Step 2: Learn
Familiarize Yourself with Relevant Terms
By learning more about medical terms and treatments, and legal requirements, you will be better able to express your wishes. Here are some common medical and legal terms that are important to know, but speak with your health care professional if you have any further questions:
Allow natural death
Allow natural death means decisions NOT to have any treatment or procedure that will delay the moment of death. It applies only when death is about to happen from natural causes, and you would still receive treatments to keep you comfortable (e.g. pain medication, oxygen, etc.)
Cardiopulmonary resuscitation (CPR)
Cardiopulmonary resuscitation (CPR) is a medical procedure used to restart your heart and breathing when the heart and/or lungs stop working unexpectedly. CPR can range from mouth-to-mouth breathing and pumping of the chest to electric shocks that restart the heart and machines that breathe for the individual. CPR can be useful in some situations, but not in all situations.
Comfort measures are treatments to keep you comfortable based on your symptoms (for example, pain relievers, psychological support, spiritual care, physical care, oxygen, etc.) but not to keep you artificially alive or cure any illness.
Dialysis is a medical procedure that cleans your blood when your kidneys can no longer do so.
End-of-life care is health care provided at the end of a person’s life. This type of care focuses on you living the way you choose during your last days or weeks and providing comfort measures until the time of death.
A feeding tube is a medical device and is a way to feed someone who can no longer swallow food..
Frailty is a health state associated with getting older; involving multiple serious health issues that increase an individual’s vulnerability. Frailty can occur as the result of a range of diseases and medical conditions – even fairly minor health events can trigger major changes in a person’s health status. We usually associate frailty with noticeable losses in a person’s physical, mental or social functioning.
HEALTH CARE PROFESSIONAL
A health care professional is a person licensed, certified or registered in their province/territory to provide health care (e.g., a doctor, nurse or social worker). They are guided by the Ontario law, the Health Care Consent Act, which outlines amongst other things, that the professional must obtain informed consent or refusal of consent each and every time a treatment option is proposed.
HOSPICE PALLIATIVE CARE (PALLIATIVE CARE)
Hospice palliative care is a philosophy of care that aims to relieve suffering and improve the quality of living and dying. It strives to help individuals and families to:
- Address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears
- Prepare for and manage end-of-life choices and the dying process
- Cope with loss and grief
- Treat all active issues
- Prevent new issues from occurring
- Promote opportunities for meaningful and valuable experiences, and personal and spiritual growth.
Informed consent refers to the decisions you make and give to health care professionals that allows medical investigations and/or treatments. Health care professionals are required to offer you, and you are entitled to receive, detailed explanations of the investigations/treatments and their risks, benefits and side effects; alternatives to these options; and what would likely happen if you refuse the options. Health care professionals must also answer any questions you have about the treatments and the information must be provided before you give verbal consent or sign a consent form. If you are mentally incapable of providing informed consent, the health care professional must turn to your Substitute Decision Maker(s) to obtain consent or refusal of consent. The health care professional does not take directions from your written expression of wishes, however expressed, but must get an informed consent before giving you treatment, except in an emergency.
An intravenous (IV) is a way to give you fluids or medicine through a vein in your hand or another part of your body.
LIFE SUPPORT WITH MEDICAL INTERVENTIONS
Life support with medical interventions can mean medical or surgical procedures such as a feeding tube, breathing machines, kidney dialysis or CPR. All of these use artiﬁcial means to restore and/or continue life. Without them, you would die.
Organ Donation is the process of surgically removing an organ or tissue from one person (the organ donor) and placing it into another person (the recipient). Transplantation is necessary because the recipient’s organ has failed or has been damaged by disease or injury. Make sure your family knows if you wish to be an organ and tissue donor. Even if you have registered as a donor, health professionals still need to ask your family for consent before recovering organs or tissue. Donation can take place only if your family consents at the time of death. Learn More About Organ Donation in your Province/Territory
See Hospice Palliative Care
POWER OF ATTORNEY FOR PERSONAL CARE
In Ontario you have an automatic Substitute Decision Maker for health care as set out in the Health Care Consent Act. If you do not want that person to act as your Substitute Decision Maker(s) you can you can prepare a document called a Power of Attorney for Personal Care to choose a different Substitute Decision Maker(s). This document is used to name someone referred to as your “attorney” to make health and other personal decisions for you when you are not mentally capable to do so for yourself. The word “attorney” does not mean a lawyer but is anyone you name in that document. The Attorney for Personal care is a type of Substitute Decision Maker.
The person you name in Power of Attorney for Personal Care will outrank your automatic Substitute Decision Maker(s). Please note that the Power of Attorney for Personal Care is not the same as the Power of Attorney for Property. The Power of Attorney for Property is a document in which you can name a person or persons to make decisions about your money and property. The attorney for property cannot make decisions for you about your health and personal care.
More information about Ontario Powers of Attorney for Personal Care and Powers of attorney for Property can be found on the following websites:
Advocacy Centre for the Elderly
Community Legal Education Ontario
Ontario Ministry of the Attorney General
Refers to the emotional, intellectual, spiritual, interpersonal and cultural aspects of care. It essentially means everything except the physical care when used in palliative care. This includes providing communication and care that enhances opportunities to direct care, maintain relationships, and explore grief associated with the illness, the many transitions and dying.
Residential Hospice is a home-like environment where adults and children with life-threatening illnesses receive end-of-life care services.
Spirituality is the dynamic dimension of human life that relates to the way persons (individual and community) experience, express and/or seek meaning, purpose and transcendence, and the way they connect to the moment, to self, to others, to nature, to the significant and/or the sacred.
SUBSTITUTE DECISION MAKER
Substitute Decision Maker(s) (SDM) is a person(s) who provides consent or refusal of consent for treatment or withdrawal of treatment on behalf of another person when that person is mentally incapable to make decisions about treatment. The Substitute Decision Maker(s) is required to make decisions for you following any wishes you expressed about your care when you were mentally capable. If your Substitute Decision Maker(s) does not know your wishes applicable to the treatment decision to be made, he or she is required to act in your best interests.
You can appoint someone to be your Substitute Decision Maker in a “Power of Attorney for Personal Care”. You may appoint more than one attorney.
If you choose not to appoint someone then the person who would make decisions on your behalf is based on a ranking list set out in the Health Care Consent Act.
Symptoms are signs that you are unwell – for example, pain, vomiting, loss of appetite, or high fever.
A Terminal Illness (or sometimes referred to as life limiting or life threatening) is an incurable medical conditions caused by injury or disease that affect health and quality of life.
A ventilator is a machine that helps people breathe when they cannot breathe on their own.
When you are in pain or experiencing unpleasant symptoms (such as feeling dizzy or sick), health care professionals will always try their best to relieve your symptoms.
If you reach the point where you no longer want care that prolongs your life, medical treatment and nursing care will always be given to keep you comfortable. For example, you may receive: