse practitioner, or physician assistant that instructs healthcare providers not to transfer a patient from any setting they may be in to a hospital, unless required for comfort care.
a medical order signed by a physician to reflect a person’s wish to reject a breathing tube at the end of life.
also known as “No Code,” a medical order signed by a physician indicating that the person does not want CPR or other measures to restore breathing and normal heart rhythms. In a DNR situation, a patient is provided comfort care. If a DNR order is not in place, medical personnel are legally required to perform CPR. A person can change a DNR and order at any time, and experts urge that such orders are reviewed regularly. The Georgia Department of Public Health provides a DNR form.
a legally binding document allowing a person, the principal, to appoint another as agent to make decisions on behalf of the principal should that person be unable to make or communicate those decisions for themself. The term Durable means that the power will be in effect even the principal becomes incapacitated.
an umbrella term which encompasses various types of future planning, such as advance care planning, legal and financial planning, burial and funeral planning, and legacy planning.
a term used to describe an advanced state or last phase of disease that is now considered terminal or irreversible due to damage to vital organs or tissues.
a estate planning document which can be used to communicate and pass ethical values, experiences, and life lessons to the next generation. It is often used when there are no assets to pass on, but the person wishes to express in writing their legacy and wishes to their loved ones, but it may also be used in conjunction with, or incorporated into a traditional last will and testament.
translated as “good death” it refers to the act of painlessly, but deliberately, causing the death of another who is suffering from an incurable or painful disease, or irreversible coma. It is commonly thought of as lethal injection, and it is sometimes referred to as “mercy killing.” All forms of euthanasia are illegal in the United States.
- Active Euthanasia – the deliberate action of a medical professional or lay person to hasten someone’s death.
- Passive Euthanasia: a patient’s death due to actions not taken by a medical professional or layperson—actions that would normally keep the patient alive.
- Voluntary Euthanasia: occurs by request of the dying person.
- Non-Voluntary Euthanasia: when a patient is unconscious or otherwise mentally unable to make a meaningful choice between living and dying, and a legal surrogate makes the decision on the patient’s behalf.
- Involuntary Euthanasia: a patient’s death is hastened without the patient’s consent. While viewed as murder, there are some instances in which the death may be viewed as a “mercy killing.”
a person named to carry out the instructions on a Last Will and Testament.
see General Durable Power of Attorney
medical care of patients that will have little or no effect on the patient’s outcome or prognosis, serving no useful purpose, measures that cannot save or prolong life.
a legal document which allows a person, the principal, to name another, an agent, to act on the principal’s behalf in matters related to the principal’s business and financial affairs. The agent may be given full or limited powers, the powers may be immediate or springing, meaning conditioned on the occurrence of a specific event or stated dates. This document does not give the agent power to make medical or health decisions for the principal. The Georgia Department of Aging provides the Georgia Statutory Financial Power of Attorney Form
also known as healthcare representative, proxy, or attorney-in-fact, a person designated by the principal in an advance directive to make healthcare decisions for that person should they be unable to communicate for themselves. The healthcare agent, unlike other agencies, has powers which extend beyond death. Healthcare agents may have authority to authorize an autopsy, donate organs, donate the body for medical research, and determine the final disposition of the remains.
a legal document in which a person, the principal, appoints another as agent to make healthcare decisions on behalf of the principal should that person become unable to make or communicate those decisions for themself. Also known as a healthcare proxy, representative, surrogate, or attorney-in-fact.
see Healthcare Agent
a range of supportive services aimed at keeping a person in their home rather than an institution. Services may include nursing, healthcare aides, physical and occupational therapy, nutrition services, social work, case management, adult day care, community clinics, care-giver respite services, and other such home support services.
An organization or institution that provides compassionate comfort care that includes palliative care for terminally ill patients whose prognosis is six months or less to live. Hospice care is modeled on a holistic philosophy of end of life care which involves an integrated team of professionals who address the full spectrum of needs at end of life with the goal of providing comfort care and improving quality of life at end of life. The team usually includes a physician, nurse, social worker, chaplain, and volunteer coordinator. Hospice care supports not only the patient, but also the family and care-givers who are helping the patient through the dying process. Bereavement support is also provided to the family after the patient dies.
a process where a person is given all information relevant to a particular decision, including a risk benefit analysis, and advised to consider the information carefully before making the decision. Often a second opinion from an independent, objective reviewer is also advised. Once the person has reviewed and understood all the information, if they decide to proceed, they sign a statement stating their decision to proceed and giving their consent.
a holistic approach of coordinated care aimed at addressing the full spectrum of a patient and their family’s needs. The team usually includes a medical director, nurse, social worker, home health aide, chaplain, volunteers, and a grief specialist.
also called life-support treatments, medical procedures that replace or support essential bodily functions to keep a person alive, the discontinuation of which would result in death. Examples include CPR, mechanical ventilation, artificial nutrition or hydration, and dialysis.
a type of advance directive, a written, legal document containing instructions about future medical treatment in the event the individual is unable to communicate for themself. Each state has its own regulations concerning the use of living wills. In Georgia, the living will, together with the healthcare power of attorney, have been incorporated into one document, the Georgia Advance Directive for Healthcare.
care in a facility that provides 24 hour supervision for people with complex health needs. Residents of long-term care facilities usually require help with one or more activities of daily living such as eating, bathing and dressing.
also known as assisted dying or assisted death (AD), physician assisted dying (PAD), it is a process which permits mentally competent adult patients with a terminal illness to request a prescription from their physician for life-ending medications. The patient must be able to self-administer and ingest the medication without assistance from another. MAiD is currently legal in 10 states and the District of Columbia, but it is not a legal option in Georgia. Opponents may also refer to this process as assisted suicide, but MAiD laws which have been enacted consider the process of MAiD to be fundamentally distinct from suicide. Under those laws, the death of person who elects to use MAiD will be deemed to have been the cause of their underlying disease and will not be considered a suicide.
This state was described in the February 12, 2002, edition of Neurology as qualitatively distinct from coma and vegetative states. For example, patients who are “minimally conscious” are impaired but have some capabilities, such as the ability to reach for and grasp objects, track moving objects, locate sounds, and process and respond to words. Patients may inconsistently verbalize or gesture to communicate, and patients may regain full consciousness. However, minimal consciousness may also be permanent.
See Medical Aid in Dying
also known as pain management or symptom management, comprehensive care centered on the physical, psycho-social, and spiritual needs of the patient at any state of health with the goal of improving quality of life by focusing on relief from pain and symptoms that interfere with activities of life, including physical and mental stress. Laws on palliative care are state specific, but every person in the US who is in need of palliative care has a legal right to receive it, regardless of whether they are on a curative or comfort care course of treatment. It is appropriate for anyone at any stage of health who is suffering with debilitating symptoms or intractable pain.
a measure of last resort and end of life used to relieve severe and refractory symptoms, or intractable pain. A coma-like state is medically induced by administration of sedative medications in monitored settings. The patient typically dies soon after from the sedation’s secondary effects of dehydration, or from other intervening complications.
a federal law passed in 1990 requiring healthcare facilities which receive Medicare or Medicaid reimbursement to recognize the authority of a person’s advance directives. Facilities must ask everyone upon admission whether they have advance directives in place, and if not, they are required to provide on and assist in having it completed. They are also required under this law to provide the Patient’s Bill of Rights and information about patients’ rights under their state law.
a medical order, signed by a physician, providing instructions regarding the patient’s treatment preferences, indicates whether a healthcare agent has been appointed and whether the patient has advance directives in place. It is intended for people who have been diagnosed with a terminal illness and are in the last year of their lives. It is valid whether a person is at home or in an institution. POLST laws are state-specific and vary from state to state. Georgia Department of Public Health provides a link to the Georgia POLST form.
a legal document allowing one person, the principal, to authorize another person, the agent, to act in a legal matter on the principal’s behalf. Powers of attorney come in several forms, and the powers given are described in each form. Examples are healthcare power of attorney, and financial (or general) power of attorney. They may be durable, meaning that they cannot be revoked due to the principal’s incapacitation, or temporary, meaning the agent’s power is confined to a specific transaction or set of dates. Powers may also be immediate, upon execution of the document, or springing, becoming effective as of a certain date or the occurrence of some designated event.
also known as Declarant, in an agency relationship, the person who gives authority to another, an agent, to act on their behalf.
any person with decision-making capacity may legally refuse or withdraw from medication, life-sustaining treatments, nutrition, and/or hydration.
short-term relief for primary caregivers, it may be arranged for an afternoon, or for several days or weeks. The patient’s respite stay may be provided in the home, or in a healthcare facility or adult day care center. Hospice offers respite care for caregivers as part of their services.
a person’s ability to make choices and manage their own life; free choice of one’s own acts or states without external coercion or compulsion.
the careful or studied practice of being neutral in a dispute, it often refers to medical organizations’ recognition of and respect for the diversity of members’ personal and religious views and choices, and those of their patients, to encourage open discussion about all end-of-life options.
the intentional taking of one’s own life
also known as an agent, a person legally designated to make decisions for another, the principal, when that person is unable to make or communicate decisions for themselves. The surrogate’s duty is to make decisions in accordance with the principal’s documented instructions, or in the absence of documented instructions, decisions which are in the best interest of the principal.
the process of decision-making by a designated agent on behalf of another, the principal, when that person is unable to make or communicate decisions for themselves.
a fatal illness that has advanced beyond hope for a cure. Generally a diagnosis of terminal illness means that the person has 6 months or less to live.
see Palliative Sedation
a dying patient’s choice to control the manner and timing of their own death through a conscious decision to refuse food and hydration of any kind – natural or artificial – with the goal of hastening their impending death. The patient must have decision-making capacity to choose this option, or have documented instructions in an advance directive for their healthcare agent to exercise this option for them on their behalf. If a patient chooses to exercise this option, it should be in a controlled setting and with full palliative care and support in place.
foregoing or ending life-sustaining treatments, including ventilators, feeding tubes, kidney dialysis, or medication that would otherwise prolong the patient’s life. This legal act may be upon the patient’s request, as the result of an advance directive, or based upon the medical determination of futility.