The North Carolina Serious Illness Coalition has created this Glossary to define important terms and concepts related to advance care planning.
Advance care planning is an ongoing process whereyou think about, and then plan for the health care you would want (or not want), if you are unable to make decisions or speak for yourself. This can be influenced by your values, family, culture, and spiritual beliefs. Your health care wishes should reflect what is most important to you.
Advance care planning isn’t just for those who are sick, dying, or elderly, but for all adults. In addition, advanced care planning may have benefit for those under the age of 18, in certain situations. Making your wishes known helps those closest to you, and your health care providers know and be ready to honor your goals and wishes if you become unable to speak for yourself.
The process of advance care planning should be revisited as your goals, wishes, and health status change throughout your life. It is strongly recommended for you to talk about your goals and wishes with those closest to you, as well as your health care providers (i.e. social workers, nurses chaplains, physicians, etc.) and to put your choices in writing, in an advance directive.
- Advance Directive / Advance Health Care Directive: A document that is designed to guide your health care if you have lost the ability, whether temporarily or permanently, to make or communicate your health care choices. Note: All reasonable effort should be made to support other forms of communication (i.e., story or alphabet boards), when speaking is limited or not possible.
- Allow Natural Death (AND): A medical term indicating that care should focus on comfort and pain management and that life-prolonging measures should not be used. Some states use the term ‘Allow Natural Death’ to direct that cardiopulmonary resuscitation (CPR) not be attempted when a person stops breathing and his or her heart stops. North Carolina documents, however, use the term ‘Do Not Resuscitate’ (DNR) for this purpose.
- Antibiotics: Medications given to treat bacterial infections.
- Artificial Nutrition and Hydration: Liquid feedings through a tube in your nose or stomach, or into your vein. These are used when you cannot eat or drink enough on your own. They can be given short-term or long-term, depending on your needs and preferences.
- Blood Transfusions: Blood products given to replace blood lost during surgery or after serious injury. A transfusion can also be done if your body is not making enough blood because of illness.
- Cardiopulmonary Resuscitation (CPR): A series of medical procedures and treatments that can be used when attempting to restart your breathing and heartbeat if those functions have stopped.
- Comfort Measures: Interventions designed to relieve distressing symptoms that can be physical, mental, emotional or spiritual.
- Decision-making Capacity: The ability to make and communicate decisions, including decisions about your health care.
- Do Not Resuscitate Order (DNR): A medical order that directs health care professionals not to attempt cardio-pulmonary resuscitation (CPR) if your heart and breathing stops.
- Durable Power of Attorney: A legal document that names a person you choose to act on your behalf in financial and legal matters and remains valid if you are unable to make or carry out decisions for yourself.
- Guardian of the Person: A person who is appointed in a legal proceeding to make decisions and act on your behalf if you lack decision-making capacity. For more information on Guardianship, visit www.nccourts.gov/guardianship
- Health Care Agent: A person named in a health care power of attorney document with the legal authority to make health care decisions on your behalf, if you are unable to make or communicate those decisions for yourself.
- Health Care Power of Attorney: A legal document that names another person (a Health Care Agent) to make health care decisions on your behalf if you are unable to make or communicate those decisions for yourself. Note that this is a different document from the Durable Power of Attorney.
- Health Care Representative (HCR)/ Legally Authorized Representative (LAR): Person(s) designated by North Carolina law to make health care decisions on your behalf, if you are unable to make those decisions for yourself. (See also, Surrogate/Proxy).
- Hospice Care: An integrated set of health care services that focuses on quality of life when cure is no longer possible. Hospice care provides both patients and their families with medical, emotional, social, and spiritual support that fits with their wishes.
- Intubation / Ventilation: Procedures used to help you breathe if you cannot breathe on your own. Intubation occurs when a tube is placed through your mouth to help move air in and out of your lungs. Ventilation is the use of a machine to pass air through a tube to breathe for you if you cannot breathe on your own.
- Kidney (Renal) Dialysis: A medical procedure to remove waste and toxins from your blood. Dialysis may sustain life when your kidneys have lost the ability to perform their essential functions.
- Life-Sustaining Treatments/Life-Prolonging Measures: Medical procedures used to artificially postpone the moment of death by maintaining essential bodily functions (for example, breathing and heartbeat) when your body cannot perform those functions on its own. These treatments include CPR, intubation, ventilation, dialysis, antibiotics, artificial hydration/nutrition, and more.
- Living Will: A document that you can prepare to express your wishes about medical treatments in specific medical conditions, if you cannot make or communicate your treatment wishes.
- Medical Orders for Scope of Treatment (MOST – Also called POST or POLST): MOST is a set of medical orders completed by a physician, nurse practitioner, or physician assistant that are designed to direct medical care for patients who are seriously ill. The MOST form, recognized in North Carolina includes medical orders regarding CPR, intubation, antibiotics, and feeding tubes.
- Organ, and Tissue Donation: The act of giving or committing to give healthy organs and tissues for transplantation into another person. The decision to donate organs and tissues can be specified in a living will, through designation at the Division or Motor Vehicles, or through: www.donatelife.net. Note: Individuals may want to have a conversation with a trusted health care provider about their specific situation and any concerns about organ/tissue donation. Whatever choice is made, the designation should match the NC Driver’s License and the Health Care Power of Attorney (HCPOA) document.
- Palliative Care: Beneficial at any stage of a serious illness, palliative care is an interdisciplinary care delivery system designed to anticipate, prevent, and manage physical, psychological, social and spiritual suffering to optimize quality of life for patients, their families and caregivers. From: https://www.nationalcoalitionhpc.org/ncp
As defined by the North Carolina Medical Society, palliative care, also known as supportive care, is a patient-centered, whole-person approach that helps improve the quality of life for individuals suffering from serious illness; it also provides needed support to personal caregivers and loves ones.
- Revoke: To discontinue or stop a document by destroying it, writing ‘VOID’ on it or creating a new document. The decision to revoke a living will or health care power of attorney should be communicated to family members and health care providers.
- Serious Illness: A chronic or acute health condition that affects a person’s general health and functioning or is potentially life-threatening.
- Surrogate/Proxy: Person’s designated by North Carolina law to make health care decisions on your behalf, if you are unable to make those decisions for yourself. (See also Health Care Representative (HCR)/Legally Authorized Representative (LAR)).