Version June 2024
| Palliative care | Palliative care is specialized multidisciplinary medical care for patients with life-threatening illness and their families that is focused on relieving symptoms, including pain, and the stress of such diseases. It aims to relieve suffering of all types in all stages of disease and is not limited to end-of-life care. Palliative care can be offered at any point along the trajectory of any serious illness, concurrent with curative, restorative, and life-prolonging therapies. Palliative care is implemented by interdisciplinary teams including clinicians, nurses, chaplains, social workers, and other care providers to minimize the physical, spiritual, psychological, and social distress of living with a serious illness. |
| Hospice | Hospice programs deliver palliative care to patients at the end of life when the focus is on comfort rather than curing illness and when the patient wishes to avoid hospitalization. In the United States, hospice eligibility is largely defined by Medicare hospice benefit guidelines, which are applicable to patients with a terminal illness and an estimated life expectancy of 6 months or less. |
| Advance directive | Advance directives are the documents a person completes while still in possession of decisional capacity about how treatment decisions should be made on their behalf should they lose the capacity to make such decisions. They are legal tools that direct decision-making about treatment and/or appoint surrogate decision-makers. |
| Living will | A living will is a document summarizing a person's preferences for future medical care. Typically, a living will addresses resuscitation and life support; however, it may cover preferences regarding hospitalization, pain control, and other potential treatments (eg, chemotherapy for cancer, implantable defibrillator for heart failure, tube feeds for dementia, dialysis for renal failure, mechanical ventilation for respiratory disease). Importantly, surrogates cannot complete a living will on the patient's behalf. |
| Medical Orders for Life-Sustaining Treatment (MOLST)/Physician Orders for Life-Sustaining Treatment (POLST) | POLST and MOLST are documents that combine an advance directive with physician orders for life-sustaining treatment. They delineate what care should be. In states that have sanctioned these documents, all care providers have agreed in advance to abide by the orders on the document. |
| Health care proxy; Durable Power of Attorney for Health Care (DPAHC) | These are legal documents through which a patient (primary individual) appoints an agent to make health care decisions legally on their behalf when they are incapable of making and executing the health care decisions stipulated in the document. |
| Surrogate | A surrogate serves as the patient's representative when a patient is unable to make their own decisions (ie, lacks decisional capacity). |
| Decision-making: Decisional capacity versus competence | In a medical context, "decisional capacity" refers to the ability to use information about an illness and proposed treatment options to make a choice that is congruent with one's own values and preferences. "Competence" refers to a legal judgment, typically by a judge, relating to whether an individual has the legal right to make their own decisions. Assessment of decisional capacity can and should be performed by the clinician at the bedside, and it need not involve psychiatry or the legal system. When decisional capacity is borderline or difficult to determine, consultation with psychiatry may be necessary. |
| Withholding versus withdrawing nonbeneficial life-sustaining therapy | Withholding care means foregoing medical treatment before it is started. Withdrawal of care refers to discontinuation of a medical intervention (such as ventilatory support) that has already been initiated. While there is no ethically meaningful difference between withholding and withdrawing care, for some clinicians and family members, the emotional weight of withdrawing a treatment is greater than that of withholding it. |
| Comfort measures only | "Comfort measures only" represents a shift in the philosophy of care indicating that treatment will focus exclusively on providing comfort rather than extending life. Comfort measures may include medications to mitigate uncomfortable symptoms associated with the disease process (eg, diuretics for leg swelling or dyspnea in the setting of end-stage heart failure). |
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