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- To order Books/Cards/Forms
- Learn Before You Decide
- Natural Dying Living Will Cards
- Natural Dying® Living Will Cards (for religious observers)
- Plan Now; Die Later—Ironclad Strategy explained
- NATURAL DYING® FORMS for a Plan Now; Die Later—Ironclad Strategy
- DNR-Registry Medallion
- On-line Store
- Video series: Plan Now, Die Later--Peacefully
- Natural Dying®
- Natural Dying®
- Articles on End of Life Planning The Sooner Mother Dies the Better Palliative Sedation: Pros and Cons
- Slide Presentations:
For general audiences
- Free phone consultation
About Caring Advocates: The Mission, the Means, and the Professional Staff
- The Mission:
- To educate professionals and the public about what seems revolutionary now but had been for eons, the conventional way that most people died. People who were extremely ill simply no longer ate or drank. Cancer patients often completely lose their interest in Food & Fluid, and their wishes are respected since they can still speak for themselves. But for those patients who cannot currently voice their wishes, however, others sometimes impose their view of what is on them. The only way to prevent this from happening is to strategically create effective documents while patients still have the capacity to make their own medical decisions.
- To help competent individuals exercise the option of Voluntary Refusal of Food & which is legally available everywhere, which is peaceful if thirst is controlled, and which all competent patients can use (even those with extreme physical limitations such as paralysis).
- To promote a culture of extended quality of life based on the ironic fact that when people know they can control WHEN they will die, they can and often do decide to live longer. This is especially true for patients who have been diagnosed with early dementia. If those patients can feel certain that an effective plan has been created that others will honor in the future, then they can avoid the tragedy of premature a choice they might otherwise make only because they CAN, rather than because they WANT to die earlier.
- The Means: We can help you explore the options, create documents to empower your Proxy, and help implement your choices of what you consider BEST. Working with you, your family members, and your professional advisers, we can offer our advice and support if you are faced with tough decisions such as when to change the goal of treatment from hoping for a cure to seeking to heal and to comfort, or when to ask your local hospice for help. Discussions with us may lead to implementation by licensed professionals in your home state.
- Permit Natural Dying: A "must" topic to discuss: We encourage dialogue of all points of view to consider whether or not we need to change our state laws about the best way to treat patients who have (in lay terms) lost their minds in other words, who have or will soon lose all personhood. The professional term, "Devastating Irreversible Brain States" refers to three diagnoses: 1) permanently unconscious coma, 2) Persistent/Permanent Vegetative State, and 3) end-stage or advanced dementia. Currently, physicians must presume that these patients wish to indefinitely receive artificial nutrition and hydration. We encourage discussions to consider this alternative: Should doctors be required to Permit Natural Dying; that is, should new laws require doctors to withhold or withdraw treatment that reflects the presumption that patients in Devastating Irreversible Brain States wish to NOT prolong their biologic existence?
- Our policy of respect for your local advisors: The information provided on the Caring Advocates website is intended to support, not replace, the relationship that exists between a patient/site visitor and his/her physician, attorney, hospice provider, religious or spiritual advisor or other professional.
- Medical Team:
- Stanley A. Terman, PhD, MD, Medical Director
- Lofty Basta, MD
- David H. Huffman MD
- Lance Lee Davis, MD
- Ferdinando L. Mirarchi, MD
- Legal Team:
- Psychology Team:
- Pastoral / Spiritual Team:
Executive & Medical Director
Dr. Stanley A. Terman is a board-certified psychiatrist. He received an AB (Brown University); a PhD (MIT); and an MD (University Iowa). He was previously on the faculty of University of California, Irvine. He founded and now leads the non-profit organization Caring Advocates. The continuous thread of Dr. Terman's professional career is to empower people to make informed decisions so they can successfully meet challenges in their lives with more pleasure, less suffering, and improved relationships. For the last fifteen years, he has specialized on reducing the suffering of terminally ill patients and their loved ones, especially those faced with unending, unbearable pain, or the many challenges of Advanced Dementia. He is passionately motivated to prevent months to years of suffering from unwanted treatment that prolongs the process of dying, and also to prevent premature dying. This goal, which he teaches to other professionals, is thus to attain timely and peaceful transitions.
Dr. Terman is the author of a medical-legal thriller that deals with physician-assisted suicide, Lethal Choice, and three non-fiction books that offer effective Advance Care Planning, especially for Advanced Alzheimer’s Dementia. They are: (1) The BEST WAY to Say Goodbye: A Legal Peaceful Choice at the End of Life; (2) Peaceful Transitions: Stories of Success and Compassion; and (3) Peaceful Transitions: Plan Now, Die Later—Ironclad Strategy. (The last two are second editions.) He also created an illustrated Living Will tool called My Way Cards or Natural Dying Living Will Cards. (The latter is designed for religious observers.) Both use plain, straightforward descriptions with almost no medical jargon. Collaborating with prominent colleagues in medicine, law, and bioethics, he developed forms and produces videos for patients who wish to create an “ironclad strategy’’ so others can learn and will honor their Last Wishes. These tools and programs are explained by about three dozen free videos that can be viewed at www.YouTube.com/DrTerman—the “Plan Now, Die Later-Peacefully” channel.
Michael S. Evans J.D., M.S.W., is an attorney and has been a member of the California Bar since 1970. He is also trained as a social worker. For 13 years he was in private law practice which included litigation involving criminal defense, mental health commitments, and divorce. He taught at the graduate level in the School of Social Work, San Diego State University, and for six years at the University of San Diego Law School. More recently, he served as legal advisor to three right-to-choose-to-die organizations. He authored model Advance Health Care Directives to broaden the range of choices available under California's Health Care Decisions Law and he drafted model legislation to further expand end-of-life choices for Californians. He has served on two bioethics committees in San Diego. He served as critical reader and contributor to sections of The BEST WAY to Say Goodbye: A Legal Peaceful Choice at the End of Life. In the late 1990s he co-founded the Center for Professional Ethics and Law, a non-profit organization which among its projects, examined the impact of court-room advocacy on the professional ethics of expert witnesses during litigation. As legal advisor to the Center, he also counsels individuals on creating and implementing Advance Directives to meet the many challenges of making end-of-life decisions.
Reverend Dennis G. Kuby is an ordained Unitarian clergyman who
lives in Berkeley, California. He was a civil rights leader when serving
the historic Unitarian Society in Cleveland, Ohio, during the 1960s.
After serving as pastor of the Unitarian Church in Studio City, California, he created a specialized Ministry of Ecology that was officially endorsed by the Unitarian Universalist Association in 1974.
His book, Meditating with Marcus Aurelius  explains why the Roman Emperor's pantheistic existentialism has been his guiding light for compassionate ministry. Formerly President of the Bay Area Hemlock Society, and also Head of Hemlock Society of California (End of Life Choices of California), Rev. Kuby also formed Berkeley's Socrates Death Acceptance Fellowship. His active interest in the arts is represented by his also heading the Bay Area Salon Society.
David H. Huffman received his M.D. from the University of Kansas.
Board-certified in both Internal Medicine and Medical Oncology, he spent most of
his career treating cancer patients. He did his residency at Johns Hopkins
before becoming a Fellow and then a Clinical Associate at the National Cancer
Institute. For almost a quarter century, he has practiced in Colorado Springs,
where he was at times, Chief of Medicine and Chief of Staff at local hospitals.
He also was on the faculty of the University of Colorado Medical Center. Among
his many honors are being listed among "Best Doctors in United States" for
1998-2002, and he was granted the "Sword of Hope Award" by the American Cancer
Society in 2001. He has published over fifty articles, some short stories and
poems, and two novels:
SUMMER SOLSTICE , and WINTER SOLSTICE . Work has been completed on his third novel, ASH CREEK ROAD. Click Here for more information.
Dr. Lofty Basta is an Egyptian Coptic Christian who trained at the Royal Infirmary in Scotland and post graduate Medical School of London and University of Iowa Hospitals. He immigrated with his wife and children to the United States over thirty years ago. Dr. Basta has had a very distinguished academic and practice career, which includes serving as Professor of Medicine and head of the Cardiovascular Section at the University of Oklahoma Health Sciences Center in Oklahoma City, Oklahoma and founder of the Tulsa Heart Center. Most recently, Dr. Basta served as Professor of Medicine and Director of the Division of Cardiology at the University of South Florida College of Medicine, was Chairman at Tampa General Hospital and practiced cardiology at Clearwater Cardiovascular and Interventional Consultants in Clearwater, Florida.
An avid researcher, Dr. Basta has published well over 100 scientific publications in many distinguished medical journals. He is section editor of medical ethics and Member of the Editorial Board of the American Journal of Geriatric Cardiology. He is the author of three books; Cardiology for the Primary Care Physician, Graceful Exit, and Life and Death on Your Own Terms as well as numerous medical textbook chapters on end-of-life care. Dr. Basta's area of special interest lies in medical ethics, particularly in end of life issues.
Lance Davis, MD, MPH is board certified in Family Medicine and serves as Medical Director for the Odyssey Health Care Hospice in Charleston, South Carolina. Dr. Lance Davis is also the Project Leader and co-author of a patient centered guidebook on end of life care called, At The Close Of Day (visit: www.atthecloseofday.com). Dr. Davis serves on several professional advisory committees that deal with end-of-life issues, is an instructor in the ethics curriculum for medical students at the Medical University of South Carolina, and delivers frequent talks and media presentations on the subject.
Dr. Davis' interest in end of life care began in medical school and was honed in residency. He strongly believes that many patients in the modern medical system are "shuffled" through hospitals when they have advanced disease processes. Often, the lengthy conversations and in-depth communications required to orchestrate an effective and compassionate end-of life-plan are simply not held. Dr. Lance Davis strongly believes that prudent advance care planning can lead to vastly improved care and experiences for patients and their families when they must deal with the challenges presented by terminal illnesses.
A veteran of the war in Iraq, Dr. Davis also serves as a Naval Reserve Medical Officer. Lance enjoys active sports, singing and playing guitar, and promoting environmental and social issues.
Dr. Ferdinando L. Mirarchi is chairman of the Department of Emergency Medicine of Hamot Medical Center in Erie, Pennsylvania. He is an assistant clinical professor of the Department of Emergency Medicine, West Penn Allegheny Health System, Allegheny General Hospital , Drexel University School of Medicine. He is also a fellow of the American Academy of Emergency Medicine and the American College of Emergency Physicians.
After completing his undergraduate studies at Temple University in Philadelphia, Dr. Mirarchi graduated from the medical school at Western University of Health Sciences College of Osteopathic Medicine in Pomona, California.
Dr. Mirarchi has been nationally and internationally published in the field of emergency medicine. He has also been interviewed on the subject of living wills by both local and national media, including USA Today, the Associated Press, and ABC News. Dr. Mirarchi serves on the consulting staff for www.emedicine.com.
In his book, "Understanding Your Living Will: What You Need to Know Before a Medical Emergency." Dr. Mirarchi explains, "Many medical personnel see a living will and automatically think a patient doesn't wish to be treated," some equate the existence of a Living Will with a Do Not Resuscitate order, even for patients who condition is reversible. What can you do about this? His book provides the answer.
Philip P. Lindsley, J.D., is Principal and Attorney
of the San Diego Elder Law Center, which he founded in 1997.
He is a widely recognized elder and disability law attorney.
His practice is limited to Medi-Cal Planning and Asset
Protection, Conservatorships and Alternatives, Life Care
Planning, Probate and Estate Administration, and Special Needs
Mr. Lindsley has been designated a Certified Elder Law Attorney (CELA) by the National Elder Law Foundation, the only elder law certification recognized and accredited by the State Bar of California and the American Bar Association. Currently, Mr. Lindsley is one of only 32 Certified Elder Law Attorneys in the State of California.
A native San Diegan, Mr. Lindsley has been practicing law in San Diego County for more than 25 years. He performed his undergraduate and graduate work in Psychology at San Diego State University, and received his law degree from University of San Diego School of Law. He is a former Adjunct Professor of Law at the University of San Diego School of Law. He taught primarily in the areas of Conservatorship and Mental Health Law.
Mr. Lindsley is a member of the Trust, Probate and Estate Planning, and Elder Law sections of the San Diego and California Bar Associations. He is past floor leader of the San Diego County Bar Association's Probate and Estate Planning section of the California Conference of Delegates.
Mr. Lindsley's expertise in elder and disability law, and his passion for the needs of elders, their families and their caregivers, make him a frequent and popular lecturer to professional and lay groups.
Christina M. Trent, J.D. graduated with Distinction from Ball State University in Indiana in 2001. Three years later, she graduated cum laude from
Thomas Jefferson School of Law in San Diego, passed the exam that
admitted her to the California Bar, and soon thereafter, married. She
also began collaborating on the creation of Caring Advocates Project
using her legal expertise in both healthcare law as it pertains to the
dying process, and non-profit law.
Both a Libertarian and a Humanitarian, Mrs. Trent is a staunch advocate of individual rights. She believes the most basic of such rights is for individuals to choose the manner of their death, whether that includes limiting or maximizing medical life-sustaining procedures.
In her free time, Mrs. Trent enjoys writing and spending time with her husband and step-children.
Robert M. Gibson, Ph.D., J.D., is licensed both as a psychologist and as an attorney in the State of California. He earned his Ph.D., in 1997 at the California School of Professional Psychology in San Diego, and his J.D., in 1998 from California Western School of Law, also in San Diego. He is currently employed in a large skilled-nursing facility where he provides psychological services, including psychotherapy, cognitive assessment, and assessment of decision-making capacity for patients with a wide range of conditions. These include various forms of dementia resulting from head injury, substance use, progressive conditions like Huntington's disease, AIDS, and Alzheimer's disease, as well as a variety of physical conditions. He also maintains a private practice with a primary focus on the assessment and treatment of addictive behavior.
Dr. Gibson has also been active in writing or revising many of his facility's policies and procedures, addressing issues like advance directives, determination of capacity, surrogate decision-makers, conservatorship, danger to self/others, and various other topics. He is a member of his facility's ethics committee, the San Diego County Bioethics Commission, as well as chair of his facility's Quality of Life Committee. Additionally, he has been a presenter at the American Medical Director's Association (AMDA), California Hospital Association Center for Rehabilitation Services and Hospital Services for Continuing Care, and various other organizations. Topics have included dementia care and have generally emphasized the issue of decision-making capacity in a variety of contexts. Additionally, Dr. Gibson has experience conducting forensic evaluations with the San Diego County Superior Court Forensic Psychiatry Clinic.
Philip Kaushall, PhD, is a psychologist in private practice in San Diego, California. He received his BSc in Psychology from Bristol University, England; his MA from Simon Fraser University in British Columbia, Canada; and his PhD in cognitive psychology from Cornell University, New York. In addition to authoring about ten research articles, he wrote the college text, "The Growing Years" (McGraw-Hill), which covers human development from infancy to old age. He was Assistant Pediatric Research Neuropsychologist in the School of Medicine at UCSD. He has been recognized by the courts as an expert in forensic evaluations in criminal proceedings, and when issues of competence, dangerousness or sanity arise.
As a Diplomate of the American Board of Psychological Specialties in Neuropsychology, he performs evaluations in personal injury and disability cases, including stress and brain trauma that result from accidents, disease factors and assaults, and due to the physical and mental decline of aging. He evaluates a wide range of difficult family issues, such as when assumed authority can be misused, and whether to intervene in the lives of the elderly who seem to be losing their grip on either healthcare or financial decisions. He also evaluates the possibility of undue influence. He is particularly interested in philosophical questions concerning the nature of consciousness and of life itself, which issues have great personal relevance for the elderly and have recently been brought to the forefront of ethical debates by the case of Terri Schiavo and by technological advances in the neurosciences.
Alice Kahn Ladas, Ed.D., is licensed to practice psychology both in New Mexico and New York. She is a Diplomate in Clinical Social Work, Diplomate of the American Board of Sexology, a Certified Bioenergetic Analyst and a Humanist Celebrant. She is currently on the Board of the United States Association for Body Psychotherapy in charge of research. After being on the staff at the Payne Whitney Clinic of New York Hospital, she worked in the private office of Dr. Nathan Ackerman when he was founding Family Therapy. Dr. Ladas graduated with Honors, Phi Beta Kappa from Smith College and received her doctorate from Columbia University. An innovative pioneer in educated childbirth, breastfeeding, sex education and somatic psychotherapy, she has given talks and workshops throughout the United States, in Europe, China and India. She is the author of many articles and co-author of the NY Times best seller, "The G Spot and Other Recent Discoveries about Human Sexuality." This book has been re-published after more than twenty years and now exists in 18 languages and 29 countries. Dr. Ladas is now directing her talents to helping people make sure that others will honor their end-of-life wishes.
Vanessa Chicca, M.A. received her Master of Arts in Counseling Psychology in 2001 from Trinity College of Graduate Studies. She has been in the ministry of helping others since her ordination in 1992 with the Assemblies of God International Fellowship.
Miss Vanessa is the author of The Teeny Tiny Diet Book and the Create Your Own Cookbook Kit. In 2001 Miss Vanessa completed Leadership Chula Vista, a course designed and presented by the Chula Vista Chamber of Commerce. The course offered input from over 50 panelists from both the public and private sectors in the South Bay area.
An avid volunteer, she has been given numerous awards for her civic involvement including a recent Certificate of Congressional Recognition in March of 2005 by Congressman Bob Filner for outstanding and invaluable service to the community with the CAST program. Miss Vanessa has been a volunteer and trainer in the CAST program for over ten years. CAST works with the police and fire departments, lending emotional support to those in need.
Born in Mt. Vernon, New York and raised in Weston, Connecticut, Miss Vanessa now lives in Southern California with her husband Bob. They have three sons, three daughters and four grandchildren.
Pastoral / Spiritual Staff
Reverend Debbie Timmons is an Ordained Religious Science Minister who graduated from Holmes Institute Seminary in 2000. After being ordained in 2003, she spent a year in a Clinical Pastoral Education Residency Program in San Diego. She is also a certified Grief Recovery Counselor and a Reiki Master. (Her prior career also strived for excellence in the area of quality assurance in manufacturing.) She served as assistant minister at two southern California churches teaching, preaching, and providing pastoral care for congregation members. Currently she is sharing her ministry as a clinical chaplain at Sharp Grossmont Hospital in La Mesa, CA, and at Hospice of the North Coast in Carlsbad. She is the supervisor and instructor for the volunteer chaplain training program at Sharp Grossmont Hospital where she is an active member of the Bio-Medical Ethics Committee.
In the hospital setting, Rev. Debbie focuses on providing spiritual care to patients and families in the critical care areas where facing difficult end-of-life decisions is a daily challenge. When she teaches classes in Advance Directives at her church and at Sharp Grossmont, she is outspoken about the importance of planning for the way we want our lives to end, which deserves as much or more attention as planning our careers, families, retirements, and vacations. Actually, such decisions present difficult moral and ethical choices, given recent advances in medical technology. Rev. Debbie's professional and personal experiences taught her that embracing the natural ending of lives allows us to find deep and abiding value so we can live more fully and without undue worry and permits us to spend our passing time healing and communing with those we love.
The Venerable Mettanando Bhikkhu, M.D., Ph.D., Buddhist monk and physician. His education includes: M.D. from Chulalongkorn,: M.A. from Oxford, England (Sanskrit with Pali and Indian Buddhist Literature); Th. M. from Harvard Divinity School (Medical Ethics, Buddhist Socio-ethical approach to AIDS epidemic in Thailand); Ph.D., from Hamburg, Germany (Meditation and Healing in Theravada Buddhist Orders of Thailand and Laos). He now teaches at five Universities in Thailand and trains doctors and nurses in Thailand in the fields of medical ethics, hospice and palliative care. He teaches healing meditation at Chivasom International Health Resort, Hua Hin, Thailand. He serves as advisor to the Secretary General of Religions for Peace, the largest organization working for world peace through religion. He also represents this organization to the United Nations office in Bangkok. He is the architect of a new healthcare reform in Thailand modeled after his innovative plan to expand hospice, which will be called the Center for Quality of Life, and will emphasize religion, education, and healthcare services. In addition to teaching at five Universities in Thailand, he consults around the world. When traveling outside the United States, he is available by phone and by e-mail. His web site is www.mettanando.com.
Rabbi Moshe Levin was ordained at the Jewish Theological Seminary of America. Currently, he is the rabbi of Congregation Ner Tamid in San Francisco, and Rabbi Emeritus of Congregation Beth El in La Jolla, California after serving for 15 years as Senior Rabbi. During his career, he was a military chaplain in Southeast Asia for the U.S. Air Force during the Vietnam War, and held pulpit positions on the island of Curacao (Dutch West Indies), Greater Washington, and Los Angeles. He has a B.A. from Brooklyn College and an MHL from the Jewish Theological Seminary. He was a student of Bible scholar Nehama Leibowitz,, archeologist Yigal Yadin, Israeli philopshpers, Ernst Simone and Rodenstreich. He received rabbinic ordination from JTS Chancellor Louis Finkelstein, H.L. Ginsburg, Isaac Klein, Boaz Cohen, Saul Lieberman, David Weiss-Halivni, and Abraham Joshua Heschel,. His writings include: The Ethical Origins of Kashrut, Near-Eastern Birthrights & the Esau Jacob Narrative, Sexuality in Jewish Law and Tradition, and The Rabbinate for the 21st Century. He is the originator of several new ceremonies in the Jewish Life Cycle, including Shatli Turanita, the first contemporary one ever performed at the birth of a girl. His most recent lecture series is entitled, "A Rationalist's Approach to God, Torah, and Spirituality." Rabbi Levin is working on a book describing the uniqueness of Jewish spirituality.
Rabbi Levin, who is the father of six children, has an interest in end-of-life issues that is both professional and personal. His thirty-seven years in the rabbinate has brought him face-to-face with countless congregants, as they prepared for and dealt with their last transition, or that of their loved ones. On a personal level, sixteen years ago he was diagnosed with lymphoma and expected a maximum of only about eight years more. Having lived with thoughts of his own end-of-life decisions for all these years, he has come to believe that confronting death has made living far more meaningful. His enduring enthusiasm for life continues to inspire people of many faiths.
Rev. Dr. Christina Tillotson is a staff minister at Seaside. She teaches classes, speaks occasionally, and leads the Seaside Sage Connection, which serves people in the "better half" of life and those who love them. Christina's full-time Ministry is Distance Dean in charge of On-Line Education for United Church of Religious Science Headquarters and Distance Learning for the Holmes Institute.
Christina became a Religious Science Practitioner in 1987, a Minister in 2003, and was ordained in 2006. She has a BA in Social Work, an MA in Education, an MA in Consciousness Studies, and earned her Doctorate in Divinity in 2003.
Christina's passion is education. She has been a public school teacher and administrator, a community college instructor, a training manager for a software company, a business and marketing trainer and consultant, and an Internet trainer and consultant. She is honored to use these skills as a Minster at Seaside and at United Church of Religious Science to spread Science of Mind throughout the world. She frequently holds classes on the use of the "Five Wishes" as a way to help planning for how we want to die, and interest which stems strongly from her personal experiences.