6-STEPS Living Will
Some important definitions
“Advance directive” means…a written instruction, such as a living will or durable power of attorney for health care, recognized under State law (whether statutory or as recognized by the courts of the State), relating to the provision of health care when the individual is incapacitated. Some States also recognize a documented oral instruction.
“Cardiopulmonary resuscitation (CPR)” refers to any medical intervention used to restore circulatory and/or respiratory function that has ceased. It is important to now that CPR is effective in healthier patients, with a declining likelihood of success as patients age and become sicker. In addition, when it does succeed, if heartbeat is not restored quickly, brain function can be seriously compromised making it possible for a patient to have a beating heart but a dead brain.
“Do not resuscitate”(DNR) is a legal order written either in the hospital or on a legal form to withhold (CPR) or Advanced Cardiac Life Support (ACLS), in respect of the wishes of a patient whose heart stopped beating or who stopped breathing. Since the term has negative connotations, some settings have replaced them with “Allow Natural Death” (AND) orders.
“Durable Power of Attorney for Health Care” (a.k.a .“Medical Power of Attorney”) is a document delegating to an agent the authority to make health care decisions in case the individual delegating that authority subsequently becomes incapable of doing so.
“Health care decision-making” refers to consent, refusal to consent, or withdrawal of consent to health care, treatment, service, or a procedure to maintain, diagnose, or treat an individual’s physical or mental condition.
Hospice care is a type of care and philosophy of care that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient's pain and symptoms, and attending to their emotional and spiritual needs. It is a broad-based intervention that address the physical, psychological, and spiritual needs of patients and their families. It can be started in hospitals and extended patients in specialized hospice facilities, nursing homes, or patients’ own homes. To be covered by Medicare, the patient must be deemed to be within six months of death.
“Life-sustaining treatment” is treatment that, based on reasonable medical judgment, sustains an individual’s life and without which the individual will die. The term includes both life-sustaining medications and interventions such as mechanical ventilation, kidney dialysis, and artificial hydration and nutrition. The term does not include the administration of pain medication or other pain management interventions, the performance of a medical procedure related to enhancing comfort, or any other medical care provided to alleviate a resident’s pain.
“Legal representative” (e.g., “Agent,” “Attorney in fact,” “Proxy,” “Substitute decision-maker,” “Surrogate decision-maker”) is a person designated and authorized by an advance directive or by State law to make a treatment decision for another person in the event the other person becomes unable to make necessary health care decisions.
Palliative Care is specialized patient- and family-centered medical care that optimizes quality of life for people with serious illnesses. It focuses on providing patients with relief from the symptoms and stress of a serious illness. It addresses physical, emotional, intellectual, spiritual, and social needs by providing information and direct services to facilitate informed shared decision making. It can begin in the hospital for patients undergoing full treatment and continue throughout the course of an illness and can extend into hospice- and home-care, often becoming the predominant mode of treatment during the comfort-care only stage.
In-Home health care can range from basic support to highly technical care involving intravenous lines, ventilators, portable diagnostic texts, and remote monitoring. It can be used briefly to foster recovery from acute stages of illnesses or on a prolonged basis to sustain life safely and comfortably outside hospitals. In-home care givers who may have to develop new skills can be assisted by professional services and telemedicine. Resources such as the Program for the All-Inclusive Care of the Elderly (PACE) provide guidance. As with all interventions, it is important to weigh the emotional, physical, and economic advantages and disadvantages of in-home care for patients and care-givers.
“Treatment” refers to intervention provided for purposes of maintaining/ restoring health and well-being, improving functional level, or relieving symptoms.
For more information see: US Department of Health and Human Services, Ref: S&C 13-17 NH, September 27, 2012