Glossary of Terms
This is a list of terms and their definitions in relation to Dying With Dignity Canada’s mission and focus of work.
A B C D E F G H I L M N P R S T V W
A
Advance Care Plan: A generic term for the umbrella of planning documents in which you think about and express your wishes for future health care and treatment in circumstances where you can’t speak for yourself.
Advance consent: If you are eligible for medical assistance in dying (MAID) and choose to self-administer the medications, you can provide advance consent – a written arrangement with your provider to complete your assisted death by intravenous (IV) administration, in the event of complications. This is not the same as a waiver of final consent.
Advance Directive: A document, written while you are well and able to make decisions, in which you state your wishes for future medical or non-medical care. It is intended to ensure that your end-of-life wishes are respected in the event that you become unable to make decisions for yourself. The name of the document is different depending on the province or territory in which you live.
Advance (Health, Care, Medical) Directive: See Advance Directive.
Advance request: An advance request would involve a competent person making a written request for medical assistance in dying (MAID) that could be honoured later, after they lose the capacity to make medical decisions for themselves. Advance requests for MAID are not currently legal in Canada.
Advocate: See support person.
Agent: See Substitute Decision-Maker. Terms vary by province/territory.
Aid-in-dying: There are many terms used around the globe for medical assistance in dying, the term we use in Canada. Terms vary in jurisdictions with assisted dying laws. See medical assistance in dying.
AND: Acronym for “Allow Natural Death.”
Antibiotics: Drugs commonly used to treat infections.
Artificial hydration: To be given fluids via a small tube inserted into a vein (venous catheter or IV).
Artificial nutrition: To be fed by a method other than by mouth. This would apply if you were in a coma or otherwise unable to swallow, and may be administered by Nasogastric tube (NG tube) or Gastrostomy tube (G-tube or PEG tube).
Assisted suicide: There are many terms used around the globe for medical assistance in dying – the term we use in Canada. Terms vary in jurisdictions with assisted dying laws. See medical assistance in dying.
Attorney for Personal Care: See Substitute Decision-Maker. Terms vary by province/territory.
B
Bill C-7: Bill C-7 received Royal Assent on March 17, 2021. It was an act to amend the Criminal Code (medical assistance in dying) and most notably expanded eligibility to permit MAID for people whose natural death is not reasonably foreseeable.
Bill C-14: Bill C-14 received Royal Assent on June 17, 2016. It formally legalized assisted dying in Canada and laid out rules for how it could be accessed.
C
Capacity: Describes a person’s ability to a make a decision. In a medical context, capacity refers to the ability to utilize information about an illness and proposed treatment options to make a choice that is congruent with one’s own values and preferences.
Cardiopulmonary Resuscitation (CPR): Applying pressure to the chest, or an electric charge to re-start the heart, and sending air directly into the lungs to assist in breathing.
Caregiver: Someone who is providing care or support to a person who is critically ill or injured or needing end-of-life care.
Cerebrovascular accident: See stroke.
Chosen family: Non-biological kinship bonds, whether legally recognized or not, deliberately chosen for the purpose of mutual support and love.
Coercion: The practice of persuading someone to do something by using force or threats.
Coma: A profound state of unconsciousness in which a person cannot be awakened by pain, light, sound, or vigorous stimulation. There may be some movements, but these are not conscious acts.
Comfort care: Care of a dying patient to make them more comfortable when further medical intervention is refused or has been judged to be of no further value in treating the patient’s condition.
Conscientious objection: When a health care provider does not wish to provide, or participate in a legal and clinically appropriate treatment or procedure because it conflicts with their personal beliefs or values.
Cultural humility: A process of reflection and lifelong inquiry, involving self-awareness of personal and cultural biases as well as awareness and sensitivity to significant cultural issues of others.
D
Death café: A group directed discussion about death with no agenda, objectives or themes. It is a discussion group rather than a grief support or counselling session; however the environment is supportive to sharing difficult experiences.
Death doula: A death doula is a non-medical person trained to care for someone holistically (physically, emotionally and spiritually) at the end of life.
Death with dignity: A term or expression used when someone’s death is aligned with their values, and is generally peaceful without much suffering. It is also the name of a U.S. advocacy organization.
Delegate: See Substitute Decision-Maker. Terms vary by province/territory.
Dementia: A general term for the loss of ability to think, problem-solve, and remember, severe enough to interfere with everyday life. Dementia is the result of changes in certain brain regions that cause neurons (nerve cells) and their connections to stop working properly. The most common primary dementia syndromes are Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia. Each dementia syndrome has a recognizable disease profile.
Directive: See Advance Directive.
Do not resuscitate (DNR): A DNR order instructs health care providers to withhold Cardiopulmonary Resuscitation (CPR) if your heart stops beating. A request for a formal DNR order varies by province or territory.
E
Euthanasia: There are many terms used around the globe for medical assistance in dying – the term we use in Canada. Terms vary in jurisdictions with assisted dying laws. See medical assistance in dying.
F
Forced transfer: The term used when a patient is made to move locations for an assisted death because the facility they are in forbids or restricts medical assistance in dying.
Frailty1: Frailty is a term widely used to denote a multidimensional syndrome of loss of reserves (energy, physical ability, cognition, health) that gives rise to vulnerability.
G
Gender Expression: The ways you present gender, through your actions, clothing, demeanor, and more. Your outward-facing self, and how that’s interpreted by others based on gender norms. (https://www.genderbread.org/)
Gender Identity: Your psychological sense of self. Who you, in your head, know yourself to be, based on how much you align (or don’t align) with what you understand to be the options for gender. (https://www.genderbread.org/)
Grievous and irremediable: In Canada, to have a grievous and irremediable medical condition, a person must have a serious illness, disease, or disability, be in an advanced state of decline that cannot be reversed, and experience unbearable physical or mental suffering from an illness, disease, disability, or state of decline that cannot be relieved under conditions that the person considers acceptable.
Guardian: See Substitute Decision-Maker. Terms vary by province/territory.
H
Health (care) directive: See Advance Directive.
Heart failure: A condition where the heart is damaged and fails to pump enough blood to the critical organs in your body.
Hospice: A facility providing health care for the sick or terminally ill and support for loved ones.
I
ICE: Acronym for “In Case of Emergency”
Independent Witness: An individual who confirms the signing and dating of the MAID request. They must be at least 18 years of age, understand what it means to request MAID, and not benefit from the person’s death in any way.
Informed consent: The voluntary decision a patient makes after understanding treatment options, risks, and benefits.
Intensive Care Unit (ICU): Sometimes referred to as the Critical Care Unit, the ICU is a hospital ward with highly specialized staff. It is for the patient with a life-threatening illness or injury, including major surgery with a threat of complications, which need constant monitoring and the support of specialized equipment.
Intravenous: To give medication or fluids through the vein.
L
Life sustaining treatment: Treatment that replaces or supports defective bodily functions. It may be used temporarily for a treatable condition until the patient is stabilized. If there is no hope of the body regaining the ability to function normally, life support may simply prolong the dying process without the benefit of increased quality of life.
Living will: See Advance Directive.
M
Mandatary: See Substitute Decision-Maker. Terms vary by province/territory.
Mature minor: In Canada, the mature minor doctrine allows children who are sufficiently mature to make their own treatment decisions. Age of maturity varies by province and territory.
MI-SUMC: Mental illness – sole underlying medical condition
Mechanical breathing: Used to support or replace the function of the lungs. The ventilator or respirator is a machine attached to a tube, which is inserted into the patient’s nose or mouth and down into the windpipe in order to force air into the lungs. It helps people with a short-term medical problem. People with irreversible respiratory failure such as that caused by injury to the spinal cord or a progressive neurological disease will require long term ventilation; and in this case, the tube in inserted through a small hole at the front of the throat into the trachea (tracheostomy tube).
Medical assistance in dying (MAID): The term we use in Canada, medical assistance in dying occurs when, after you have met the eligibility criteria and with your consent, a nurse practitioner or physician provides or administers medication that intentionally causes death.
Mental illness or disorder: Conditions that are primarily within the domain of psychiatry, such as depression and personality disorders.
N
Neurocognitive medical condition: A general term that describes decreased mental function due to a medical disease other than a psychiatric illness. This includes conditions such as dementia, Huntington’s and Parkinson’s.
Nurse practitioner (NP): Registered nurses who have additional education and nursing experience, which enables them to autonomously diagnose and treat illnesses, order and interpret tests, prescribe medications, perform medical procedures and provide MAID in Canada.
P
Palliative care: As a specialized form of healthcare, hospice palliative care aims to relieve suffering and improve the quality of life for those living with a life limiting illness, as well as their families. Hospice palliative care addresses the specific physical, psychological, social, spiritual, and practical issues, and their associated expectations, needs, hopes and fears on an individual basis2. Most often this care is provided in a hospital or hospice setting but can be provided at home, and may be given in conjunction with medical treatment such as chemotherapy or radiation.
Palliative sedation: The administration, by a clinician, of drugs to lower your level of consciousness and relieve intolerable symptoms. Palliative sedation can only be used after consent from you or your Substitute Decision-Maker, although it is your health care provider who determines eligibility for palliative sedation.
Personal Directive: See Advance Directive.
Physician-assisted dying (PAD): There are many terms used around the globe for medical assistance in dying – the term we use in Canada. Terms vary in jurisdictions with assisted dying laws. See medical assistance in dying.
Power of Attorney/Power of Attorney for Personal Care: These terms usually indicate someone who is legally appointed to speak on your behalf if you lose capacity. Typically, you would have a witnessed document naming your Power of Attorney / Power of Personal Care and outlining their responsibilities. Terms and responsibilities differ across the provinces/territories. See Substitute Decision-Maker.
Provision: A MAID provision is the process through which a nurse practitioner or physician assists an individual, at their request, to intentionally end their life with the administration of drugs that can be taken orally or administered intravenously.
Proxy: See Substitute Decision-Maker. Terms vary by province/territory.
R
Reasonably foreseeable death: Natural death has become “reasonably foreseeable” means that, in the professional opinion of the medical or nurse practitioner, taking into account a combination of the patient’s known illnesses and physical frailties (age-related and otherwise), how or when the patient’s natural death will occur is reasonably predictable. This is not always mean the patient’s condition is terminal3.
Refusal or withdrawal of treatment: See Voluntary Stopping of Care (VSC).
Representative: See Substitute Decision-Maker. Terms vary by province/territory.
S
Self-administered death: In Canada, a physician or nurse practitioner can give or prescribe to a patient a substance that they can self-administer to cause their own death. Terms vary in jurisdictions with assisted dying laws.
Slippery slope: A logical fallacy that claims one event or action will lead to another, more extreme event or action.
Stroke: Damage to the brain caused by a blockage of blood flow, or bleeding into the brain. The degree of disability resulting depends on the location and severity of the initial cause.
Substitute Decision-Maker: Someone you appoint to make decisions on your behalf if you lose capacity to make decisions about your own personal care and/or finances. Terms and responsibilities differ across the provinces/territories.
Suicide: Suicide is death caused by injuring oneself with the intent to die.
Support person: Someone who assists a patient in navigating the health care system. This is not a legal role, nor is it the same as a Substitute Decision-Maker, although a Substitute Decision-Maker may also act as a support person.
T
Terminal illness: A medical condition which cannot be cured and has progressed to the point where death may be expected within weeks or months.
Track 1: If you are assessed for MAID as a Track 1 patient, it means your death is reasonably foreseeable. Safeguards differ for Tracks 1 and 2.
Track 2: If you are assessed for MAID as a Track 2 patient, it means you death is not reasonably foreseeable. Safeguards differ for Tracks 1 and 2.
V
Voluntary assisted dying (VAD): There are many terms used around the globe for medical assistance in dying – the term we use in Canada. Terms vary in jurisdictions with assisted dying laws. See medical assistance in dying.
Voluntary stopping of care (VSC): People who wish to allow their life to end naturally sometimes refuse or discontinue care which includes health care to prevent or cure illness. This may be referred to as voluntary stopping of care (VSC) or voluntary stopping of personal care (VSPeC).
Voluntary stopping of eating or drinking (VSED): Refusal or stopping of oral or tube delivered nutrition or hydration.
W
Waiver of final consent: A document that allows someone who has already been assessed and approved for MAID in Track 1 to receive it on or before their chosen date even if they do not have the capacity to consent at the time of the MAID procedure. It is a written agreement signed between a Track 1 patient and their MAID provider.
Wishes: See Advance Directive.
1 https://www.cmaj.ca/content/173/5/489
Empower. Inform. Protect your rights.