A legal document in which people state their wishes regarding medical treatment and preferences in case they are incapacitated. Advance directives include living wills, health care directives, and medical power of attorney. In Minnesota an advance directive is referred to as a health care directive. The person appointed to make decisions in case of incapacitation is called the health care agent.

A thoughtful family-based discussion about care wishes and goals as someone faces end of life decision-making. The goals of advance care planning are three-fold:

• To elicit clear understanding of the kind of care a person facing a life-threatening or life-limiting illness would want

• To determine who would speak for that person if he were unable to speak for himself (health care agent)

• To complete a written health care directive

Refers to a group of treatments used when a person’s heart stops beating or a person stops breathing. It can include any of the following: mouth-to-mouth breathing, chest compressions (pressing on the chest to push blood through the heart), electric shock, (paddles), and drugs used to stimulate the heart.

Care that relieves pain and suffering and controls debilitating symptoms but does not prevent dying. This includes:

• Administration of medications or other treatments such as radiation to relieve pain

• Administration of medications for anxiety, constipation, breathing difficulty and other symptoms

• Provision of personal care such as bathing and turning

• Provision of emotional and spiritual support to the dying person, family and friends

• Administration of other treatments that enhance comfort

The ability to understand the significant benefits, risks, and alternatives to proposed health care and to make and communicate a health care decision.

A physician’s order not to pass a tube into a patient’s windpipe to facilitate breathing. Intubation includes use of an artificial breathing machine called a ventilator.

Also called "no code," a DNR is a physician’s order to not attempt to restart a failed heartbeat or to apply cardiopulmonary resuscitation (CPR) to restore normal breathing.

See advance directive.

Health Care Agent/Proxy

The person designated in a health care directive to make decisions for a patient if the patient lacks decision-making capacity.

A philosophy of care for people who are dying that emphasizes comfort over cure. Hospice care is available in a wide variety of settings including the home, hospitals, nursing homes, and residential hospices. Hospice care is provided by an interdisciplinary team of health care professionals who:

• Attend to the physical, emotional and spiritual needs of the patient and family

• Have expertise in pain and symptom management

• Follow up with grief support services for the family

A special benefit under Medicare Part A that covers hospice services. Criteria for hospice admission include:

• A terminal illness with a prognosis of six months or less as certified by a physician

• Patient consent to pursue a "hospice philosophy of care" that includes a focus on comfort rather than either cure or prolonging life

The hospice Medicare benefit includes:

• Interdisciplinary team support from nurses, social workers, chaplains, volunteers, home health aides and therapists

• Coverage for all prescriptions and treatments related to the terminal illness. In patient respite care

• Medical equipment to maintain patient comfort such as oxygen or a hospital bed

• 24 hour hospice on-call service

• Bereavement follow-up for the family

See advance directive.

Another name for a health care agent. A medical power of attorney has authority to make medical decisions. This is not the same as a power of attorney for property or financial matters.

Care focused on relieving symptoms rather than curing a disease. Like hospice care, it addresses the physical, emotional and spiritual needs of a patient and family.

An illness or condition that is incurable and irreversible. When a person is diagnosed as terminally ill, death is expected in a relatively short period of time.

A machine that helps a patient breathe. Sometimes it is used temporarily until a person can breathe without assistance and other times it is a permanent breathing aide.