Access. Degree to which the health care system aids or inhibits an individual or group in gaining entry and receiving needed services in light of constraints in financing and delivery if care.

Active euthanasia. Intentional or direct ending of a human life either in response to a competent request (voluntary active euthanasia) or without such a request (nonvoluntarv active euthanasia).

Advance directives. Instructions (usually written) from a competent individual that stipulates the forms of medical treatment to be provided by caregivers and/or designates someone to act as a proxy should the person at some future date lose decision making capacity. Living wills and durable powers of attorney for health care documents are common examples. Legal provisions vary from state to state.

Assault. An intentional physical attack designed to make the victim fearful; produces reasonable apprehension of harm. Actionable under criminal and civil law.

Assent. Agreement to research or treatment given by a mature minor not legally old enough to give a valid informed consent.

Autonomy. 1) Derived from Greek words meaning "self rule." Referring to the patient's right of self-determination concerning medical care. Autonomy may be used in various senses including freedom of action, effective deliberation, and authenticity. It supports such moral and legal principles as respect for persons and informed consent. 2) Making decisions for oneself, in light of a personal system of values and beliefs.

Battery. The willful touching of one person by another without permission. Actionable under criminal and civil law.

Beneficence. The state or act of intentionally doing or producing good. The principal of beneficence involves duties to prevent harm, remove harm, and promote the good of another person. The obligation of health care professionals to seek the well-being or benefit of other patients. Duties of beneficence concern the welfare of others.

Best Interest standard. A judgment based on an idea of what would be most beneficial to a patient, usually pursued in the absence of a patient's expressed wishes.

Bioethics committees. An. interdisciplinary group that deals with conflicts of values in patient care in acute and long-term settings. Such committees discuss policy issues (e.g., regarding withholding and withdrawing of life-sustaining treatments).

Capitation. A method of payment for health services often found in health maintenance organizations and preferred provider organizations. A provider is paid a fixed amount for each person served for a period of time, without regard to the number or nature of the services provided to each person.

Certificate of need (CON). Document provided by state regulators that limits capital expenditures by hospitals, nursing homes, and other institutional providers to prevent duplication of services and facilities.

Common law. Laws developed via precedents set in court decisions rather than those passed by legislatures.

Competent. A legal concept that describes people who are able to make decisions for themselves. Minors are presumed to be incompetent, except under certain specified conditions. The corollary medical-ethical term is decisional capacity.

Confidentiality. The professional-client promise not to reveal information without consent.

Consent. See Informed consent.

Contract. A legally enforceable promissory agreement between two or more people that creates, alters, or terminates a legal promise to undertake stated obligations.

Cost benefit analysis. An analytic procedure to aid In balancing a procedure's or program's fiscal cost with its benefits, frequently expressed in dollars. Sometimes referred to as risk-benefit analysis.

Cost containment. The effort to control the overall cost of the health care delivery system. Government and insurance regulations that endeavor to create a more cost-effective system.

Defendant. The person in a criminal case who is accused of committing a crime. The party in a civil action against whom suit is brought.

Deontologism. The ethical theory according to which actions are judged right or wrong based on their inherent characteristics or principles rather than on their consequences.

Deposition A sworn statement made as part of the process of discovering the facts after a lawsuit has been filed.

Diagnosis related group (DRG). A patient classification system utilized in the Medicare prospective payment system that relates demographic, diagnostic, and therapeutic characteristics of patients to length of inpatient stay and amount of resources consumed.

Do not resuscitate (DNR). An order in a patient's record not to revive a patient who develops a cardiopulmonary arrest.

Double effect. A doctrine originating in Roman Catholic theology that holds that an evil effect is morally, acceptable provided a proportional good effect will accrue, so long as the evil is not intended.

Durable power of attorney for health care. An advance directive that goes into effect in the event that a patient who has completed such a document loses decisional capacity. Allows an individual to name a person(s) who is empowered to make health care decisions when the individual becomes incapacitated.

Emancipated minor. A teenaged minor, who is legally, independent of parental control and who can thus give informed consent to medical treatments.

Emergency. A sudden unexpected occurrence or event causing serious threat to life and health.

Euthanasia. The act of either permitting a person to die or intentionally ending a person's life, generally rooted in motives of mercy, beneficence, or respect for patient dignity.

Felony. A serious criminal offense commonly Punished by more than' one year's imprisonment (e.g., murder or burglary).

Fidelity. Being faithful to a person or principle.

Gatekeeper. The role of a manager of a patients care and treatment (by specialists and institutions) usually fulfilled by a primary care physician. Because the gatekeeper is charged with screening diseases and disorders, and recommending or approving interventions as necessary, the role is designed to enhance cost effectiveness.

Good Samaritan law. A legal doctrine designed to provide immunity from liability for those who stop to render aid in an emergency.

Guardian ad litem. A court-appointed guardian who acts on behalf of a person Involved in a lawsuit or court proceeding and who cannot act on her or his own behalf.

Health Care Financing Agency (HCFA). The federal agency within the Department of Health and Human- Services that administers the Medicare and Medicaid programs at the federal level.

Health maintenance organization (HMO). A system for providing comprehensive prepaid health care in which providers deliver health services to a group of subscribers at a predetermined cost.

Iatrogenic. A clinical problem or disorder that results from factors found within the health care environment. An example is the development of an infectious disease contracted during hospitalization.

Indictment. A formal written accusation ofa crime brought by a prosecuting attorney against a person charged with criminal conduct.

Informed consent. The legal and ethical requirement that no significant medical procedure can be performed until the competent patient has been informed of the nature of the procedure, risks and alternatives, as well as the prognosis if the procedure is not done. The patient must freely and voluntarily agree to have the procedure done.

Justice. The principle that states that fairness requires equals to be treated equally.

Living will. An advance directive document that allows a person in advance of a debilitating illness to state his or her preferences regarding the withholding or withdrawal of life-sustaining treatment or other significant medical interventions.

Macroallocation. The assessment and distribution of goods and services on a society-wide basis.

Malpractice. Negligent professional conduct or the improper discharge of professional duties that fails to meet the standard of care, resulting in harm to a person.

Managed care. An effort to contain health care costs by limiting inappropriate or excessive utilization of health care services.

Mature minor. A teenaged minor who may give consent because the physician judges that he or she understands the nature, purposes, and risks of the proposed treatment.

Medicaid. The federally aided, state operated and administered program that provides medical benefits for certain low-income persons in need of health and medical care. Typically people who are aged, blind, disabled or members of families with dependent children with one parent absent are included; regulations vary from state to state.

Medicare. The federal health insurance program for people age 65 and older who receive Social Security or Railroad Retirement benefits; it also incorporates persons who need kidney transplantation or dialysis, regardless of age or income.

Metaethics. The branch of ethics having to do with the meaning of moral terms and their justification.

Microallocation. The distribution of scarce resources on an individual or small-group scale.

Misdemeanor. An unlawful act of a less serious nature than a felony, usually punishable by fine or imprisonment for a period of less than 1 year.

Murder. The intentional, and willful taking of a human life.

Negligence. An act or failure to act as an ordinary prudent person in the performance of duties.

Nonmaleficence. The state of not doing harm or evil; see also beneficence.

Passive euthanasia. Intentionally allowing a person to die by withholding or withdrawing treatment or by permitting the disease process to progress without further intervention.

Paternalism. Treating another person the way a parent treats a child in an attempt to promote the other's good either without acknowledgment or against the other's wishes.

Peer review. The evaluation by practicing physicians or others of the efficacy and efficiency of services ordered or performed by other practicing medical professionals.

Plaintiff. The party to a civil suit whose lawsuit seeks damages or other relief.

Preferred provider organization (PPO). A contractual arrangement in which providers negotiate with group purchasers, either directly or through the insurer or other third party, to provide health services for a given population.

Primary care. The first-line level of health care typically found in a person's entry into the health care system, usually involving preventive services as well as diagnosis and treatment of common illnesses.

Privileged communication. Information communicated to an attorney, physician, spouse, or counselor that may not be revealed, even in court, without the consent of the person who made the statement.

Proxy consent. Voluntary informed consent given on behalf of another who is for some reason incapable of giving it for himself or herself.

Rationality. The capacity to draw reasonable inferences from the known to the unknown.

Substituted judgment standard. Decisions based on an estimation of what an individual would have chosen.

Suicide. The intentional, uncoerced, and direct causation of one's own death.

Suit. Court proceeding in which a person who alleges injury seeks damages or other legal remedies from another. The term is not usually used in criminal cases.

Third-party payer. Any organization, public or private (e.g., an insurance company) that pays or insures health or medical expenses on behalf of beneficiaries or recipients; payments arc usually, based on premiums received from the insured, an employer or a combination of the two.

Utilitarianism. The perspective that an action is morally justifiable because it produces the greatest balance of good over evil, taking into account all individuals affected.