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Advance Directive
An advance directive has two parts:
Living Will
A legally binding document, stating your requests for medical treatment at the end of your life. This document is only used in the instance you cannot make your wishes known yourself.
Health Care Proxy
A person, appointed by you, who will make health care decisions on your behalf if you are unable to make those decisions yourself. These decisions include:
Choices about medical care (tests, treatments, surgeries)
Requesting or Declining life-support treatments
Pain management choices
The right to admit you to treatment facilities
The right to apply for Medicare or Medicaid, or other programs, on your behalf
A health care proxy is also known as a Health Care Power of Attorney, a Medical Power of Attorney, a Health Care Agent, or an Authorized Representative.
Conservator
A person who'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.
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
A protective legal process in which the court may appoint a person called a Conservator.
Continuum of Care
A concept involving a system that guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity of care. The continuum of care covers the delivery of healthcare over a period of time, and may refer to care provided from birth to end-of-life.
Declarant
An individual who executes an advance health care directive.
Delaware Medical Orders for Scope of Treatment (DMOST)
A document signed by both a patient or their representative and the patient’s health care practitioner stating the patient’s wishes for medical treatment at the end of their life. This is different to an advance directive because:
It is available for patients with approximately one year to live
It is a document based on a conversation between the patient and their medical practitioner
It becomes medical orders after being signed by the medical practitioner
It travels with the patient through all aspects of the health care field.
In other states this form is called the Physician Order for Life Sustaining Treatment (POLST). Go to polst.org to learn more about the National POLST Paradigm.
Do Not Hospitalize Orders (DNH)
Medical orders, signed by a physician, nurse practitioner or physician assistant, to instruct health care providers not to transfer a patient from a setting such as a nursing facility (or the patient’s home) to the hospital unless needed for comfort.
Do Not Intubate Orders (DNI)
Medical orders, signed by a physician, nurse practitioner, or physician assistant, that instruct health care providers not to attempt intubation or artificial ventilation in the event of respiratory distress.
Do Not Resuscitate Orders (DNR)
Medical orders, signed by a physician, nurse practitioner, or physician assistant, that instruct health care providers not to attempt cardiopulmonary resuscitation (CPR) in the event of cardiac and respiratory arrest.
Durable Financial Power of Attorney
A legal document in which you appoint a person you trust, called an attorney, to manage your money, property, and business matters if in the future you become disabled or incapacitated and are unable to manage your financial affairs yourself. A durable power of attorney is usually created with the help of an attorney. A durable power of attorney can avoid the need for conservatorship.
Electronic Record
A longitudinal record of patient health information generated by one or more encounters in any care delivery setting.
Emergency Medical Services (EMS) Provider
Individual providers certified by the Delaware State Fire Commission or the Office of Emergency Medical Services, within the Division of Public Health, Department of Health and Social Services, or emergency certified medical dispatchers by the National Academy of Emergency Medical Dispatch.
Emergency Medical Services (EMS) Provider Agency
A provider agency certified by the Delaware State Fire Prevention Commission or the Office of Emergency Medical Services, or an emergency medical dispatch center under contract with the Department of Public Safety.
EMS Prehospital Advance Care Directive Order (PACD)
An advance health care directive signed by the individual’s physician on forms approved by the Director of the Division of Public Health. PACD is replaced by DMOST.
End-of-Life Decisions
Decisions that require a range of questions including palliative care, patient's right to self determination, medical experimentation, and ethics. These decisions don’t refer only to patients in the final hours or days of their lives, but more broadly care of all those with a terminal illness or terminal disease condition that has become advanced, progressive and incurable. Ideally, end-of-life decisions respect the person’s values and wishes while maintaining their comfort and dignity.
Equity
The highest level of health for all people; this refers to efforts made to ensure that all people have full and equal access to opportunities that enable them to lead healthy lives.
Guardian
A judicially appointed guardian or conservator having authority to make health care decisions for an individual.
Health Care
Any care, treatment, service or procedure to maintain, diagnose or otherwise affect an individual’s physical or mental condition.
Health Care Decision
A decision made by an individual or the individual’s agent, surrogate or guardian regarding the individual’s health care, including: selection and discharge of health care providers and institutions; acceptance or refusal of diagnostic tests, surgical procedures, programs of medication resuscitation; and directions to provide, withhold or withdraw artificial nutrition and hydration and all other forms of health care.
Health Care Institution
An institution, facility or agency licensed, certified or otherwise authorized or permitted by law to provide health care in the ordinary course of business or practice of profession.
Health Care Proxy
A legal document in which you appoint a trusted person, called a Health Care Agent, to make health care decisions on your behalf if you become unable to make effective health care decisions for yourself.
Hospice
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. 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. (HCM) In US, hospice is both philosophy of care and a Medicare benefit with clear requirements.
Individual Instruction
An individual’s direction concerning a health-care decision for that individual.
Life-Sustaining Procedure or Life-Sustaining Treatment
Any medical procedure, treatment, or intervention that:
utilizes mechanical or other artificial means to sustain, restore, or supplant a spontaneous vital function
is of such a nature as to afford an individual no reasonable expectation of recovery from a terminal condition or permanent unconsciousness.
Procedures that can include, but are not limited to, assisted ventilation, renal dialysis, surgical procedures, blood transfusions, and the administration of drugs, antibiotics, and artificial nutrition and hydration.
Living Will
A personal document or statement in which a person specifies future medical treatments in the event of incapacity, usually at end-of-life or if one becomes permanently unconscious, in a persistent vegetative state or “beyond reasonable hope of recovery.”
Mechanical Ventilation
In the healthcare setting or home, helps patients breathe by assisting the inhalation of oxygen into the lungs and the exhalation of carbon dioxide. Depending on the patient’s condition, mechanical ventilation can help support or completely control breathing.
Medical Orders for Life-Sustaining Treatment (MOLST)
A specific order set for scope of medical treatment and provided on the MOLST form approved by the Division of Public Health. For State of DE it is a DMOST form. POLST and MOLST are designations for similar forms in other states.
Medically Ineffective Treatment
A medical treatment or procedure that, to a reasonable degree of medical certainty, will not:
prevent or reduce the deterioration of the health of an individual
or prevent the impending death of an individual.
Palliative Care
According to the Center to Advance Palliative Care, “palliative care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a specially-trained team of doctors, nurses, social workers, chaplains, and other specialists who work together with a patient’s other doctors to provide an extra layer of support. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.” Go to caringinfo.org to learn more about palliative care.
Patient Self-Determination Act of 1991
This legislation required many hospitals, nursing homes, home health agencies, hospice providers, health maintenance organizations (HMOs), and other health care institutions to provide information about advance health care directives to adult patients upon their admission to the healthcare facility.
Permanent Unconsciousness
A medical condition that has existed for at least 4 weeks and that has been diagnosed in accordance with currently accepted medical standards and with reasonable medical certainty as total and irreversible loss of consciousness and capacity for interaction with the environment. The term includes, without limitation, a persistent vegetative state or irreversible coma. This condition must be certified in writing in the patient’s medical record by the attending physician and by at least 1 other physician who shall be a board-certified neurologist and/or neurosurgeon.
Personal Directive
A personal document or statement in which you give your health care agent information and instructions about your values, preferences, and choices for future medical care. A personal directive can be a personal letter or memo, and is also commonly known as an advance care directive, a living will, or medical directive. A personal directive is not legally binding but offers your health care agent essential information about the kind of care you want if you become incapacitated.
Physician
An individual licensed to practice medicine under Chapter 17 of Title 24 of the Delaware Code.
Power of Attorney for Health Care
The designation of an agent to make health care decisions for the individual granting the power.
Prehospital Advanced Care Directive (PACD)
An EMS prehospital advanced care directive signed by the individual and the individual’s physician, on forms approved by the Director of Public Health.
Primary Physician or Attending Physician
A physician designated by an individual or the individual’s agent, surrogate, or guardian to have primary responsibility for the individual’s health care, or in the absence of a designation, or if the designated physician is not reasonably available, a physician who undertakes the responsibility for the individual’s health care.
Supervising Health Care Provider or Health Care Provider
The primary physician, or if there is no primary physician or the primary physician is not reasonably available, the health care provider who has undertaken primary responsibility for an individual’s health care.
Surrogate
An adult individual or individuals who
have capacity
are reasonably available
are willing to make health care decisions, including decisions to initiate, refuse to initiate, continue or discontinue the use of a life sustaining procedure on behalf of a patient who lacks capacity
are identified by the attending physician in accordance with 16 Del §2507 as the person or persons who are to make those decisions.
Terminal Condition
Any disease, illness or condition sustained by any human being for which there is no reasonable medical expectation of recovery and which, as a medical probability will result in the death of such human being regardless of the use or discontinuance of medical treatment implemented for the purpose of sustaining life or the life processes.
Withholding or Withdrawing Treatment
To stop life-sustaining treatments or discontinuing them after they have been used for a certain period. This is generally done when treatments are no longer helping to improve a patient’s health, or the treatment is causing more symptoms.
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