Glossary of Important Terms

Acute mourning: The initial phase of disorientation, dulled senses, denial, and yearning. 

Advance Directive: This is a general term describing two kinds of legal documents [See Living Will and Durable Powers of Attorney]. Such documents allow a person to give instructions about future medical care in case they are unable to participate in medical decisions due to serious illness or incapacity. Each state has its own regulations concerning the use of advance directives. Find yours here. 

Ambiguous grief: Occurs when a loss is psychologically felt but not physically confirmed (or when the individual is “there” but not there as with Alzheimer’s Disease). 

Amputation metaphorLoss analogy commonly used by grieving parents (e.g., loss of childlike loss of limb). 

Anticipatory grief: Grief that occurs before a loss, as distinguished from grief occurring at or after a loss.  

Assisted Death: This is also known as “physician-assisted suicide”, “physician-assisted dying” or “aid in dying” and is legal the US states of Oregon and Washington. It permits mentally competent, terminally-ill adult patients to request a prescription for life-ending medication from their physician. The Oregon and Washington laws mandate that the medication must be self-administered. 

Autonomy: This is the exercise of self-determination and choice among alternatives, based on the individual’s values and beliefs. 

Bier: A bier is a moveable frame for transporting a coffin in a church or crematorium, or before burial in a cemetery 

Chronic grief: Continuance of acute grief reactions over time. 

Chronic grief syndrome: Abnormal grief reaction with loss of a deeply dependent relationship.  

Columbarium: A columbarium is a building used for storing cremation ashes, usually with recessed niches for individual urns 

Continuum of Care: This relates to a course of therapy during which a patient’s needs for comfort care and symptom relief is managed comprehensively and seamlessly. Hospice provides a continuum of care to terminally-ill patients, and aid-in-dying is assumed as the option of last resort at the end of that continuum. 

Coma: The National Institute of Neurological Disorders and Stroke defines coma as “a profound or deep state of unconsciousness. An individual in a state of coma is alive but unable to move or respond to his or her environment.” Comas can result from chronic illness or severe injury/trauma. 

Comfort Care: This medical specialty, also referred to as palliative care, is often associated with hospice; however, it can also be used independently and alongside curative treatments. Palliative care is available in every state, appropriate for anyone at any stage of life suffering with a debilitating illness–terminal or not–and focuses on pain management and providing comfort. 

Compassion fatigue: Vicarious trauma and emotional depletion incurred by caregivers with high involvement with suicidal individuals and other high-risk persons. 

Complicated mourningDifficult long-term state after a traumatic loss. 

Conflicted grief: Occurs in losses involving ambivalent or troubled relationships. 

Coroner: A coroner is a local government official responsible for investigating the circumstances of someone’s death if the cause or identity of the person is unknown. 

Delayed grief: Bereavement occurring years or decades after the loss. 

Disenfranchised grief: Grief that is denied or restricted by social pressure or other interference.  

DNR / DNI: DNR/DNI stands for Do Not Resuscitate/Do Not Intubate and is a specific physician order. Do Not Resuscitate means that in the event of cardiac arrest, no CPR or electric shock will be performed to re-start the heart. Do Not Intubate means that no breathing tube will be placed in the throat in the event of breathing difficulty or respiratory arrest. Each of these orders may be given separately and are generally prominently noted in the patient’s medical chart. The patient can change a DNR and DNI order at any time, and experts urge that such orders are reviewed regularly. In a DNR/DNI situation, a patient is provided comfort care. Without such an order, emergency medical technicians are legally required to perform CPR. 

Double Effect: This is the doctrine established by St. Thomas Aquinas in the 13th century in which an action that has two effects—one that is intended and positive and one that is foreseen but negative—is ethically acceptable if the actor intends only the positive effect. The doctrine is often used to describe the impact of administering high doses of morphine or terminal sedation—treatments intended to relieve suffering but that often hasten death. Since the intention is comfort care, this is not considered euthanasia and is legal and generally practiced throughout the United States and around the world—generally in private and without publicity. 

Dual diagnosis: Occurrence of two behavioral health disorders (e.g., depression and drug abuse) (aka “double trouble”). 

Durable Power of Attorney: This is a document appointing a surrogate to make medical decisions in the event that an individual becomes unable to make those decisions on their own. It is also sometimes referred to as a “health care proxy.” 

Duty to warn: The ethical obligation to disclose the risk of suicide or other harm to a third party. 

Euthanasia: This is translated literally as “good death” and refers to the act of painlessly but deliberately causing the death of another who is suffering from an incurable, painful disease or condition. It is commonly thought of as lethal injection and it is sometimes referred to as “mercy killing.” All forms of euthanasia are illegal in the United States. 

  • Active Euthanasia: This is generally understood as the deliberate action of a medial professional or layperson to hasten a patient’s death. 
  • Passive Euthanasia: This is generally understood as a patient’s death due to actions not taken by a medical professional or layperson—actions that would normally keep the patient alive. 
  • Voluntary Euthanasia: This occurs at the request of the person who dies. 
  • Non-Voluntary Euthanasia: This refers to when a patient is unconscious or otherwise mentally unable to make a meaningful choice between living and dying, and a legal surrogate makes the decision on the patient’s behalf. 
  • Involuntary Euthanasia: This occurs when a patient’s death is hastened without the patient’s consent. While generally viewed as murder, there are some instances in which the death may be viewed as a “mercy killing.” 

Exhumation: Exhumation is the removal of a body from a burial site, usually for reburial elsewhere, which requires a license. 

Futile Measures: This generally refers to the medical care of patients in which the care will have little or no effect on the patient’s outcome or prognosis. 

Green Funeral: A green funeral is a funeral that uses environmentally friendly practices and materials, such as natural burial and biodegradable coffins. It is sometimes referred to as green burial, natural burial or woodland burial. 

Guardian Ad Litem: A Latin term for a court-appointed representative who makes decisions in a legal proceeding on behalf of a minor or an incompetent or otherwise impaired person. 

Hospice: Hospice is an organization or institution that provides comfort (a.k.a. palliative) care for dying individuals when medical treatment is no longer expected to cure the disease or prolong life. Hospice sometimes also applies to an insurance benefit that pays the costs of comfort care usually at home for patients with a prognosis or life expectancy of six months or less. 

Intent: This is a concept used to draw a moral distinction between aid-in-dying and other acts/omissions that cause death—such as terminal sedation and withdrawing life-sustaining therapy. “Intent” assumes the ability to draw a clear distinction between knowledge of a certain outcome and an intention to produce that outcome. 

Life-Sustaining Treatment: This is any treatment, the discontinuation of which would result in death. Such treatments include technological interventions like dialysis and ventilators. They also include such simpler treatments as feeding tubes and antibiotics. 

Living Will: A “living will” is a type of advance directive containing instructions about future medical treatment in the event the individual is unable to communicate specific wishes due to illness or injury. Each state has its own regulations concerning the use of living wills. 

Mausoleum: A mausoleum is a structure housing above-ground tombs. 

Minimally Conscious: This state was described in the February 12, 2002 edition of Neurology as qualitatively distinct from a coma and vegetative states. For example, patients who are “minimally conscious” are impaired but have some capabilities, such as the ability to reach for and grasp objects, track moving objects, locate sounds, and process and respond to words. Patients may inconsistently verbalize or gesture to communicate, and patients may regain full consciousness. However, minimal consciousness may also be permanent. 

Pallbearer: A pallbearer is someone who carries or escorts the coffin at a funeral. Usually either close family or friends of the person who has died, or professionals provided by the funeral director. Pallbearers are traditionally male, but women sometimes do it, regardless of whether the coffin is carried or escorted. Many funeral directors provide their own pallbearers for a funeral.  

Palliative Care: This medical specialty is often associated with hospice; however, it can also be used independently and alongside curative treatments. Palliative care is available in every state, appropriate for anyone at any stage of life suffering from a debilitating illness–terminal or not–and focuses on pain management and providing comfort. [See also comfort care] 

Patient Self-Determination Act of 1991: This federal law requires health care facilities that receive Medicare and Medicaid funds to inform patients of their right to execute advance directives regarding end-of-life care. 

Persistent Vegetative State: Some comatose patients lapse into a persistent vegetative state. According to the National Institute of Neurological Disorders and Stroke, patients in such a state “have lost their thinking abilities and awareness of their surroundings but retain non-cognitive function and normal sleep patterns. Even though those in a persistent vegetative state lose their higher brain functions, other key functions such as breathing, and circulation remain relatively intact. Spontaneous movements may occur, and the eyes may open in response to external stimuli. They may even occasionally grimace, cry or laugh. Although individuals in a persistent vegetative state may appear somewhat normal, they do not speak, and they are unable to respond to commands.” 

Physician-Assisted Death/Physician-Assisted Suicide: These terms are synonyms for assisted death. 

Post-mortem Examinations: A post-mortem examination is a medical investigation of the body of a person who has died, ordered by a coroner or procurator fiscal and carried out by a pathologist, to discover the cause of their death 

Refusal of Medication/Treatment and Nutrition/Hydration: Terminally ill patients who feel they are near the end of life may legally and consciously refuse medication, life-sustaining treatments, nutrition, and/or hydration. Published studies indicate that “within the context of adequate palliative care, the refusal of food and fluids does not contribute to suffering among the terminally ill”, and might actually contribute to a comfortable passage from life. “At least for some persons, starvation does correlate with reported euphoria.” 

Spirituality and ‘a good death’Patients with cancer approaching death embark on an inner journey involving a search for meaning, and their quality of life is closely related to their spiritual wellbeing. six factors contributing to a ‘good death’: 1) social engagement and connection to identity; 2) carer’s characteristics and actions; 3) carer’s confidence and ability to care; 4) preparation and awareness of death; 5) presentation of the patient at death, and 6) support for grieving carers after death. 

Studied Neutrality: This refers to various medical organizations’ recognition of and respect for the diversity of members’ personal and religious views and choices — as well as those of their patients — in order to encourage open discussion about all end-of-life options. 

Suicide: Suicide is generally defined as the act of taking one’s own life voluntarily and intentionally — generally as the result of an individual’s self-destructive impulse and mental illness and often independent of a terminal illness. Because a terminally-ill adult patient who is deemed mentally competent chooses to hasten his or her death through a physician’s assistance, “physician-assisted dying” is more accurate than “physician-assisted suicide.” 

Surrogate Decision Making: This is a procedure that allows a loved one to make medical-care decisions in accordance with a patient’s known wishes. If the patient’s wishes are not known, the decisions are generally said to be made in the patient’s “best interests.” 

Terminal Sedation: Generally practiced during the final days or hours of a dying patient’s life, this coma-like state is medically induced through medication when symptoms such as pain, nausea, breathlessness or delirium cannot be controlled while the patient is conscious. Patients generally die after of the sedation’s secondary effects of dehydration or other intervening complications. 

Thanatology: Study of death, dying, bereavement, and grief. 

Trauma:  A psychological reaction to a stressful, harmful, or life-threatening occurrence that is outside the range of normal experience and beyond control.   

Traumatic loss: A death that is sudden, unexpected, preventable, and/or of a child. 

 Trigger: Factor (e.g., event, memory, date, place, sound, or object) which initiates and aggravates behavior or other response (e.g. trauma). 

 Withholding/Withdrawing Treatment: This refers to omitting or ending such life-sustaining treatments as ventilators, feeding tubes, kidney dialysis or medication that would otherwise prolong the patient’s life. This legal action may be upon the patient’s request, as the result of an advance directive or based upon the medical determination of futility. 

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