1. Complete a clear and specific Living Will to speak effectively for you—if you cannot speak for yourself

The cards describe in words and line drawings what it is like to live in Advanced Dementia and other terminal illnesses—for you and your loved ones.

EASY: Sorting Natural Dying cards is EASY: Make one treatment decision at a time. Illustrated cards describe conditions using almost no medical jargon. Consider the condition and judge what treatment you do, or do not want. Then memorialize your choices in your Natural Dying–Living Will.

Diligent and Respectful: How will others make treatment decisions on your behalf? By “shared decision-making.” Your physician will evaluate your current condition. Your proxy/agent will present your judgments from your Living Will. Optional: Others–family members, counselors, and/or religious authorities–can provide additional input

Effective: To avoid conflict, use a clear and specific Living Will combined with a video of yourself where you explain your wishes clearly and convincingly. Avoid vague Living Wills that may prolong suffering. Until resolved, conflicts may result in To Delay is To Deny.

Safe: As many as four out of five physicians may unintentionally misinterpret Living Wills as DNR orders. Patients who are critically ill and who want CPR, may therefore not receive it–unless they add clear instructions in their Living Wills.

Why sort Natural Dying cards a second time?

There are two reasons to repeat the process in about a month:

  1. Think again after reflection and discussion with others.
  2. Prove your decisions are mostly consistent over time.

Both may prevent future challenges that claim you might have not really known what you were deciding, or that you have since changed your mind.

Can you change your mind? Yes, as long as you possess mental capacity to make end-of-life treatment decisions.
What might change? Your diagnosis; getting older: further reflection on your goals of treatment; a change of relationships; and further direct experience, reading or discussions with others.

Highly recommended: Review and update your decisions about one year later.
As a Caring Advocates member, you can revise and submit your choices any time, for your “UPDATED FINAL” Natural Dying—Living Will.

Important: When you sort the cards, you will be asked to indicate how strictly you want your future proxy/agent and your treating physician to follow the wishes you expressed.

How to submit your choices so you receive your Natural Dying Living Will.
Click Here

Differences between Natural Dying Living Will Cards and My Way Cards

Would you like more information regarding the differences between My Way Cards and Natural Dying Living Will Cards?

Natural Dying Living Will Cards are for those who want to be sure they are following the teaching of their religion. More Information:: How the Natural Dying Living Will works for religious observers)

My Way Cards are for those who wish to prioritize their autonomous right to self-determination.

Each version has its own set of introductory cards. For both, the 48 conditions described and the treatment options offered are the same. If you would like more detailed information, read this short article.

What if you are asked to make a decision for an Advanced Dementia patient who does not have a clear and specific Living Will?

Consider: “Consensus for Substituted Judgment”—a new, unique way to make treatment decisions.

When physicians ask loved ones or surrogates to make treatment decisions, there are two goals:
(A) Be accurate: make the same decision that patient would have made; and
(B) Minimize surrogate decision–makers’ stress.

How “Consensus for Substituted Judgment” works:
Briefly: Several people who knew the patient well before she became ill sort the cards as they imagine what treatment decisions the patient would have made for each condition . Reaching a consensus may maximize accuracy and minimize stress. More info

I am very impressed with what Dr. Terman has been doing at both a practical and theoretical level (an outstanding mix of the two) to improve the lives and control of people with dementia.

Dr. Tony Hope, founder and Director, Oxford University's Ethox Centre; leader of Nuffield Council's report, "Dementia: Ethical Issues"