Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) - integrated adult policy: guidance

Glossary of Terms

Advance care planning

Advance care planning as a philosophy, promotes discussion in which individuals, their care providers and often those close to them, make decisions with respect to their future health or personal and practical aspects of care.

Advance statement/Statement of wishes

A written record or verbal communication on record of what the patient would wish to happen in certain circumstances. It may include changes in health state or preferences for practical things to be done in future to inform future care. Only comes into force if the patient loses capacity.*

*Scottish law does not provide a specific framework for advance statement other than for the treatment of mental illness. There is no law in Scotland that details a document or registering body for advance decisions to refuse treatment, advance directives or living wills. However , the Adults with Incapacity Act states that in determining what, if any, intervention is to be made, account shall be taken of past and present wishes and feelings of the adult. This guiding principle allows previous witnessed statements about an intervention to be used as evidence of previous wishes.

Advance Directive or Advance Decision**

A statement of a person's views about how they would or would not wish to be treated if the patient loses capacity. This can be a general statement about, for example, wishes regarding place of residence, religious and cultural beliefs and other personal values and preferences as well as about medical treatment and care.

**Known in England as an Advance Decision to Refuse Treatment ( ADRT).

Capacity

The ability to make a decision. An adult is deemed to have capacity unless, having been given all appropriate help and support, it is clear that they cannot understand, retain, use or weigh up the information needed to make that a particular decision, or communicate their wishes.

Clinician

A health professional, such as a doctor or nurse, involved in clinical practice. End of life

Patients are 'approaching the end of life' when they are likely to die within the next twelve months. This includes not only patients whose death is imminent (expected within hours or days) but those who have advanced, progressive incurable conditions, those with general frailty and co-morbidities which mean they are expected to die within twelve months, those at risk of dying from a sudden acute crisis in an existing condition and those with life-threatening acute conditions caused by sudden catastrophic events.

End stage

Final period or phase in the course of a progressive disease leading to a person's death.

Life limiting condition or illness

An active and progressive condition that is expected to reduce a person's life expectancy and requires palliative care.

Legal Proxy (Legally appointed welfare attorney/welfare guardian/person appointed under an intervention order)

A person with legal authority to make certain decisions on behalf of another adult. The different types of legal proxy:

Powers of attorney - a means by which individuals, while they have capacity, can grant someone they trust powers to act as their continuing (financial) and/or welfare attorney in case capacity is lost at some future point.

Guardianship order (welfare and/or financial) - may be applied for by individual(s) or local authority and granted by the sheriff where the adult has lost capacity and required someone to make specific decisions on their behalf over the long term.

Intervention order (welfare and/or financial) - may be applied for by an individual or local authority and granted by the sheriff to carry out a one-off action or to deal with a specific issue on behalf of the adult with incapacity.

Overall benefit

An assessment of the appropriateness of treatment and care options that encompasses, not only the potential clinical benefits, burdens and risks of those options, but also non-clinical factors such as the patient's personal circumstances, wishes, beliefs and values. This ethical principle closely relates to the legal principles of 'best interests' (England, Wales and Northern Ireland) and 'benefit' (Scotland).

Palliative care

Medical care focussed on the relief of pain, stress and other debilitating symptoms of serious illness. Palliative care is not dependent on diagnosis or prognosis and can be provided at the same time as curative treatment. The objective is to relieve suffering and provide patients with the best possible quality of life.

Second opinion

An independent opinion from a senior clinician who has experience of the patient's condition but who is not directly involved in the patient's care. The opinion should be based on an examination of the patient by the clinician. Exceptionally, where this is not possible for practical reasons, the clinician may give a second opinion remotely, for example by telephone, on the basis of up to date information about the patient's condition.

Relevant others

Anyone nominated by the patient, including close relatives, partners and close friends, paid or unpaid carers outside the healthcare team and independent advocates. It may, in some circumstances, include attorneys for property and financial affairs and other legal proxies.