Artificial Feeding: procedures in which a person (patient) is fed by means other than self administration in an oral-enteral process. This may include medical enteral procedures (gastrostomy tube, nasogastric tube, transpyloric or transcutaneous enteral tubes), or parenteral nutrition (IV hydration/dextrose or total parenteral nutrition/hyperalimentation to include proteins and lipids.

Assent: a concept which applies to children (minors) and refers to their right to have their own perspective represented in all decision-making about his/her health care. The elements of assent include: a) a developmentally appropriate understanding of the nature of one's illness; b) a description of the proposed treatment and the experience it will involve for the child; c) an effort to solicit the willingness of the child to participate in the treatment.

Baby Doe Regulations: refers to federal legislation under DHHS: Child Abuse and Neglect Prevention and Treatment Program, Federal Register 1985, 50:1478-901, implemented in October of 1985. Addresses standards of care for sick/handicapped infants and limits acceptable withholding of treatment to situations in which: a) the infant is chronically and irreversibly comatose; b) treatment would prolong dying or not correct all life-threatening conditions; c) treatment would be futile and inhumane.

Best Interest Standard: an assessment of what is good for a patient, typically the incompetent patient/child/infant, in a particular clinical situation which respects the patient's dignity and worth as a person but which does not rely on the patient's own concept of his/her good. In the case of children, parents are presumed to have an important (but not necessarily sole) role in determining their child's best interest.

Brain Death: cerebral functions are absent (deep coma or cerebral unreceptivity and unresponsivity) and brainstem functions are absent (brainstem reflexes, respiration).

Cardiopulmonary Resuscitation (CPR): an array of interventions undertaken at the time of a cardiac or respiratory arrest in order to reestablish vital signs and bodily functions.

Competence: a term which may be viewed in a psychological sense to infer a necessary condition of acting voluntarily and apprehending information. Judgement of competence always requires a context. One legal concept of competence presumes that someone over the age of 18 year has the right to make decisions about his/her health care unless a judge has determined otherwise. This right includes refusing treatment even when others consider it to be in the person's best interest. Other legal standards cluster about various abilities to comprehend and process information and to reason about the consequences of one's actions.

Consent: refers to the self-determined decisions concerning one's own health care made by a person with the capacity and legal competence to make such decisions. The right of consent continues even when one is not conscious.

"Do Not Resuscitate" (DNR) Order: a signed order directing that no resuscitation efforts (CPR) are to be undertaken in the event of a cardiac or respiratory arrest.

Dilemma: moral obligations to others exist on both sides of the choice; ethical reasons that support choosing both alternatives.

Durable Power of Attorney: an individual's written designation of another person to act on his or her behalf, when the designation is authorized by a state's durable power of attorney statute. Under state law, a power of attorney terminated when the designating individual loses decision-making capacity, whereas the durable power of attorney does not.

Due Care: The care which a person should exercise in choosing and acting in order to have reasonable grounds to expect his/her action to have results in accord with his/her intention and his/her obligation to other people.

Duty: The conduct or action required of a person on moral grounds.

Emergency: A sudden, acute medical crisis in the condition of a patient, requiring immediate medical attention in order to avoid injury, impairment, or death.

Ethics Committee: a committee composed of persons from multiple disciplines, which usually directs its attention to one or more of the following: education of hospital staff and/or community on issues in bioethics; policy development or adaptation for procedures or guidelines in patient care and hospital practice which impact on bioethical issues; and case consultation in patient care which poses ethical problems.

Ethics: refers to principles of morality and right and wrong conduct. The study of moral conduct, systems, and ideas. Medical ethics refers generically to physician, nursing, and healthcare ethics.

Euthanasia: (Literally "good dying"); modern usage refers to the physician allowing death to take place without intervening (passive), or actively doing something to bring about death (active), in instances where medical care is concerned; often termed "mercy killing". Also considered in terms of being voluntary (at patient's informed, competent and uncoerced request;), or nonvoluntary.

Fidelity: truth telling.

Fiduciary: (Based upon trust); specifically, the nature of the relationship between the physician and patient based upon the patient's trust that the physician will act responsibly, that he will help and not harm, that she will advocate the patient's "good" at all times.

Formalism: a philosophical view that certain types of acts follow fixed moral principles (or rules) such that circumstances, including consequences, do not alter cases; deontology.

Futility: a term dealing with the hopelessly ill and dying; at least three meanings bear consideration:

Physiologic futility–the proposed intervention or continued treatment cannot reverse a physiologic condition in the patient that is leading to death. This strict definition of futility means that the intended medical effect of the treatment is not likely to occur, as determined by scientific evidence or local medical experience.

Personal futility–the proposed intervention or continued treatment may have the desired medical effect, but the resulting benefit does not outweigh the burden of continued life. This "best interest" or "disproportionate burden" definition of futility may mean that conscious- ness of the patient is not restored, or he/she will not leave the ICU, or that severe suffering will persist.

Social futility–the proposed intervention or continued treatment may have the desired medical effect, and personal benefit may outweigh the burden, but the treatment is not available, as determined by the social consensus, due to scarce resources.

Hospice: supportive and palliative care of the dying and terminally ill patient for whom curative intervention is no longer relevant. Hospice care may be provided in a facility such as a hospital or long-term care facility (nursing home), or the patient's home, and involves multiple disciplines which contribute extensive support services.

Institutional Review Board (IRB): a hospital committee concerned with the review, revision, and implementation of research protocols which address implications for human research and ethical issues of research in general. IRBs are regulated by federal guidelines.

Living Will: a written treatment directive (advance directive) directing what forms of medical treatment the individual wishes to receive or forego should he/she be in given (stated) medical conditions (typically irreversible coma, severe dementia, or terminal illness), and lack decision-making capacity.

Morals: the conduct and codes of conduct of individuals and groups. Three popular uses exist: a) in contrast to immoral (right versus wrong); b) in contrast to nonmoral (actions which have no bearing or question of right or wrong); c) "morals"... the behavior pattern of an individual or group.

Palliative Care: medical interventions intended to alleviate suffering, discomfort, and dysfunction but not to cure (such as pain medication or treatment of an annoying infection).

Persistent Vegetative State (PVS): a condition following significant brain injury in which the patient is permanently unconscious, comatose, but retains "vegetative" (autonomic) functions for a prolonged (perhaps indefinite) period. Neocortical functions are irreversibly lost.

Physician-assisted Suicide: the assisted (facilitated) suicide of a patient by a physician; the patient commits suicide by some means provided by, or with instructions from, the physician.

Proxy Decision Maker: a designated person who will act on behalf of an individual who become incapable of making decisions. Such an individual may be designated by an advance directive (Durable Power of Attorney for Health Care).

Reasonable Person Standard: a standard used when neither substituted judgement nor the best interests standard is applicable in decision making. The patient (typically incompetent or never competent, i.e. infant or mentally impaired) has never previously expressed their wishes. Two situations generally require that this standard be applied: 1) some permanently unconscious patients (e.g. some patient in PVS) who have no interests in the usual sense of the word and cannot be benefited or burdened; 2) some incapacitated dying patients left on life support to preserve organs for transplantation.

Rights: those things to which people have a just claim; a claim to a condition to which the individual is entitled.

Substituted Judgement: the use of previously expressed (written, spoken or implied) directions by an appointed proxy or surrogate to carry out the patient's wishes for health care when the patient is unable to participate actively in decision-making. These substituted "judgements" (directions/decisions) are actually those of the patient, or consistent with what he/she would make, and are only communicated by the proxy.

Surrogate: an individual whose role it is to make health care decisions for another person (e.g. parent, spouse, designated proxy).

Surrogate Mother: a woman to agrees to carry the developing fetus of which is not the biologic contributor of the ovum; pregnancy is typically the result of implantation of an early dividing conceptus from two donor's gametes fertilized under in vitro conditions.

Terminally Ill: having an incurable or irreversible condition that has a high probability of causing death within a relatively short period of time with or without treatment (e.g. 6-12 months).