“Now Care Planning”

Now Care Planning” is for patients who already reached advanced dementia—but lack a living will that is adequate, effective, and acceptable—so their physicians honor what proxies/agents know for sure the patient would want now. Now Care Planning uses “Substituted Judgment.” Those who knew the patient well give their opinions on how the patient would have responded to the patient decision aid My Way Cards—a unique tool that . . .
 Uses Severe enough suffering as the single compelling criterion to inform others when the patient would prefer to be allowed to die of his/her underlying disease.
 Describes and illustrates about 50 conditions that are easy to understand and comprehensive as they reflect what people dread most about prolonged dying in advanced dementia and other terminal illnesses.
 Uses the intervention Natural Dying that can be effective for all patients, including those who have “No Plug to Pull”; that is, whose lives do not depend on continuing high-tech, life-sustaining treatment.

Plan Features

Start the program to answer, “Does the patient qualify?” (FREE) Optional: Read the PDF.
FREE trial of an excerpt of the online program (Optional)
“Plan to Plan”
Consultation with end–of–life Planning Counselor

“Six Steps to Now Care Planning”:
Overview, optional reading. Receive the readable PDF via email.

Step 1: Does the patient qualify for Now Care Planning? (Online)

Step 2: Does the patient resist being spoon-fed? (Note: this behavior is not required.) (Online)

12-condition excerpt of the full program. You answer: “Would the patient have judged any condition causes severe enough suffering to want to be allowed to die?” (Completing this excerpt can expedite your finishing the “Full Bundle.”) (Online)


 Consultation with family members, and with the patient, if possible.
(Often covered by health insurance.)
Contact us to arrange a FREE 10-Minute telephone consultation.
Email or phone: dr.terman@psychiatricalternatives.com
800-64 PEACE (647-3223)
Or purchase Consultation Time with Dr. Terman or another clinician.



Steps 3 to 6: Complete the full bundle. Treating physician may decide to write the orders for Natural Dying.




Step 1: Do concerned individuals who know the patient’s values, think the patient qualifies for “Now Care Planning”?

Step 2: Does (or did) the patient show resistance to being spoon–fed? (Not required.)

Step 3: Loved ones use “My Way Cards” to express their opinions about 49 conditions: “When the patient had capacity, would s/he have judged this condition–by itself–causes severe enough suffering to want others to allow him/her to die of their underlying disease?”

Step 4: Discussion with counselor to answer:
(A) Is there a “Consensus of Substituted Judgments” for one condition for which the patient would want Natural Dying?; and,
(B) Has the patient reached one such condition, NOW

Step 5: “Shared decision–making” with treating physician, to consider signing a pre–printed Physician Orders for Life–Sustaining Treatment order form and to request a second bioethics or independent clinician opinion.

Step 6: The treating physician reviews the second opinion; holds a conference; may then write orders for Natural Dying; if not proxy/agent and counselor consider other options.

Want to learn about our other Protocol, Strategic Advance Care Planning? Click here.