Go to Top

GLOSSARY

 

 

GLOSSARY

 

  •  

    A

    Advance care planning:

    Advance care planning is an ongoing shared decision-making process between patients, their families and/or caregivers, and/or health care providers. Different types of advance care planning may be appropriate at different stages of life and illness, but should include the following three components: education, a structured approach to thinking about the choices that patients face and a method of communicating those choices.  Source: Butler M, Ratner E, McCreedy E, Shippee N, Kane RL. Decision Aids for Advance Care Planning: An Overview of the State of the Science. Ann Intern Med. 2014 Jul 29.

    Advance directive:

    An advance directive is a written instruction relating to the provision of future health care when an individual is lacks capacity (see definition below).The term “advance directive” generally refers to three documents: a living will (also known as a health care directive or directive to physicians), a durable power of attorney for health care form (Health Care Agent), and a personal statement of values and goals of care. Other documents can also be included under the umbrella term “advance directive” at an individual’s discretion such as other forms instructions for organ donation and donation of one’s body for educational or scientific purposes. Physician Orders for Life-Sustaining Treatment (POLST) are not advance directives.

    Artificial hydration and artificial nutrition (a.k.a. medically assisted nutrition):

    Artificial hydration and artificial nutrition are medical treatments that supplement or replace ordinary eating and drinking by giving a chemically balanced mix of nutrients and/or fluids through a tube placed directly into the digestive tract (enteral) or through a tube directly into a vein (parenteral). It is administered through a feeding tube, nasogastric tube or a catheter into a large vein.


     C

    Capacity

    Capacity in health care planning usually refers to an adult’s ability to make effective decisions about his or her health care, safety and well-being. Generally speaking, adults have capacity if they can understand the medical diagnosis and prognosis, appreciate the nature of the recommended care and the risks and benefits of each alternative, and use logical reasoning to make a decision. Capacity can vary over time, and illness or medication can affect the person’s capacity. If you are unsure whether a person has capacity to make health care decisions, you can ask a doctor or clinician to make a medical determination.

    Cardiopulmonary resuscitation (CPR):

    Cardiopulmonary resuscitation (CPR) is a set of medical procedures that attempt to restart the heartbeat and breathing of a person who has no heartbeat and has stopped breathing. Such procedures may include the following:

    • Chest compressions to mimic the heart’s functions and cause blood to circulate
    • Inserting an airway into the mouth and throat, or inserting a tube into the windpipe
    • Ventilating artificially, through mouth-to-mouth or other mechanically assisted breathing
    • Using drugs and/or electric shock (defibrillation) to stimulate the heart
    • CPR can be life-saving in certain cases for otherwise healthy people but is much less effective when a person is very frail/elderly or has a serious chronic illness.

     Comfort care/Do not resuscitate

    In Washington, Comfort care/do not resuscitate verification protocols (CC/DNR) are options included on a Physician Orders for Life-Sustaining Treatment (POLST) form (see POLST entry for definition) that direct emergency medical service personnel to make a patient in respiratory or cardiac arrest as comfortable as possible without attempting resuscitative measures.

    Conservator

    A conservator is a person (such as a family member or friend) or entity appointed by the court to manage the money, property and business affairs of a disabled or incapacitated person.

    Conservatorship

    Conservatorship is a protective legal process in which the court may appoint a person called a conservator. A conservator’s role is to marshal and manage the property of an individual who is disabled and who requires a substitute financial decision maker either to prevent the property from being wasted or dissipated, or so that the financial support, care and welfare of the person is effectuated and managed.


     D

    Dementia:

    Dementia is not a specific disease but an overall term that describes a wide range of symptoms and conditions. Dementia is associated with a decline in memory, thinking skills and the ability to communicate to the point that it affects an adult’s ability to perform daily tasks. There are many types of diagnosed dementia conditions such as Alzheimer’s disease, vascular dementia, Lewy body disease, frontotemporal dementia and others. Dementia can be diagnosed at several stages, as early, middle or late stage dementia. The diagnosis alone may not tell you whether an individual has the decision-making capacity to sign an Advance Directive and participate in health care planning. If you are unsure whether a person has the ability to make effective health care decisions, ask a doctor or clinician to make a medical determination.

    Dialysis

    Dialysis is the process of filtering the blood through a machine via two small tubes inserted into the body in order to remove waste products from the body in the way that the kidneys normally do. Dialysis can be done temporarily in order to allow the kidneys time to heal, or it can be done on a longer term basis in order to prolong life.

    Durable power of attorney for health care:

    A durable power of attorney for health care, also known as “durable medical power of attorney,” is considered an advance directive that allows a competent adult to grant other individuals the authority to give informed consent for medical decisions in the event that he or she is unable to express his or her preferences consistent with Washington state law (RCW 11.94.010).  (Source: Washington State Power of Attorney. Chapter 11.94 RCW. http://apps.leg.wa.gov/rcw/default.aspx?cite=11.94) .

    This individual is known as a “health care proxy,” “health care surrogate,” “health care agent,” or “health care power of attorney.” The term “durable” refers to fact the form remains in effect after the individual is no longer able to make medical decisions.


     G

    Guardian

    A guardian is a person (such as a family member or friend) or entity appointed by the court to make some or all personal and health care decisions for an incapacitated person, as ordered by the court.

    Guardianship

    Guardianship is a legal process where the court can appoint a person to be a guardian to safeguard the rights of an incapacitated person and ensure that health care services are provided as needed. A limited guardianship is limits the guardian’s decision making authority to only those areas where the incapacitated person is unable to make effective decisions about his or her safety, health and well-being. The incapacitated person retains the authority to make his or her own decisions in all other areas.


     H

    Health care agent (a.k.a. “health care proxy,” “health care surrogate,” “health care agent” or “health care power of attorney”)

    A health care agent is a trusted person, officially appointed in a durable power of attorney for health care, who speaks on behalf of a person 18 years of age or older who is unable to make or communicate health care decisions. The agent is called upon only if the doctor determines that a patient lacks capacity to make health care decisions. Unless otherwise limited by the person, the agent has all the rights that the patient has with regard to medical decision making, including the rights to refuse treatment, agree to treatment or have treatment withdrawn. A health care agent’s decisions should be made based on the patient’s stated wishes, if known; or if unknown, an interpretation of what the patient would have wanted; or finally, an assessment of the patient’s best interest.

    Health care planning

    Health care planning, as referred to in the Honoring Choices PNW process, involves both:

    • Everyday planning: Making health care decisions with your doctors based on your current health status, and
    • Advance care planning: Creating a written plan about your choices and preferences for future medical care in advance to let others know how to care for you if you are unable to make medical decisions yourself.

    Hospice

    Hospice is a not a place, but rather a philosophy of holistic end-of-life care and a program model for delivering comprehensive palliative care to people who are in the final stages of terminal illness, and to their loved ones, in the home or a home-like setting known as an in-patient hospice. Hospice provides palliative care in the last months of life. It involves a team-oriented approach that is tailored to the specific physical, psychosocial and spiritual needs of the person and includes support to the family during the dying process. Hospice also provides bereavement support after death occurs.


     I

    Incapacitated person

    An incapacitated person is an adult who has a clinically diagnosed medical condition that results in the inability to receive and evaluate information or make or communicate decisions. The incapacitated person is unable to make some or all effective decisions about his or her safety, health and well-being. If a Washington state court determines a person to be incapacitated, and that guardianship is appropriate, the court can appoint a guardian to advocate for and make personal and health care decisions on the person’s behalf as ordered by the court.

    Intellectual disability

    An adult with an intellectual disability is defined as a person with sub-average intellectual functioning existing concurrently with limitations in adaptive skills. The abilities and limitations of a person with an intellectual disability diagnosis can vary widely. The diagnosis alone may not tell you whether an individual has the decision-making capacity to make advance directives and other documents. If you are unsure whether a person has the ability to make effective health care decisions, ask a doctor or clinician to make a medical determination.


     L

    Life-sustaining treatment

    Life-sustaining treatment refers to medical procedures such as cardiopulmonary resuscitation, artificial hydration and artificial nutrition, and artificial ventilation/ breathing and other medical treatments intended to prolong life by supporting an essential function of the body when the body is not able to function on its own.

    Living will (a.k.a. “health care directive” or” directive to physicians”)

    A living will is an advance directive that describes an individual’s health care wishes for the end of life when that individual is unable to communicate those wishes. In Washington state this is known as the “health care directive” or “directive to physicians.” The living will is codified in section 030 of the Washington State Natural Death Act (Chap 70.122 RCW) which states that “Any adult person [may] execute a directive directing the withholding or withdrawal of life-sustaining treatment in a terminal condition or permanent unconscious condition” and is required to be signed by the declarer in the presence of two qualified witnesses. The directive specifies whether the declarer does or does not want to “have artificially provided nutrition and hydration” if the declarer is “diagnosed to be in a terminal condition or in a permanent unconscious condition.” (Source: Washington State Natural Death Act. Chapter 70.122 RCW. http://apps.leg.wa.gov/rcw/default.aspx?cite=70.122)


     P

    Physician Orders for Life-Sustaining Treatment (POLST)

    POLST is a non-hospital medical order meant for individuals with serious illness or frailty, “for whom a health care professional would not be surprised if they died within one year” (Source: About the National POLST Paradigm. POLST Physician Orders for Life-Sustaining Treatment Paradigm. Available: http://www.polst.org/about-the-national-polst-paradigm/. Accessed: June 2014.) The POLST is not a replacement for advance directives such as a living will or durable power of attorney for health care that provide instructions for future treatment. The POLST provides medical orders for current treatment to guide emergency medical personal and in-patient treatment decisions, when available.

    Palliative care

    Palliative care is a comprehensive approach to treating serious illness that focuses on the physical, psychosocial and spiritual needs of the patient. The goal of palliative care is to prevent and relieve suffering and to support the best quality of life for patients and their families through such interventions as managing pain and other uncomfortable symptoms, assisting with difficult decision-making, and providing support, regardless of whether or not a patient chooses to continue curative, aggressive medical treatment.

    Personal values statement

    A personal values statement is a summary of individuals’ values and goals of care relating to their end-of-life wishes. It is a personal story or narrative that helps families, surrogates and health care providers understand patients as people apart from their illness and/or disability. This statement will help to fill in the gaps in health care requests that may occur in living wills/health care directives.


     W

    Washington State Natural Death Act

    The Washington State Natural Death Act, (Chap 70.122 RCW) passed by the Washington State Legislature in 1992, contains an example of a directive to withhold or withdraw life-sustaining treatment, or health care directive. The act “declares that the laws of the state of Washington shall recognize the right of an adult person to make a written directive instructing such person’s physician to withhold or withdraw life-sustaining treatment in the event of a terminal condition or permanent unconscious condition. The legislature also recognizes that a person’s right to control his or her health care may be exercised by an authorized representative who validly holds the person’s durable power of attorney for health care.” (Source: Washington State Natural Death Act. Chapter 70.122 RCW. http://apps.leg.wa.gov/rcw/default.aspx?cite=70.122)

     

  • Advance care planning:

    Advance care planning is an ongoing shared decision-making process between patients, their families and/or caregivers, and/or health care providers. Different types of advance care planning may be appropriate at different stages of life and illness, but should include the following three components: education, a structured approach to thinking about the choices that patients face and a method of communicating those choices.  Source: Butler M, Ratner E, McCreedy E, Shippee N, Kane RL. Decision Aids for Advance Care Planning: An Overview of the State of the Science. Ann Intern Med. 2014 Jul 29.

    Advance directive:

    An advance directive is a written instruction relating to the provision of future health care when an individual is lacks capacity (see definition below).The term “advance directive” generally refers to three documents: a living will (also known as a health care directive or directive to physicians), a durable power of attorney for health care form (Health Care Agent), and a personal statement of values and goals of care. Other documents can also be included under the umbrella term “advance directive” at an individual’s discretion such as other forms instructions for organ donation and donation of one’s body for educational or scientific purposes. Physician Orders for Life-Sustaining Treatment (POLST) are not advance directives.

    Artificial hydration and artificial nutrition (a.k.a. medically assisted nutrition):

    Artificial hydration and artificial nutrition are medical treatments that supplement or replace ordinary eating and drinking by giving a chemically balanced mix of nutrients and/or fluids through a tube placed directly into the digestive tract (enteral) or through a tube directly into a vein (parenteral). It is administered through a feeding tube, nasogastric tube or a catheter into a large vein.

  • Capacity

    Capacity in health care planning usually refers to an adult’s ability to make effective decisions about his or her health care, safety and well-being. Generally speaking, adults have capacity if they can understand the medical diagnosis and prognosis, appreciate the nature of the recommended care and the risks and benefits of each alternative, and use logical reasoning to make a decision. Capacity can vary over time, and illness or medication can affect the person’s capacity. If you are unsure whether a person has capacity to make health care decisions, you can ask a doctor or clinician to make a medical determination.

    Cardiopulmonary resuscitation (CPR):

    Cardiopulmonary resuscitation (CPR) is a set of medical procedures that attempt to restart the heartbeat and breathing of a person who has no heartbeat and has stopped breathing. Such procedures may include the following:

    • Chest compressions to mimic the heart’s functions and cause blood to circulate
    • Inserting an airway into the mouth and throat, or inserting a tube into the windpipe
    • Ventilating artificially, through mouth-to-mouth or other mechanically assisted breathing
    • Using drugs and/or electric shock (defibrillation) to stimulate the heart
    • CPR can be life-saving in certain cases for otherwise healthy people but is much less effective when a person is very frail/elderly or has a serious chronic illness.

     Comfort care/Do not resuscitate

    In Washington, Comfort care/do not resuscitate verification protocols (CC/DNR) are options included on a Physician Orders for Life-Sustaining Treatment (POLST) form (see POLST entry for definition) that direct emergency medical service personnel to make a patient in respiratory or cardiac arrest as comfortable as possible without attempting resuscitative measures.

    Conservator

    A conservator is a person (such as a family member or friend) or entity appointed by the court to manage the money, property and business affairs of a disabled or incapacitated person.

    Conservatorship

    Conservatorship is a protective legal process in which the court may appoint a person called a conservator. A conservator’s role is to marshal and manage the property of an individual who is disabled and who requires a substitute financial decision maker either to prevent the property from being wasted or dissipated, or so that the financial support, care and welfare of the person is effectuated and managed.

  • Dementia:

    Dementia is not a specific disease but an overall term that describes a wide range of symptoms and conditions. Dementia is associated with a decline in memory, thinking skills and the ability to communicate to the point that it affects an adult’s ability to perform daily tasks. There are many types of diagnosed dementia conditions such as Alzheimer’s disease, vascular dementia, Lewy body disease, frontotemporal dementia and others. Dementia can be diagnosed at several stages, as early, middle or late stage dementia. The diagnosis alone may not tell you whether an individual has the decision-making capacity to sign an Advance Directive and participate in health care planning. If you are unsure whether a person has the ability to make effective health care decisions, ask a doctor or clinician to make a medical determination.

    Dialysis

    Dialysis is the process of filtering the blood through a machine via two small tubes inserted into the body in order to remove waste products from the body in the way that the kidneys normally do. Dialysis can be done temporarily in order to allow the kidneys time to heal, or it can be done on a longer term basis in order to prolong life.

    Durable power of attorney for health care:

    A durable power of attorney for health care, also known as “durable medical power of attorney,” is considered an advance directive that allows a competent adult to grant other individuals the authority to give informed consent for medical decisions in the event that he or she is unable to express his or her preferences consistent with Washington state law (RCW 11.94.010).  (Source: Washington State Power of Attorney. Chapter 11.94 RCW. http://apps.leg.wa.gov/rcw/default.aspx?cite=11.94) .

    This individual is known as a “health care proxy,” “health care surrogate,” “health care agent,” or “health care power of attorney.” The term “durable” refers to fact the form remains in effect after the individual is no longer able to make medical decisions.

  • Guardian

    A guardian is a person (such as a family member or friend) or entity appointed by the court to make some or all personal and health care decisions for an incapacitated person, as ordered by the court.

    Guardianship

    Guardianship is a legal process where the court can appoint a person to be a guardian to safeguard the rights of an incapacitated person and ensure that health care services are provided as needed. A limited guardianship is limits the guardian’s decision making authority to only those areas where the incapacitated person is unable to make effective decisions about his or her safety, health and well-being. The incapacitated person retains the authority to make his or her own decisions in all other areas.

  • Health care agent (a.k.a. “health care proxy,” “health care surrogate,” “health care agent” or “health care power of attorney”)

    A health care agent is a trusted person, officially appointed in a durable power of attorney for health care, who speaks on behalf of a person 18 years of age or older who is unable to make or communicate health care decisions. The agent is called upon only if the doctor determines that a patient lacks capacity to make health care decisions. Unless otherwise limited by the person, the agent has all the rights that the patient has with regard to medical decision making, including the rights to refuse treatment, agree to treatment or have treatment withdrawn. A health care agent’s decisions should be made based on the patient’s stated wishes, if known; or if unknown, an interpretation of what the patient would have wanted; or finally, an assessment of the patient’s best interest.

    Health care planning

    Health care planning, as referred to in the Honoring Choices PNW process, involves both:

    • Everyday planning: Making health care decisions with your doctors based on your current health status, and
    • Advance care planning: Creating a written plan about your choices and preferences for future medical care in advance to let others know how to care for you if you are unable to make medical decisions yourself.

    Hospice

    Hospice is a not a place, but rather a philosophy of holistic end-of-life care and a program model for delivering comprehensive palliative care to people who are in the final stages of terminal illness, and to their loved ones, in the home or a home-like setting known as an in-patient hospice. Hospice provides palliative care in the last months of life. It involves a team-oriented approach that is tailored to the specific physical, psychosocial and spiritual needs of the person and includes support to the family during the dying process. Hospice also provides bereavement support after death occurs.

  • Incapacitated person

    An incapacitated person is an adult who has a clinically diagnosed medical condition that results in the inability to receive and evaluate information or make or communicate decisions. The incapacitated person is unable to make some or all effective decisions about his or her safety, health and well-being. If a Washington state court determines a person to be incapacitated, and that guardianship is appropriate, the court can appoint a guardian to advocate for and make personal and health care decisions on the person’s behalf as ordered by the court.

    Intellectual disability

    An adult with an intellectual disability is defined as a person with sub-average intellectual functioning existing concurrently with limitations in adaptive skills. The abilities and limitations of a person with an intellectual disability diagnosis can vary widely. The diagnosis alone may not tell you whether an individual has the decision-making capacity to make advance directives and other documents. If you are unsure whether a person has the ability to make effective health care decisions, ask a doctor or clinician to make a medical determination.

  • Life-sustaining treatment

    Life-sustaining treatment refers to medical procedures such as cardiopulmonary resuscitation, artificial hydration and artificial nutrition, and artificial ventilation/ breathing and other medical treatments intended to prolong life by supporting an essential function of the body when the body is not able to function on its own.

    Living will (a.k.a. “health care directive” or” directive to physicians”)

    A living will is an advance directive that describes an individual’s health care wishes for the end of life when that individual is unable to communicate those wishes. In Washington state this is known as the “health care directive” or “directive to physicians.” The living will is codified in section 030 of the Washington State Natural Death Act (Chap 70.122 RCW) which states that “Any adult person [may] execute a directive directing the withholding or withdrawal of life-sustaining treatment in a terminal condition or permanent unconscious condition” and is required to be signed by the declarer in the presence of two qualified witnesses. The directive specifies whether the declarer does or does not want to “have artificially provided nutrition and hydration” if the declarer is “diagnosed to be in a terminal condition or in a permanent unconscious condition.” (Source: Washington State Natural Death Act. Chapter 70.122 RCW. http://apps.leg.wa.gov/rcw/default.aspx?cite=70.122)

  • Physician Orders for Life-Sustaining Treatment (POLST)

    POLST is a non-hospital medical order meant for individuals with serious illness or frailty, “for whom a health care professional would not be surprised if they died within one year” (Source: About the National POLST Paradigm. POLST Physician Orders for Life-Sustaining Treatment Paradigm. Available: http://www.polst.org/about-the-national-polst-paradigm/. Accessed: June 2014.) The POLST is not a replacement for advance directives such as a living will or durable power of attorney for health care that provide instructions for future treatment. The POLST provides medical orders for current treatment to guide emergency medical personal and in-patient treatment decisions, when available.

    Palliative care

    Palliative care is a comprehensive approach to treating serious illness that focuses on the physical, psychosocial and spiritual needs of the patient. The goal of palliative care is to prevent and relieve suffering and to support the best quality of life for patients and their families through such interventions as managing pain and other uncomfortable symptoms, assisting with difficult decision-making, and providing support, regardless of whether or not a patient chooses to continue curative, aggressive medical treatment.

    Personal values statement

    A personal values statement is a summary of individuals’ values and goals of care relating to their end-of-life wishes. It is a personal story or narrative that helps families, surrogates and health care providers understand patients as people apart from their illness and/or disability. This statement will help to fill in the gaps in health care requests that may occur in living wills/health care directives.

  • Washington State Natural Death Act

    The Washington State Natural Death Act, (Chap 70.122 RCW) passed by the Washington State Legislature in 1992, contains an example of a directive to withhold or withdraw life-sustaining treatment, or health care directive. The act “declares that the laws of the state of Washington shall recognize the right of an adult person to make a written directive instructing such person’s physician to withhold or withdraw life-sustaining treatment in the event of a terminal condition or permanent unconscious condition. The legislature also recognizes that a person’s right to control his or her health care may be exercised by an authorized representative who validly holds the person’s durable power of attorney for health care.” (Source: Washington State Natural Death Act. Chapter 70.122 RCW. http://apps.leg.wa.gov/rcw/default.aspx?cite=70.122)