Home Care & Hospice
Terms to understand about end-of-life care
Advance directive – A general term that describes one or more documents that may include living wills and medical powers of attorney. These documents allow a person to give instructions about future medical care if he or she is 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) – The patient and family request that resuscitation (CPR) attempts will not be performed if cardiac arrest occurs. An AND allows the dying process to happen with full comfort measures. No other aggressive treatment will be performed.
Assisted suicide – Provide someone the means (drugs or a weapon) to commit suicide, knowing the person will use it to end his or her life. It is not legal in Indiana.
Brain death – Irreversible loss of all brain function. Most states legally define death to include brain death.
Capacity – As it relates to end-of life decisions, a person who can understand the medical problem as well as the risks, benefits and alternatives to the recommended treatment options. “Capacity” is sometimes used interchangeably with “competency,” but does not mean the same thing. Competency is a legal status recognized by the court.
Do-not-resuscitate order (DNR) – At the request of a person or the person’s family, a DNR instructs healthcare providers not to attempt cardiovascular resuscitation (CPR) in case of cardiac or respiratory arrest. To be valid, a DNR must be signed by a physician. An “out-of-hospital DNR” is written for people who do not want to receive CPR and are at home or someplace other than an acute care facility. Aggressive or supportive treatment may occur if a medical crisis arises. Patients may be kept alive with artificial nutrition, hydration, antibiotics and/or ventilation.
Hospice care – A program for providing end-of-life care with comfort measures to support people who are in the final stages of a terminal illness. Hospice also includes support for the patient’s family while the patient is alive and during the time of bereavement – for at least a year after the patient’s death. Goshen Health offers hospice care.
Living will – A type of advance directive used for individuals to document their wishes for medical treatment during a terminal illness if they are unable to communicate. A living will serves to guide the family and doctors in deciding how aggressively to use medical treatments to delay death. A living will may also be called a directive to physicians, healthcare declaration or medical directive.
Medical (or healthcare) power of attorney – A document used by an individual to appoint someone to make decisions about medical care if the individual is unable to communicate. This document may also be called a healthcare proxy, durable power of attorney for health care or appointment of a healthcare agent. The person appointed may be called a healthcare agent, surrogate, attorney-in-fact or proxy.
Palliative care – A comprehensive approach to treating serious or terminal illness that focuses on the physical, psychological, spiritual and existential needs of the patient. The goal is to achieve the best quality of life by relieving suffering, controlling pain or symptoms and enabling the patient to achieve maximal functional capacity. Respect for the patient’s culture, beliefs and values is an essential component. Palliative care is sometimes called comfort care. All hospice-type care is palliative care, but not all patients receiving palliative care are hospice patients.
Physician Orders for Scope of Treatment (POST) – Not intended to replace a living will or medical power of attorney, a POST may be completed by a person who has at least one of the following:
- Advanced progressive illness
- Advanced chronic progressive frailty
- Condition caused by injury, disease or illness from which, to a reasonable degree of medical certainty, there can be no recovery and death will occur from the condition within a short period of time without the provision of life-prolonging measures
- Medical condition that, if the person were to suffer cardiac or pulmonary failure, resuscitation would be unsuccessful or within a short period of time the person would experience repeated cardiac or pulmonary failure resulting in death
The treating physician, advance practice nurse or physician assistant may execute a POST form. A POST addresses a person’s preferences for CPR, antibiotic use, artificially administered nutrition, and medical interventions, such as full comfort measures (allow natural death), limited additional interventions or full life-sustaining treatments. The document must be in English; translated versions can only be used for interpretation. A patient who is physically unable to sign may direct a person to sign on his or her behalf. Other state’s version of POST may be honored if similar to the Indiana POST. Only a legally appointed representative can sign for an individual.
Surrogate decision making – Allows an individual or group of individuals (usually family) to make decisions about medical treatments for a patient who has lost the capacity to make decisions and who does not have advance directives. Most states have passed statutes that permit surrogate decision-making for patients without advance directives.
Beginning July 1, 2018, Indiana law established a hierarchy of who will make decisions for you if you do not have a healthcare representative. The order of priority is:
- Court-appointed guardian
- Adult child*
- Adult sibling*
- Adult grandchild*
- Nearest other adult relative in the next degree of kinship who is not listed above
- An adult friend who has maintained regular contact with the individual and is familiar with the individual’s activities, health and religious or moral beliefs
- Individual’s religious superior if the individual is a member of a religious order
*If there are multiple members at the same priority level, then the majority of available individuals controls.
The following individuals may NOT provide health care consent:
- Spouse who is legally separated or has a petition for dissolution, legal separation or annulment of marriage that is pending in court
- Individual who is subject to a protective order or other court order to avoid contact with the individual who is unable to make their own decisions
- Individual who is subject to a pending criminal charge in which the ill individual was the alleged victim.
Withholding or withdrawing treatment – Foregoing life-sustaining measures or discontinuing them after they have been used for a certain period of time.
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