With Links to Longer Definitions
Advance Directives
Advance directives are written legal documents by which patients express their wishes about the kind of health care they want to receive in the evnt they become unable to make their own treatment decisions. This usually means if he or she is physically or mentally incapacitated or otherwise unable to makes these desires known. They are designed to allow competent patients the opportunity to guide future health care decisions. Advance directives include living wills and medical powers of attorney, sometimes called durable powers of attorney.
There are usually two types of advanced directives: the Living Will and medical powers of attorney, often called a Durable Power of Attorney for Health Care.
A living will is a legal document that allows people to state in advance their desire to receive, or their desire to withhold, life-support and other life-sustaining procedures when they are permanently unconscious or terminally ill and unable to make informed decisions. It usually permits the withholding or withdrawal of any treatment that might be considered life prolonging or that artificially extends the dying process.
A Durable Power of Attorney for Health Care is a document that allows patients to specify in advance a person to act as their agent, proxy, or surrogate decision-maker to make health-care decisions for them should they become unable to make their own health care decisions.
Durable Powers of Attorney for Health Care are very flexible documents, allowing both the naming of an agent to make decisions for the patient when the patient is unable to do so, and the specification of the treatments that the patient wants or does not want to receive. Unlike the Living Will, the patient does not need to be terminally ill or suffering from an irreversible coma.
See:
Living Will Definition
Advance Directives Questions & Answers
Advance Care Planning Questions & Answers
Termination of Life-Sustaining Treatment Questions & Answers
Assisted suicide
The ending of one's own life by taking a medication knowingly provided by a physician for that purpose. A physician knowingly supplies the means, which usually involves a prescription for a lethal dose of barbiturates (sleeping pills). Some physicians provide other, less-effective, medications, because they feel hesitant to be linked to any prescription that is rigorously controlled in most jurisdications around the world.
See
American Medical Association Physician-assisted suicide
Assisted Suicide Q & A (From S. Jamison: Final Acts of Love)
Assisted Suicide Questions & Answers
Comfort Care
Comfort Care refers to care that is designed to provide comfort and dignity when curative therapy is no longer appropriate. It includes the process of relieving pain and suffering, and controlling debilitating symptoms, while not preventing the patient from dying. Comfort care usually includes administering pain medication along with oral hydration and nutrition, providing hygienic care, and preventing unnecessary complications from occurring. This approach has been comprehensively developed within the hospice movement which provides specialized medical, nursing and support services for terminally ill patients and their families.
See:
Hospice Definition
Definition & History of Hospice & Palliative Care Fact Sheet
Hospice (Adopted from: South Australian VES -- SAVES)
Palliative Care Definition
Decisional Capacity
Refers to the ability of a patient to make a rational choice in his or her own best interest. A person may be diagnosed as mentally incapacitated if he or she cannot make a decision on a matter in question, or if they cannot communicate a decision because they are unconscious. That is, the patient needs to understand the question in its context, the nature of the decision he or she is being asked to answer, and the implications of the answer.
In this regard, decisional capacity is the ability to understand information relevant to a decision and to appreciate the reasonably foreseeable consequences of a decision or lack of decision. Capacity is specific to particular decisions: a person may be capable with respect to deciding about a place of residence, for example, but incapable with respect to deciding about a treatment. In addition, capacity can change over time, in that, a person may be temporarily incapable because of delirium but subsequently recover his or her capacity.
The ethical principles of patient autonomy and respect for persons require that capable people be allowed to make their own informed decisions. However, the ethical principle of physician beneficence requires that incapable people be protected from making decisions that are harmful or that they would not make if they were capable.
The relevant areas of patient capacity specified in the Aid to Capacity Assessment (a commonly used tool to determine decisional capacity) include:
- Ability to understand the medical problem.
- Ability to understand the proposed treatment.
- Ability to understand the alternatives (if any) to the proposed treatment.
- Ability to understand the option of refusing treatment or of it being withheld or withdrawn.
- Ability to appreciate the reasonably foreseeable consequences of accepting the proposed treatment.
- Ability to appreciate the reasonably foreseeable consequences of refusing the proposed treatment.
- Ability to make a decision that is not substantially based on delusions or depression.
Also see
Canadian Medical Association Journal, Bioethics for clinicians
Double Effect
The ethical principle of Double Effect is used to justify medical treatment designed to relieve suffering where death is its unintended (though foreseen) consequence. According to this principle, effects that would be morally wrong if caused intentionally are permissible if foreseen but unintended. This principle is often cited to explain why certain forms of care at the end of life that result in death are morally permissible and others are not.
According to the rule, administering high-dose opioids to treat a terminally ill patient's pain may be acceptable even if the medication causes the patient's death. In contrast, the rule does not authorize practices such as physician-assisted suicide, voluntary euthanasia, and certain instances of forgoing life-sustaining treatment.
The principle of Double Effect comes from "the rule of double effect" developed by Roman Catholic moral theologians in the Middle Ages as a response to situations requiring actions in which it is impossible to avoid all harmful consequences. The rule makes the "intention" of the doctor a crucial factor in judging the moral correctness of the action. This is because Roman Catholic teaching has been that it is never permissible to "intend" the death of an "innocent person". An innocent person is one who has not forfeited the right to life by the way he or she behaves, eg, by threatening or taking the lives of others.
See
Double effect Fact Sheet
"Double Effect" Fact Sheet (Adapted from SAVES -- South Australian Voluntary Euthanasia Society)
Timothy Quill on the Rule of Double Effect
Do Not Resuscitate order (DNR)
See
American Medical Association DNR Orders
British Medical Association Doctors Want Rule Change on Resuscitation
DNR -- Do Not Resuscitate Orders -- Q & A for Patients
DNR -- Do Not Resuscitate Orders -- Q & A for Physicians
Euthanasia
The term euthanasia comes from the Greek "eu" which means "good" and the word "thanatos" which means "death". Today, the term has come to mean the intentional act by a physician to bring about a gentle and easy death of a patient.
It also is used synonomously with the term "voluntary euthanasia" whereby the physician responds to a voluntary request from a competent patient to end his or her life. This is accomplished by the physician administering a lethal dose of medication.
See:
Euthanasia (Helga Kuhse for the Voluntary Euthanasia Society of Victoria, INC.)
(includes the following)
Active and passive euthanasia
Involuntary euthanasia
Non-voluntary euthanasia
Voluntary euthanasia
Euthanasia (adapted from South Australian VES -- SAVES)
The Philosophy of Euthanasia: The Internet Encyclopedia of Philosophy
British Medical Association Policy on Euthanasia
American Medical Association Policy on Euthanasia
"Futility" is a term used in medical care to characterize interventions in seriously ill patients who are often terminal that will have little effect on outcome or prognosis. Typically these include treatments that cannot reasonably be expected to achieve even its physiological objective. In this regard, futility refers to the benefit of a particular intervention for a particular patient. With futility, the central question is "Does the intervention have any reasonable prospect of helping this patient?" Although the ethical requirement to respect patient autonomy entitles a patient to choose from among medically acceptable treatment options (or to reject all options), it does not entitle patients to receive whatever treatments they ask for. Instead, because the goal of medicine is to help the sick, physicians are under no obligation to offer treatments that do not benefit their patients. The obligations of physicians are limited to offering treatments that are consistent with professional standards of care. In this regard, futile interventions are ill advised because they often increase a patient's pain and discomfort in the final days and weeks of life, and can expend finite medical resources.
See
Futility Fact Sheet
Medical Futility Questions & Answers
"Futility" (Link -- University of Washington, School of Medicine, Ethics Curriculum)
Hospice is a non-institutional health care alternative for terminally ill persons. Nearly all hospice care is delivered to a patient in his or her home. When treatment appears futile, many terminally ill patients have chosen to spend their last days at home with the help of a hospice program. Hospice care is more of a treatment philosophy, used by patients when they no longer desire aggressive care for their disease. Hospices do not focus on reversing disease. They emphasize pain treatment and palliative care (alleviating symptoms) through an interdisciplinary team approach comprised of nurses, social workers, physicians, dietitians, home health aides and highly trained volunteers. Hospices provide nursing care, medical equipment such as movable beds or walkers, drugs, social services, and physical therapy. Programs are usually run by home health agencies or visiting nurse associations in consultation with a physician.
See:
Definition & History of Hospice & Palliative Care Fact Sheet
Hospice (Adopted from: South Australian VES -- SAVES)
Palliative Care Definition
Informed Consent
The concept of individual autonomy, the right of an individual to make decisions about one’s life and medical care, is the basic principle underlying patients’ rights. In the United States this principle was articulated as early as 1914 by Justice Cardozo in a landmark decision: "Every human being of adult years and sound mind has a right to determine what shall be done with his own body." The doctrine of informed consent has since evolved to guide medical decision-making by:
The principle of informed consent requires a physician to provide information about a patient’s medical condition and treatment options enabling the patient to make an informed decision as to whether or not to consent to a proposed test or procedure. The physician must consider disclosure of a variety of factors including:
Living Will
A legal document that allows people to state in advance their desire to receive, or their desire to withhold, life-support and other life-sustaining procedures when they are permanently unconscious or terminally ill and unable to make informed decisions. A living will is made in anticipation of the time when they no longer have the capacity to make decisions or to communicate decisions on their own behalf. For example, through a living will you could refuse treatment that would keep you alive, if there is no chance of reasonably recovering from your condition. It usually permits the withholding or withdrawal of any treatment that might be considered life prolonging or that artificially extends the dying process. Laws governing living wills also often require that comfort measures always be provided to such patients.
See: Are Living Wills Followed?
Advance Directive Definition
Mental Incapacity
A person may be diagnosed as mentally incapacitated if they cannot make a decision on a matter in question – they do not understand the nature of the decision and its implications, or if they cannot communicate a decision because they are unconscious.The ethical principles of patient autonomy and respect for persons require that capable people be allowed to make their own informed decisions. However, the ethical principle of physician beneficence requires that incapable people be protected from making decisions that are harmful or that they would not make if they were capable.
see Decisional Capacity Definition