Advance Directive: Instructions from a person capable of making decisions regarding future medical treatment in the event that he or she becomes incapable of making those decisions. An advance directive may specify medical treatment the individual consents to or refuses (a treatment directive), may designate a surrogate decision maker (a proxy directive), or both. See also Durable Power of Attorney for Health Care Decisions and Living Will.

Anatomical gift: a donation of all or part of a human body to take effect upon or after death.

Autonomy: In ethics, the principle that independent actions and choices of an individual should not be constrained by others.

Beneficence: In ethics, the principle that one has a duty to convey benefits or to help others farther their important and legitimate interests.

Best Interest/Reasonable Person Standard: A legal standard to guide surrogate decision making. By this standard, the surrogate makes the decision from the point of view of a hypothetical ‘reasonable person’ on the basis of objective, socially shared criteria, usually in conjunction with the physician and knowledge of diagnosis/prognosis. Compare to Substituted Judgment.

Brain Death: Irreversible cessation of all function of the entire brain, including the brainstem.

Capable of Decision Making: A patient who is deemed, usually without the involvement of a court, to possess the mental ability to make decisions or to participate in decision making. Capacity involves the patient’s ability to take in, understand and appreciate or evaluate the nature and purpose of the treatment and the consequences of giving or refusing consent based on his/her own values and goals. Compare to Competent.

Cardiopulmonary resuscitation or CPR: treatment to try to restart breathing or heartbeat. CPR may be done by breathing into the mouth, pushing on the chest, putting a tube through the mouth or nose into the throat, administering medication, giving electric shock to the chest, or by other means.

Comfort care: any measure taken to diminish pain or discomfort, but not to postpone death.

Competent: Any adult who has not been determined by a court to be incompetent; there is a legal presumption of competence. Compare to Capable of Decision Making.

Confidentiality: This is fundamentally an issue of who is to control the dissemination of certain information. In the pledge of confidentiality typically found in codes of professional ethics, the professional promises not to reveal information about a patient and / or client without consent. Ethical questions are acute when protecting the confidence of a client and / or patient resulting in general social harm or infringements of the rights of other parties.

Consent: A voluntary act by which one person agrees to allow someone else to do something. For medical liability purposes, consent should be in writing, with an explanation of the procedures to be performed. Compare to Informed Consent.

Donor Registry Enrollment Form: a form that has been designed to allow individuals to specifically register their wishes regarding organ, tissue and eye donation with the Ohio Bureau of Motor Vehicles Donor Registry.

Do-Not-Resuscitate Order: A directive by a physician to withhold cardiopulmonary resuscitation in the event that a patient experiences cardiac or respiratory arrest. Some states or hospitals make a distinction between different levels of care that may be designated by the DNR order, such as DNR-Comfort care only versus DNR – comfort care / arrest.

Durable Power of Attorney (For Health Care Decisions): A legal instrument empowering a designated person to act on another’s behalf. Unlike the traditional power of attorney, the “durable” power does not lapse if the person who executed it becomes incapable of decision making. As a matter of fact, the DPOA-HC does not take effect until the patient is unable to speak on his or her own behalf or he or she relinquishes that right to another. Originally intended to permit financial or property transactions, durable powers of attorney are also used to delegate medical decision-making authority, as is the case for the durable power of attorney for health care decisions. The person named in this document serves in the surrogate’s role when the patient becomes incapacitated or relinquishes decision-making authority. (See surrogate decision-maker) There are limits to this person’s decision-making authority that vary by state. In many states, these limits include the following: can only order life-sustaining treatment be withdrawn if the patient has a terminal condition or is in a permanently unconscious state; cannot withdraw life sustaining treatment if the patient is pregnant, unless there is a substantial risk to the patient’s life if the pregnancy is continued or two physicians determine that the fetus would not be born alive; no authority to withdraw comfort care; cannot change treatment that has already been consented to by the patient, unless there is a physical change in the patient’s condition, or the treatment is no longer effective or beneficial; may only withdraw nutrition and hydration if the patient has a terminal condition or is in a permanently unconscious state and it will not provide comfort or alleviate pain, and the form gives the surrogate this authority, and is consistent with the living will or other written directives.

Enteral Nutrition: The infusion of nutrients into a person’s stomach or intestine via tubes placed through the nose or though a surgical opening into the gastrointestinal tract. (Though the term is sometimes defined to include oral nutrition supplements, it usually refers only to tube feeding.)

Ethics consultation: Effective ethics consultation has been shown to improve ethical decision making and practice, enhance patient and provider satisfaction, facilitate the resolution of disputes, and increase knowledge of health care ethics. Possible goals of clinical ethics

consultation include: facilitation of communication among involved parties; provision of ethics-based analysis and recommendations and / or ethics education to institutional staff; building of ethics awareness and sensitivity.

Extraordinary means (of preserving life): Procedures whose burdens outweigh the benefits. Extraordinary means are all medicines, treatments and operations, which cannot be obtained or used without excessive expense, pain or other inconvenience, or which, if used, would not offer a reasonable hope of benefit. Aggressive or burdensome treatments would not be required, but would remain permitted to the patient. It is not acceptable to hasten death yet it is permissible to avoid the prolongation of death (dying process). The distinction between extraordinary and ordinary means of preserving life is a moral distinction, not a medical one. In general, the physician determines what is medically appropriate while the patient and family determine what is ordinary based on circumstances and values, in light of the diagnosis and prognosis, as explained by the physician and with the benefit of the physician’s experience and guidance.

Guardian: Person appointed by a court to protect the interests of a person who is incapable of decision making.

Harm or Injury: Any wrong or damage done to another, either to the person, to rights, or to property.

Health Care Ethics: Medicine, Biology, Physiology, Morality, Philosophy, Law, Religion, and Ethics all form the basis of what modern day scholars refer to as health care ethics. Ethics is a “general term referring to both morality and ethical theory,” which forms a normative approach that evaluates “standards of right or good action.” Health care ethics involves a consideration of moral principles implicated in making medical decisions concerning the biological phases of a person’s life and death as impacted upon by society’s deeply held traditions and beliefs.

Health Care Ethics and the Law: Health care ethics requires a constant interplay between law and medicine to ensure that such professions are practiced within socially acceptable norms of client and patient expectations. It is the forum in which policy, morals, and principles collaborate to affect appropriate conduct in two of the most ancient and relied upon professions. A review of traditional medical and legal constructs is helpful in evaluating the interdisciplinary nature of law, ethics, and medicine.

Hydration: The addition of water, as by intravenous fluids, to the body.

Incapable of Decision Making: A patient who is deemed, usually without the involvement of a court, to lack the mental ability to make decisions or to participate in decision making. Compare to Incompetent.

Incompetent: A person who has been determined by a court of law to be unable to make and articulate rational decisions.

Informed Consent: A legal term that refers to a person’s consent to a proposed medical intervention after being provided information deemed relevant to that decision. The information that is legally required includes: diagnosis, nature and purpose of proposed intervention, risks and consequences of proposed treatment, probability that the treatment will be successful, feasible treatment alternatives, and prognosis if treatment is not given.

According to the requirements of informed consent, no procedure can be preformed until the patient or client (a) has been informed of the nature of the procedure, risks, alternatives, and the prognosis if the procedure is not done; (b) has been determined to be mentally competent to give or refuse consent; and (c) has given a free and willing consent to having the procedure done. This is a principle of law and general ethics, and is included as a provision in some professional codes of ethics.

Integrity: In ethics, the principle that health care professionals have a clear responsibility to act in accordance with the ethical mandates of their profession and reasonable standards of practice. A health care professional should respect the considered choice of a patient or the patient’s surrogate, but is not required to violate personal commitments to ethical or religious mandates.

Interests: An interest is something that matters in some way to some conscious living being, such as desires, aspirations, wants, goals, needs, beliefs, intentions, objectives, preferences, etc.

Intrinsic Value and Disvalue: An intrinsic value is something which is good or desirable for its own sake, as an end in itself. An intrinsic disvalue is something which is bad or worth avoiding for its own sake. Many things have been thought to be intrinsic goods, such as pleasure, happiness, virtue, knowledge, truth, autonomy, civil liberty, creativity, love, friendship, self-realization, beauty, satisfaction of desires, etc. Many things have been thought to be intrinsic disvalues, such as pain, unhappiness, suffering, vice, ignorance, falsehood, constraint, stagnation, hatred, enmity, lack of self realization, ugliness, and /or lack of desires or interests.

Living Will: A document in which a person capable of decision making expresses in advance his or her wish regarding certain life-sustaining treatments in the event that he or she becomes incapable of decision making in the future. See right to Die Act.

Next of Kin: Those persons who by the law of descent are adjudged the closest blood relatives of the patient or decedent.

Nonmaleficence: In ethics, generally associated with the maxim, “primum non nocere” (above all, do no harm). The principle that one has a duty not to inflict evil, harm, or risk of harm.

Nutritional Support: Artificial methods of providing nourishment and fluids. See Enteral Nutrition and Parenteral Nutrition.

Ordinary means (of preserving life): Procedures whose benefits outweigh the burdens. Ordinary means of preserving life are all medicines, treatments, and operations, which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain, or other inconvenience. Ordinary means are determined by the circumstances of the person, place, time, and culture.

Pain and Suffering: Pain in its broadest sense includes suffering and refers to any quality of feeling which is normally experienced as disagreeable or undesirable and which we normally wish to avoid for its own sake. In a narrower sense, however, pain and suffering may be distinguished as follows. Pain in the narrower sense refers to localized bodily disagreeable feelings such as those resulting from bodily lesions, infections, cuts, bruises, bums, cramps, broken bones, poisons, stings, and the like. Suffering, by contrast, refers to such non-localized disagreeable feelings as are involved in depression, anxiety, uncertainty, guilt, shame, grief, boredom, sadness, fear, anger, terror, alienation, loneliness, and the like

Palliative Care: Care intended to keep a patient comfortable, but not intended to prolong life. It is the interdisciplinary study and management of patients with active progressive or serious illness with the goal to improve the quality of living and dying. It is both a therapeutic approach and a philosophy of care. It focuses on matching goals to treatments, on what can be done rather than on what can not, and emphasizes quality of life.

Permanently unconscious state means an irreversible condition in which the patient is permanently unaware of self and surroundings. Two physicians must examine the patient and agree that the total loss of higher brain function has left the patient unable to feel pain or suffering.

Power of Attorney: A legal document authorizing one to act as the attorney or agent of another.

Privileged Communication: Statement made to an attorney, physician, spouse, or anyone else in a position of trust. Because of the confidential nature of such information, the law protects it form being revealed, even in court, without the consent of the person who made the statement. However, the law provides an exemption from liability for disclosing information when there is a higher duty to speak, such as statutory reporting requirements.

Professional: A professional is a person who has made a specific commitment to meet a need and has received certification by a largely self-regulating body to which he or she belongs, confirming public expectations of training and skill to meet that need.

Professional Ethics: A set of ethical principles generated by a group of professionals and designed specifically to govern their professional practices. Controversy arises when principles of professional ethics appear to claim immunity on behalf of professionals from general ethical obligations, when a doctrine of therapeutic privileges is invoked to justify deception.

Proxy Consent: Voluntary informed consent given on behalf of another who is for some reason incapable of giving it for himself or herself.

Proxy Directive: An individual’s written designation of another person to act on behalf of the designated individual in the event he or she becomes incapable of decision making. See Durable Power of Attorney (for Health Care Decisions).

Quality of Life: A measure of the value of an individual’s life from the point of view of that individual. This is to be distinguished from the value of the individual’s life to others or to society at large. For example, a man who is quadriplegic may not be able to function as a productive member of society (and thus be a net burden from the societal perspective), but he may find life in this state quite meaningful and thus rate his quality of life satisfactory.

‘Right To Die Act’: Living Will legislation that authorizes advance directives in case of terminal illness or irreversible coma.

Standard of Care: Those acts performed or omitted that an ordinary prudent person would have performed or omitted. It is a measure against which a defendant’s conduct is compared.

Substituted Judgment: A legal standard for surrogate decision making. By this standard, the surrogate makes the decision on the basis of what is known about the patient’s personal values and preferences. Compare to Best Interest.

Surrogate Decision Maker: A person who is designated to make decision on behalf of a person who is incapable of making decisions. A surrogate decision maker may be selected before a person becomes incapable of decision making by means of a durable power of attorney for health care decisions, by means of a living will, or may be selected after a patient has become incapable of decision making. The role of a surrogate is to help the healthcare team understand and appreciate the values and wishes of their loved one and the implications of those values and wishes for care.

Terminally Ill: A person for whom a prognosis of death has been made based on diagnosis of an illness that has a predictable fatal progression that cannot be stopped by any known treatment; an irreversible, incurable and untreatable condition caused by disease, illness or injury.

Treatment Directive: A written statement prepared by an individual directing what forms of medical treatment the individual wishes to receive or forego should he or she become incapable of decision making some time in the future. See Living Will.