Glossary of Terms for Advance Care Planning

Perhaps you are thinking about a time when you may not be able to make decisions about your own health care. You may have a chronic illness that will one day take away your mental or physical capabilities. You may be about to go in for surgery and want a backup plan if something unexpected happens. You may simply be thinking about your future and trying to protect yourself or your family if any big decisions need to be made without your input.

You may have heard of an advance directive, or living will, and want to put one in place. But, you may be are confused about some of the terms you read. Here is a glossary of some common terms related to advance care planning that may help you understand this concept better.

Common terms

Advance directive

This is a legal document that usually includes 2 parts, your living will and a medical power of attorney. This gives your medical team and family members directions for your care and designates a person to carry those directions out. Every state has different rules about advance directives, so be sure to look up the instructions for your state.

Coma

This is a state of being alive but not being conscious. People in comas cannot move or respond to the people around them. This can be the result of illness or injuries and trauma.

CPR (cardiopulmonary resuscitation)

CPR is a series of procedures that are used when a heart stops beating in order to restart the heart. This can include pushing on the chest, using electric shock, and using drugs to restart the heart and breathing.

DNR/DNI

DNR stands for do not resuscitate and DNI stands for do not intubate. These orders state that if their heart stops beating, or the person is unable to breathe on their own, CPR will not be used to restart the heart (DNR), and a tube will not be used to help with breathing (DNI). These orders are placed in a patient’s chart and must be followed by their medical team. DNR and DNIs can be requested separately or together and can be changed at any time. These orders MUST be signed by a doctor to be valid. There need to be separate orders for hospitals and homes.

Hospice

This is specialized care given at the end stages of a person's life. Hospice care is meant to comfort and not to treat or cure. It is usually reserved for the last few months of someone's care. Hospice care can be delivered at home, or at a hospital, nursing home, or specialized hospice facility. This may be a benefit paid by insurance.

Living will

This is the written portion of an advance directive that states your wishes about your medical care if you are unable to communicate or at the end of life. Again, every state has different rules about living wills, so be sure to look up information specific to your state. Living wills may need to be witnessed and notarized, so think about preparing one sooner than later.

Medical power of attorney

This is the person you trust to make healthcare decisions for you if you are not able to make your own. It is an important part of your advance directive. This person may also be referred to as your healthcare proxy, durable power of attorney, or healthcare agent.

Palliative care

This is care focused on improving quality of life, providing comfort, and dealing with pain management. While palliative care is an important part of hospice, it can be given at any point during a chronic or terminal illness. Palliative care may be given at the same time someone is being treated, in both inpatient and outpatient settings.

PEG (percutaneous endoscopic gastrostomy)

This is a tube that is surgically inserted into the stomach to give food and liquid when a person cannot eat or drink on their own.

Ventilator

This is a machine used to help a patient breathe when they are unable to do so on their own. It works by pushing air into the lungs through a tube inserted into the airway.

Withdrawing or withholding treatment

This is the process of stopping a treatment that is no longer improving a patient’s quality of life. Or, the treatment may be causing more harm than good. Because such treatment may be keeping the person alive, it may need to be written into an advance directive or a doctor's statement that the treatment is no longer helping.