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    Health Maintenance Guidelines

    These are some of the terms you will see when reading about Advance Health Care Directives (AHCD). If there is a medical term you do not understand, please ask your doctor

    Advance Health Care Directive (AHCD)
    AHCD is the term used in California for a combined document that takes the place of a “Living Will” and a Durable Power of Attorney for Health Care. It allows you to name agent(s) to make health care decisions when you can’t make them yourself and state what
    treatments you want or don’t want and under what circumstances. The document can do one or both.

    Agent (health care representative/proxy)
    In an AHCD, this is a person who has been legally designated to make decisions for someone else.

    Artificially provided fluids and nutrition
    A provision of food and water to seriously ill patients who are unable or unwilling to eat. Methods might include using a feeding tube or intravenous line.

    Brain Dead
    Total irreversible cessation of all brain functioning. The patient can be maintained pink and warm on machines to allow for organ donation, but is legally and medically dead. “The dead are not kept alive on life support and they don’t die again when machines are
    stopped.” (NY Times Article)

    Cardiopulmonary Resuscitation (CPR)
    Treatment to restart the heart or breathing. It may include the use of mechanical devices and/or drugs.

    Code status
    This relates to your wishes if your heart stops and CPR is a treatment option. A Do Not Resuscitate Order is a “code status”.

    Lack of responsiveness; may be temporary or permanent; may be different levels.

    Comfort care
    Also called palliative care; measures to soothe, relieve pain.

    Decision-making capacity
    Ability to understand benefits and risks of a proposed treatment and its alternatives and make an informed decision.

    “Do not resuscitate” DNR
    Does not mean no medical care. It means that if your heart or lungs fail, you do not want to be put on life support (breathing machine) or given Cardiopulmonary Resuscitation (CPR) where electric shock or chest compressions is used to try to restart your heart. You still will get full medical care, medications or oxygen to get you better. But, if your heart and lung fail, we will focus on relief of pain and provide comfort care for you until the end of your life.

    Durable Power of Attorney for Health Care
    A document that names agent(s) to make health care decisions. DPAHCs were originally only valid for seven years. A DPAHC is still valid if written after 1992; otherwise, complete an AHCD.

    Incurable and irreversible chronic disease
    Disabling diseases which get progressively worse over time, eventually resulting in death. Because the disease may advance at a very slow rate, the diseases are not considered terminal in their early stages.

    Life-sustaining measures
    Any medical procedure, device, artificially provided fluids and nutrition, drugs, surgery or therapy that uses a mechanical or other artificial means to sustain, restore or take the place of a vital bodily function to prolong the life of a patient.

    Living Will
    This term is not used in California. In California, the correct term is AHCD; a document that gives health care instructions.

    May be designated for donation/transplantation. An organ is any part of the body exercising a specific function such as the heart, kidney, lungs, pancreas, intestines and liver.

    Palliative Sedation
    To relieve suffering; legal to give medication(s) up to point of anesthesia to relieve pain.

    Permanent unconsciousness
    Medical condition defined as total and irreversible loss of consciousness. This includes conditions known as persistent vegetative state and irreversible coma. The patient cannot interact with his or her surroundings and do not experience pleasure or pain.

    Persistent vegetative state (PVS)
    A condition of permanent unconsciousness. Patients cannot interact with their environment or other people. Not normally regarded as a terminal condition and the patient can survive for many years with medical care, artificial fluids and nutrition.

    Physician’s Orders for Life-Sustaining Treatment (POLST)
    POLST is not the same form as an AHCD. POLST was a new form introduced in 2009 and it can only be completed by a doctor.

    Pre-hospital Do Not Resuscitate Order
    An official State document in which a person states he/she wishes to forgo specific treatments designed to assist with breathing or restart the heart to sustain life.

    Person verbally appointed to make decisions

    Terminal condition
    A term used by insurance companies indicating final stage of irreversibly fatal illness, disease or condition with life expectancy of one year or less with or without life-sustaining treatment.

    May be designated for donation/transplantation. A collection of similar cells including skin, bone, cornea, heart valves, connective tissue

    Free will; conscious choice