Ad Litem: See Guardian ad litem
Amicus Curiae Brief: Amicus curiae is Latin for "friend of the court." Amicus curiae briefs are reports to the court supplied by parties with some special expertise, but with no direct interest in the case.
ANH: See Artificially provided Nutrition and Hydration
Artificially-provided Nutrition and Hydration (ANH): Any of several methods for providing nutrition and hydration to patient who are unable (or unwilling) to take in food and fluids by mouth. See Different kinds of tube feeding explained.
Best Interests: This is an end-of-life decision making criteria that a number of state courts have invoked for incompetent patients, usually when there is not enough information to make a decision on the basis of "substituted judgment." It typically means choosing that course of action that "would probably be conceived by a reasonable person in the patient's circumstances." (This is a definition advanced by the President's Commission.) The Wisconsin Supreme Court argued that, while any analysis begins with the presumption that continued life is in the best interests of the patient, that presumption can be overcome by considering a number of factors, including; "the degree of humiliation, dependence and loss of dignity probably resulting from the condition and treatment; life expectancy with and without treatment; the various treatment options; and the risks, side effects and benefits of each of those options." See In re Guardianship of L.W. (1992).
Brain Death: Brain death involves the irreversible loss of all brain functions, including vegetative functions. The body can only be maintained for short periods of time (hours, or perhaps, days) even with aggressive treatment. These patients can be pronounced legally dead after two electroencephalograms, taken 24 hours apart, confirm the absence of all brain activity. Typically, vegetative functions are artificially maintained only long enough to harvest organs and tissues for transplantation.
Clear and Convincing Evidence: The "clear and convincing evidence" standard is really just a narrow, strict reading of the "substituted judgment" concept. With substituted judgment, a surrogate decision maker makes the decision about life sustaining treatment that he or she thinks the patient would make, if able, based on the patient's specific and general statements and general personal beliefs. When a court invokes the "clear and convincing evidence" standard, it usually implies that the surrogate must demonstrate that the patient clearly articulated a preference about not wanting a particular life sustaining treatment in a particular circumstance. If the standard of evidence is not met, the default is to provide all life-sustaining treatment for as long as the patient is alive.
It should be noted that some courts use the term "clear and convincing evidence" loosely and really allow for the more lenient "substituted judgment" process in coming to terms with what the patient would want. For example, see the Greenspan decision from the Illinois Supreme Court and the Gardner decision from the Maine Supreme Judicial Court.
Also, the term "clear and convincing evidence" is often used in reference to medical diagnosis and prognosis. It can mean, for example, that before a person can be considered to be in a persistent vegetative state (PVS), that determination must be certified by two specialist physicians, along with the patient's attending physician. See the Gardner decision from the Maine Supreme Judicial Court.
Coma: A coma is an unarousable, sleep-like conditions resulting from injury to the brain stem. A coma may last for an extended period of time, but rarely are they permanent, and many comas last only a few hours, days or weeks. Sometimes, a coma can evolve into a PVS.
Common Law: Common law refers to traditional, unwritten law based on custom and usage. Common law carries great weight in judicial proceedings next to statutory law (laws passed by the legislature and signed into law by the governor, or laws passed by a successful initiative process), case law (law based on appellate court opinions), and constitutional law (the law as it is enshrined in the state and federal constitutions).
Friend of the Court Brief: See Amicus Curiae Brief
Gastrostomy: See Gastrostomy
G-Tube: See Gastrostomy
Guardian Ad Litem: Guardian ad litem is Latin for "guardian at law" and refers in the medical decision making context to a person who is appointed by the court to look out for the best interests of the incompetent patient.
Intravenous (IV) Line: See Intravenous
IV: See Intravenous
Locked-In State: The locked-in state is sometimes referred to as the state of severe and permanent paralysis. Patients in a locked-in state suffer from a complete and irreversible loss of all motor functions, making it very difficult or impossible for them to acknowledge or communicate with others even though they maintain normal levels of consciousness. The end stage of amyotrophic lateral sclerosis (Lou Gehrig's Disease) is a common cause of the locked-in state. Diagnostic tests (e.g., CT scans and MRIs) can reliably distinguish between the locked-in state and the PVS.
Nasogastric (NG) Tube: See Nasogastric
NG Tube: See Nasogastric
PEG Tube: See Gastrostomy
Percutaneous Endoscopic Gastrostomy (PEG): See Gastrostomy
Persistent Vegetative State (PVS): A clinical condition of complete unawareness of the self and environment. Even though PVS patients may exhibit sleep wake cycles, they show no evidence of response to or understanding of environmental stimuli. Unlike with a coma, there is no reasonable hope for recovery for those in a PVS. Normally it takes up to 3 months to make a definitive diagnosis of PVS for patients who suffered a loss of oxygen to the brain. It can take a year to make a definitive diagnosis of PVS for patients who suffered a blow to the head. Although life expectancy for patients in a PVS is between two and five years, there a a number of cases where PVS patients are sustained on life support for decades. It has been estimated that there are somewhere between 15,000 and 35,000 PVS patients being sustained in the U.S. at any given time.
- Council on Ethical and Judicial Affairs (Council). 1990. "Persistent Vegetative State and the Decision to Withdraw or Withhold Life Support," Journal of the American Medical Association. Vol. 263, pp. 426-30.
- Multi-Society Task Force on PVS. 1994. "Medical Aspects of the Persistent Vegetative State" The New England Journal of Medicine. Vol 330, pp. 1499-1508 and pp. 1572-1579.
PVS: See Persistent Vegetative State (PVS)
Substituted Judgment: This standard of decision making permits the decision maker to take into account the patient's general value system and personal beliefs as well as previously made statements about medical treatments. The decision maker is to "stand in the patient's shoes" and make the decision the patient would make in the same situation, if able. The description of the concept in the Jobes decision (New Jersey) is often cited by other courts, and instructs the surrogate decision maker to refer to:
"the patient's personal value system for guidance. The surrogate considers the patient's prior statements about reactions to medical issues, all facets of the patient's personality that the surrogate is familiar with -- with, of course, particular reference to his or her relevant philosophical, theological, and ethical values -- in order to extrapolate what course of medical treatment the patient would choose."
Total Parenteral Nutrition (TPN): See Total Parenteral Nutrition
TPN: See Total Parenteral Nutrition