Advance Healthcare Directive (AHD)

End of Life Management Toolkit #5 | by Team Passare and Y Colaborative

Advance Healthcare Directive Glossary
Advanced care planning: A process that honors one’s life while preparing for possible decisions in the future through a dialogue regarding end-oflife wishes. Typically, advance care planning results in the creation of a healthcare directive document.
Advanced directive: A general term that describes two kinds of legal documents, living wills and medical powers of attorney. These documents allow a person to give instructions about future medical care should he or she be unable to participate in medical decisions due to serious illness or incapacity. Each state regulates the use of advance directives differently.
Artificial nutrition and hydration: Artificial nutrition and hydration supplements or replaces ordinary eating and drinking by giving a chemically balanced mix of nutrients and fluids through a tube placed directly into the stomach, the upper intestine or a vein.
Benefits and Burdens: A commonly used guideline for deciding whether or not to begin or stop medical treatments. A benefit can refer to the successful outcome of a medical procedure or treatment. Outcomes can be medical (e.g., the heart beats again) or functional (e.g., the person is able to walk to the bathroom after being incapacitated by a stroke), or one that supports the patient’s values (e.g., the patient is able to die at home as wished). . Discussions of the benefits and burdens of medical treatments should occur within the framework of the patient’s overall goals for care.
Brain death: The irreversible loss of all brain function. Most states legally define death to include brain death.
Case Law: Law that is based on a judge’s decision in a court case, rather than by legislation
Capacity: In relation to End of Life decision-making, a patient has medical decision making capacity if he or she has the ability to understand the medical problem and the risks and benefits of the available treatment options. The patient’s ability to understand other unrelated concepts is not relevant. The term is frequently used interchangeably with competency but is not the same. Competency is a legal status imposed by the court.
Cardiopulmonary resuscitation: Cardiopulmonary resuscitation (CPR) is a group of treatments used when someone’s heart and/or breathing stops. CPR is used in an attempt to restart the heart and breathing. It may consist only of mouth-to-mouth breathing or it can include pressing on the chest to mimic the heart’s function and cause blood to circulate. Electric shock and drugs also are used frequently to stimulate the heart.
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 physician’s written order instructing healthcare providers not to attempt cardiopulmonary resuscitation (CPR) in case of cardiac or respiratory arrest. A person with a valid DNR order will not be given CPR under these circumstances. Although the DNR order is written at the request of a person or his or her family, it must be signed by a physician to be valid. A non-hospital DNR order is written for individuals who are at home and do not want to receive CPR.
Durable Power of Attorney for Health- Care (or Health Care Proxy): A document in which you appoint someone else to make all medical treatment decisions for you if you can’t make them for yourself. The person you name is called your agent, proxy, representative or surrogate. You can also include instructions for decision-making.
Emergency Medical Services (EMS): A group of governmental and private agencies that provide emergency care, usually to persons outside of healthcare facilities; EMS personnel generally include paramedics, first responders and other ambulance crew
Euthanasia: Based on a term meaning “good death.” It is a term that traditionally has been used to refer to the hastening of a suffering person’s death. “Mercy killing” is another term often used. Voluntary Active Euthanasia involves a physician engaging in an act to cause a patient’s death, such as by giving a lethal injection, with the patient’s full informed consent. Involuntary or Non-voluntary Active Euthanasia refers to an act to end a patient’s life, without that patient’s full informed consent.
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.
Guardian or Conservator: 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.
Healthcare agent: The person named in an advance directive or as permitted under state law to make healthcare decisions on behalf of a person who is no longer able to make medical decisions.
Healthcare 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 healthcare directive. Our What is a Healthcare Directive 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:
Healthcare agent: 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.”
Healthcare surrogate: 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.
Hospice: Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice and palliative care involve a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the person’s needs and wishes. Support is provided to the persons loved ones as well.
Incapacity: The inability to receive and evaluate information effectively or to communicate decisions to such an extent that the patient lacks the capacity to manage his or her health care decisions. A finding of incapacity is made by two physicians or a physician and a licensed psychologist who have personally examined the patient.
Intubation: Refers to “endotracheal intubation” the insertion of a tube through the mouth or nose into the trachea (windpipe) to create and maintain an open airway to assist breathing.
Life-sustaining procedure: Refers to “endotracheal intubation” the insertion of a tube through the mouth or nose into the trachea (windpipe) to create and maintain an open airway to assist breathing.
Living will: A type of advance directive in which an individual documents his or her wishes about medical treatment should he or she be at the end of life and unable to communicate. It may also be called a “directive to physicians”, “healthcare declaration,” or “medical directive.”
Mechanical ventilation: Mechanical ventilation is used to support or replace the function of the lungs. A machine called a ventilator (or respirator) forces air into the lungs. The ventilator is attached to a tube inserted in the nose or mouth and down into the windpipe (or trachea).
Medical power of attorney: A document that allows an individual to appoint someone else to make decisions about his or her medical care if he or she is unable to communicate. This type of advance directive may also be called a healthcare proxy, durable power of attorney for healthcare or appointment of a healthcare agent. The person appointed may be called a healthcare agent, surrogate, attorney-in-fact or proxy.
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.
Palliative care: A comprehensive approach to treating serious illness that focuses on the physical, psychological, spiritual, and existential needs of the patient. Its goal is to achieve the best quality of life available to the patient by relieving suffering, and controlling pain and symptoms.
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.
Physician-Hastened Death Sometimes referred to as Physician-Assisted Suicide A physician supplies the means, usually a prescription for a lethal dose of medication, which a terminally ill individual can use to end his or her own life.
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.
Power of attorney: A legal document allowing one person to act in a legal matter on another’s behalf regarding to financial or real estate transactions.
Principal: The author/writer of a healthcare directive. You are the principal of your healthcare directive, and your mother is the principal of her healthcare directive.
Respiratory arrest: The cessation of breathing - an event in which an individual stops breathing. If breathing is not restored, an individual’s heart eventually will stop beating, resulting in cardiac arrest.
Surrogate decisionmaking: Surrogate decision-making laws allow an individual or group of individuals (usually family members) to make decisions about medical treatments for a patient who has lost decision-making capacity and did not prepare an advance healthcare directive. A majority of states have passed statutes that permit surrogate decision making for patients without advance directives.
Terminal condition: An incurable condition caused by injury or illness that reasonable medical judgment finds would cause death imminently, so that the application of life-sustaining procedures serves only to postpone the moment of death.” Two doctors, one of whom is the patient’s attending physician, must personally examine the patient and certify that the patient’s illness or injury is terminal.
Ventilator: A ventilator, also known as a respirator, is a machine that pushes air into the lungs through a tube placed in the trachea (breathing tube). Ventilators are used when a person cannot breathe on his or her own or cannot breathe effectively enough to provide adequate oxygen to the cells of the body or rid the body of carbon dioxide.
Withholding or withdrawing treatment: Forgoing life-sustaining measures or discontinuing them after they have been used for a certain period of time.
Passare

From birth to death, life is a series of passages.  Passare provides an online service that connects people to trusted End of Life Management experts and resources.  With Passare, you can explore, plan and prepare for End of Life Management, simplifying the process while honoring ensuring the specific needs and wishes of you and your family. Passare gives you control over one of life’s most important passages. 

Y Collaborative 

Y Collaborative provides consulting services that help individuals, families, businesses and organizations to prepare for the expected and unexpected. Renowned for its sensitivity and care, Y Collaborative guides clients through the myriad questions about how to prepare for times when they may not be able to speak for themselves so that they can maintain control of their lives. TM We provide tools and support to have meaningful conversations with family, friends and trusted advisors. We also assist clients to understand and complete Advanced Directives, DNR (Do Not Resuscitate) orders, Medical Powers of Attorney and other important documents so that they maintain control of the decisions made on their behalf. Y Collaborative can help anyone – those who realize that it is valuable now to think about what they want to have happen and those who want to control how they want to be treated in the future – as well as those who don’t want to deal with these issues now.

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