Glossary: Integrative End-of-Life Care

Death Doula

A death doula is a trained professional who provides support to individuals at the end of life, facilitating conversations about death, assisting with end-of-life planning, and offering comfort and guidance to ensure a peaceful and meaningful transition.

DNR or DNI

DNR/DNI stands for Do Not Resuscitate/Do Not Intubate and is a specific physician order. A DNR means that in the event of cardiac arrest, no CPR or electric shock will be performed to restart the heart. A DNI 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 (Deathwithdignity, 2024).

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 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 (Deathwithdignity, 2024).

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" (Deathwithdignity, 2024).