Glossary of Terms
Act 39: Vermont’s end-of-life choice law, adopted in 2013, enabling mentally competent adult Vermont residents who have received a diagnosis from two doctors of six months or less to live to receive a legal prescription for terminal medication to be self-administered.
Advance Directive for Healthcare: This legal document serves two functions and is operative when a patient is unable to communicate or make decisions for themselves. First, it states an individual’s preferences for medical treatment or withholding of medical treatment, Second, it appoints a health care agent empowered to speak for the patient if the patient is unable to do so. The appointment of an agent is sometimes called a durable power of attorney, and the directive used to be called a living will, but there is no substantive difference with the terms currently in use.
Aid in Dying or Medical Aid in Dying: The process that allows a mentally competent, terminally ill adult to legally request a prescription for a life-ending medication from their physician. The medication must be self-administered.
Death with Dignity: Death with dignity refers to both a concept and a movement; in both cases it includes the ideas of limiting suffering and providing control and choice at the end of life. The initiative to get Vermont’s Act 39 in place was originally called Death with Dignity Vermont. Similar laws are available in Oregon, Washington, California, Colorado, Hawaii, New Jersey, Maine, and the District of Columbia.
Euthanasia: The intentional ending of a person’s life upon their request, performed by a physician or other medical healthcare professional, and usually by lethal injection. Euthanasia is illegal everywhere in the United States and is not a practice Patient Choices Vermont supports. It is legal in certain European countries.
Hospice: Hospice care is available to a terminally ill person who is expected to have six months or less to live. Hospice care can be provided in the home or in a hospice facility and typically involves services provided by a team of health care professionals who maximize comfort for a person who is terminally ill by reducing pain and addressing physical, psychological, social and spiritual needs. To help families, hospice care also provides counseling, respite care and practical support. Unlike other medical care, the focus of hospice care isn't to cure the underlying disease. The goal of hospice care is to support the highest quality of life possible for whatever time remains.
Palliative Care: Sometimes called “comfort care,” palliative care is aimed at relieving a person’s physical and sometimes emotional pain through medication, physical therapy, spiritual counseling or other methods, and with the understanding that the treatment is not intended to cure or prolong the person’s life.
Palliative/Terminal Sedation: The continuous administration of medication to relieve severe, intractable symptoms when all other treatment interventions have been exhausted. The intention is to relieve suffering and not to hasten death.
Right to Die: Typically refers to a patient’s right to refuse life sustaining treatments. The right to die movement preceded the death with dignity movement as a result of well-known cases of patients who were in a long term coma, and whose families fought for the right to remove life support systems.
Terminal Illness: Describes an irreversible and incurable illness from which the medical expectation is death. The federal definition of “terminally ill” is defined as a prognosis of six months or less, which triggers Medicare of Medicaid expense reimbursement for the patient’s hospice care.
Voluntary Stopping of Eating and Drinking (VSED): The conscious stopping of all eating and drinking in order to hasten death. This procedure is one of several options for those facing unbearable suffering. VSED is gaining in popularity and acceptance as a method of hastening death because the process seems more natural, especially when considering patients nearing death naturally lose their desire to eat and drink. Studies have reported that aside from initial thirst, which can be managed, the resulting death takes two weeks or less, and with active support and symptom management, can be a peaceful one. VSED may be more distressing for the family and loved ones than it is for the patient, who often lapses into a coma-like state following several days without fluids.
Withdrawal of Treatment: A decision to withhold or withdraw life-sustaining treatment is a common feature of medical practice when caring for people who are approaching the end of life. It means the removal of a treatment that was started in an attempt to sustain life. Patients and health care agenets may make a decision to stop treatments when they are no long working to sustain life, or when prolonging life is no longer the primary goal due to a marked decrease in quality of life. Some common treatments that may be withdrawn as patients nears death include mechanical ventilation, artificial nutrition, defibrillators and chemotherapy. Withdrawal of life sustaining treatments goes hand in hand with introducing and continuing with treatments and other supports to assure comfort as the patient dies.
PCV's Helpline for Vermont Residents: 802-448-0542, or info@patientchoices.org.