Important Terminology

Advance 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.

Allow Natural Death (AND) – A request to Allow Natural Death is meant to ensure that only comfort measures are provided. By using the AND, physicians and other medical professionals would be acknowledging that the person is dying and that everything that is being done for the patient–including the withdrawal of nutrition and hydration–will allow the dying process to occur as comfortably as possible. While a DNR patient in Intensive Care might be put on a ventilator, given artificial hydration, or have a feeding tube inserted, an AND patient would have all of those things withdrawn, discontinued, or not even started, since such treatments are painful and burdensome for the terminally ill. The AND would prevent this unintentional pain and simply Allow a Natural Death.
Source: Reverend Chuck Meyer – Hospice Patients Alliance –

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.

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.

Do-Not-Resuscitate (DNR) order – A DNR order is 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.
DNR, DNAR (Do Not Attempt Resuscitation) and DNI (Do Not Intubate- opening the airway with a tube) are all instructions for care in cardiac arrest and Cardiopulmonary Resuscitation.

Comfort Measures Only (CMO) – Care that is not focused on “fixing” or curing. Measures are taken to make the patient feel calm comfortable.

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.

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. This term is synonymous with Healthcare Proxy and MDPOA (Medical Durable Power of Attorney).

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.

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 Treatment – Treatments (medical procedures) that replace or support an essential bodily function (may also be called life support treatments). Life-sustaining treatments include cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition and hydration, dialysis, and other treatments.

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 Aid in Dying – Laws in a few states allow physician aided death for those who choose to end their lives rather than suffer due to terminal illness with accompanying intractable symptoms. Also see Voluntary Stopping of Eating and Drinking (VSED).

Medical Power of Attorney (MDPOA) – 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.

MOST Form (Medical Orders for Scope of Treatment) – A physician’s ORDER filled out with the patient, detailing DNR, CPR, DNI status etc. for complex and advanced illnesses, the frail elderly or the terminally ill.

Palliative Care – A comprehensive approach to treating serious illness that focuses on the physical, psychological and 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.

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.

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.

Slow Medicine – Slow medicine urges our health care providers to “slow down” when considering care that may present more harm than good for the elderly. It educates patients and families how to push back against emergency room trips and hospitalizations designed for those with treatable illnesses. The inevitable erosion of advanced age is not cause for presuming immortality and inflicting futile care on our most vulnerable.

Surrogate Decision-making – 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 directive. A majority of states have passed statutes that permit surrogate decision making for people without advance directives.

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.

Voluntary Stopping of Eating and Drinking (VSED) – Legal in all states, decision to stop all intake (including fluids) to allow natural death. For more information visit the website

Withholding or Withdrawing Treatment – Forgoing life-sustaining measures or discontinuing them after they have been used for a certain period of time.

Source: National Hospice and Palliative Care Organization –

In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality and created a new difficulty for mankind: how to die.

Atul Gawande, MD

Author, "Being Mortal"