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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Advance directives: An advance directive is a written document or series of forms. It needs to be signed to make it binding. The document indicates an individual's choices about medical treatment. In the document, you can also name someone to make decisions about your medical treatment on your behalf if you are no longer able to make these decisions yourself. This designated person becomes the durable power of attorney for health care. By completing the appropriate advance directives, you can predetermine any medical decisions, including end-of-life decisions, about your future medical care in a legally sound way.

Two types of advance directives are generally completed: a living will and a medical power of attorney (also referred to as designation of a health care surrogate or health care proxy).

• Living will: This written statement tells health care professionals what type of life-prolonging treatments or procedures to perform if someone has a terminal condition or is in a persistent vegetative state. Living wills should not be confused with a regular will. A living will only deal with and address issues regarding your medical care while you are still living.
• Medical power of attorney (or designation of a health care surrogate): This legal document allows you to select any person to make medical decisions for you if you should become temporarily or even permanently unable to make those decisions for yourself. This person is also referred to as your attorney-in-fact or durable power of attorney for health care, but it is not necessary for them to be a lawyer. Most people choose a family member, a relative, or a close friend as their surrogate decision maker. It is important that the designated power of attorney knows and understands your wishes and preferences and can easily and promptly provide a written copy of the necessary documents.

Life-prolonging treatments: These procedures are not expected to cure your terminal condition or make you better. They generally are used to sustain life while other specific therapies are utilized to treat or cure the underlying disease. But sometimes these measures may become futile and only prolong the dying process. Examples of life prolonging treatments include mechanical ventilator (breathing machine), kidney dialysis, and cardiopulmonary resuscitation (CPR).

Terminal condition: If a patient has an incurable (without cure) condition that is in its terminal stages, medical treatment may only prolong the dying process. And without such treatment or procedures, death will occur in a short period of time.

Persistent vegetative state: This permanent coma or state of being unconscious is caused by injury, disease, or illness. The individual becomes unaware of her/his surroundings, and no reasonable expectation of recovery exists.

Do not resuscitate (DNR): Your doctor discusses this form or document with you, and it tells health care professionals and emergency personnel that if your heart stops beating (cardiac arrest) or if you stop breathing (respiratory arrest) that they are not to attempt to revive you by utilizing CPR, chest compressions, intubation, or shocking the heart. A DNR is not the same as a living will. More recently, most states have adopted a unified form which documents a patient's wishes with regards to DNR wishes as well as artificial hydration and nutrition. This is called a POLST form or Physician Orders for Life Sustaining Treatment. This form can be signed by the patient or their decision maker and the treating physician.

Artificial nutrition and hydration: This procedure is the invasive administration of nutrition and fluids through IV lines and feeding tubes. Hydration directly into veins (IV or intravenous) and tube feeding are not the natural process of eating food, hydration, or drinking liquid. Sometimes intravenous (IV) antibiotics are also listed under this or a separate category.

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