Advance Care Planning - Glossary of Terms

Advance Care Planning – Glossary

A glossary of commonly used acronyms and words for end-of-life planning is offered below as a resource.

A.N.D.            Allow a Natural Death
C.P.R.            Cardiopulmonary Resuscitation
D.N.I.             Do Not Intubate
D.N.A.R.        Do Not Attempt Resuscitation
D.N.R.            Do Not Resuscitate
P.O.L.S.T.      Physician Orders for Life-Sustaining Treatment

 

Advance care planning: a process that honors one’s life while preparing for possible decisions in the future through a dialogue regarding end-of-life wishes. Typically, advance care planning results in the creation of a health care directive document.

Advance directive: a legal document that expresses the principal’s end-of-life wishes. More recently, many states have adopted the term health care directive instead of advance directive. Some use advance health care directive to capture the broadest meaning of the document. The Learning page offers more detail.

Cardipulmonary resuscitation (C.P.R.): procedures and medications to restart or stabilize a person’s heart and breathing. C.P.R. can include chest compressions, electrical stimulation to the heart, and other procedures or medications to restart the heart or maintain its rhythm. It may also include rescue or artificial breathing using intubation (ventilation) to reduce the risk of brain injury due to lack of oxygen.

Decision-making capacity: the ability to understand and make medical decisions for oneself. This is sometimes referred to as competence. Typically, this means the patient must be able to understand information about the treatment decision, use the information rationally, appreciate the consequences, and communicate a decision. The process to determine the patient’s level of competence usually involves evaluation by the attending doctor, and a psychiatrist or licensed psychologist.

Do not intubate (D.N.I.): a written doctor’s order that indicates the patient does not want to receive intubation. This means the patient does not want to have a tube inserted in the airway and attached to a ventilator that mechanically breathes for him.

Do not resuscitate (D.N.R.): a written doctor’s order that indicates the patient does not want to receive resuscitation. This means the patient does not want to have resuscitation attempted if his heart or breathing stops. D.N.R. means the medical team should not attempt C.P.R., intubation, internal or external stimulation of the heart or administer medications to stimulate the heart. Some hospitals use the phrase Do Not Attempt Resuscitation (D.N.A.R.) to emphasize that procedures are an attempt to restart the heart but may not succeed.

Durable healthcare power of attorney: Introduced in the 1980s, this is a document in which the principal appoints the person or people who are authorized to make medical decisions on his or her behalf—if the principal is unable to make or communicate his or her own healthcare wishes. The authority given in this document is limited to healthcare decisions.

Financial power of attorney: a legal document in which the principal appoints a person who is authorized to make financial decisions and complete financial transactions on the principal’s behalf. The authority given in this document is limited to financial matters.

Guardian: a person who has the legal authority to make healthcare decisions and to manage property and financial matters on behalf of another person. A guardian can be appointed by the court in the absence of a healthcare agent.

Healthcare agent: is the person(s) named by the principal in the durable healthcare power of attorney document. A healthcare agent has the legal authority to make healthcare decisions for the principal when he is unable to make or communicate his own wishes for treatment.

Health care directive: is a legal document that expresses the principal’s healthcare wishes. It typically includes the principal’s healthcare instructions and a durable healthcare power of attorney that names the principal’s healthcare agent and alternate agents. Some states use the term advance directive or advance health care directive. The Learning page offers more detail.

Healthcare instructions: Details treatment the principal (writer/author) wants to receive, as well as treatment the principal may want to refuse in a given situation. Healthcare instructions can include a principal’s non-medical wishes and preferences at the end of life, in addition to core medical instructions.

Healthcare proxy: A person who makes medical decisions on behalf of another person. Three types of proxies exist:

  1. A “healthcare agent” is the person named by the principal in the durable healthcare power of attorney document. The healthcare agent has legal authority to make healthcare decisions for the principal. Sometimes this person is simply referred to as the “healthcare power of attorney” since their authority is given in this document. Some states use the phrase “healthcare representative.”
  2. A “healthcare surrogate” is a person who may be asked to make medical decisions in an emergency, when the principal has not written a healthcare power of attorney, or the healthcare agent cannot be reached. A spouse, adult child, sibling, parent, or close friend may be asked to serve as the surrogate. Medical personnel can, by default, serve as the surrogate if no one else is available. This is also called a “designated decision-maker” in some states.
  3. A court may appoint a “guardian” or “conservator” if a healthcare agent has not been authorized, and if an appropriate surrogate is not available. Typically, a guardian or conservator has broader powers, including the ability to manage financial decisions as well as medical decisions.

Life-sustaining procedure: any medical procedure, treatment or intervention that utilizes mechanical or other artificial means to sustain, restore, or supplant a spontaneous vital function. These procedures can include, but are not limited to, assisted ventilation, renal dialysis, surgical procedures, blood transfusions and the administration of drugs, antibiotics and artificial nutrition and hydration.

Living will: In 1969, the concept of a “living will” was introduced as a new type of legal document by Luis Kutner, an Illinois attorney. The living will was intended to record the principal’s wishes for types of healthcare treatment. Early living will forms were designed primarily to reflect the principal’s desire to have treatment withheld or withdrawn if the principal faced an incurable, irreversible disease or condition. Some have broadened in scope.

Medical power of attorney: see Durable Healthcare Power of Attorney

M.O.L.S.T.: Medical Orders for Life-Sustaining Treatment. This is a document written as a doctor’s orders for end-of-life treatment. Note: Various states and/or hospitals also use the acronyms M.O.S.T., P.O.L.S.T. and P.O.S.T.

M.O.S.T: Medical Orders for Scope of Treatment. This is a document written as a doctor’s orders for end-of-life treatment.

Patient Self-Determination Act: Legislation passed by Congress in 1990. This act gives patients the right to facilitate their own healthcare decisions, and to accept or refuse medical treatment of any kind. It requires healthcare delivery systems (hospitals, nursing homes, hospice providers) to:
• Ask each admitted patient if they have a health care directive
• Include a copy of the directive in the patient’s chart, if a copy is provided by the patient
• Offer information about health care directives, including information about the patient’s right to refuse treatment
• Make a health care directive form available
• Explain the hospital’s policy on following a patient’s health care directive.
• Facilitate the transfer a patient to another physician or hospital if the attending physician or hospital is unwilling to adhere to the patient’s health care directive.

P.O.L.S.T.: Physician Orders for Life-Sustaining Treatment. This is a document written as a doctor’s orders for end-of-life treatment.

P.O.S.T.: Physician Orders for Scope of Treatment. This is a document written as a doctor’s orders for end-of-life treatment.

Principal: the author/writer of a health care directive. You are the principal of your health care directive, and your mother is the principal of her health care directive.