Avoiding Prolonged Dying in Advanced Dementia:
       Why is it so important?
       How can healthcare professionals help?

        By Stanley A Terman, Ph.D., M.D.
        Psychiatrist and Bioethicist

       January 6, 2016; 11:30 am to 1:30 pm/video coming soon
       San Francisco Bay Area Network for End-of-Life Care     
Caring Advocates' Training Program for

HealthCare Professionals to Provide Effective Advance Care Planning Counseling


Patients who have a high risk of reaching the advanced stage of dementia may suffer from the “Dementia Fear.” Many wake up every day with this worry: “If I don't kill myself when I CAN, then I won't be able to die when I would PREFER.” Some loath the prospect of getting stuck in Advanced Dementia so intensely that they try to commit suicide before they have lost capacity. They thus sacrifice years of reasonably good living.

Among their reasons are: Not wanting to suffer the anguish of mental confusion, to suffer a dramatic change in personality, to be prone to bouts of anger and violent outbursts, and to be totally dependent on others for routine personal care. Less commonly appreciated but just as compelling, they do not want to risk chronic suffering from unrecognized and untreated pain.
(Recommended: View a 32-second video at https://youtu.be/-6FkR-9jhQ0 .)

Sadly, many patients are misinformed by “experts” who say there is no other alternative. Others are just not aware of what they can do: they can complete diligent, strategic Advance Care Planning so they can then feel confident that others will honor their wishes so they will die when they want—after they lose capacity.

Dr. Stanley Terman's presentation will explain how health care professionals can spread the word that “Premature Dying” is not necessary. His presentation will also contrast the ethical, legal, moral, religious, and practical aspects of four end-of-life interventions:

(1) Withholding all food and fluid per the patient's previous request;
(2) Withdrawing assistance of hand-feeding/drinking if the patient so requested in her Natural Dying—Living Will;
(3) Advance refusal of thickened food and fluid—even if the risk of aspiration pneumonia is high—if previously requested; and,
(4) The arguments for a new movement to change the law so that it would be legal to withhold food and fluid for patient whose symptoms of Advanced Dementia become severe enough.
The presentation will note new causes of concern and new emerging areas of hope.
One great concern is that the diagnosis of cognitive impairment among former NFL players is 19 times higher than in other men between the ages of 30 and 49. Now, thanks to Dr. Omalu, we know the cause: repetitive head trauma (without loss of consciousness) that leads to chronic traumatic encephalopathy (CTE). Dr. Terman wants to encourage discussions about ways to approach football players in high school and college about their risks. 
Dr. Terman will also note what changes in lifestyle can lower the risk of dementia.
Finally, he will describe a new program for health care professionals that will train them to help people complete effective Advance Care Planning, where effective means others will honor their wishes.
For those that can attend in person, here are the details:
Date: Wednesday, January 6th, 2015
Time: 11:30am-1:30pm
Fine Arts Hall - 1601 19th Avenue, San Francisco , CA 94122  (Street Parking)
Nate Hinerman, PhD or Sandra Fish
415) 305-9519 or email: info@sfeol.org

Also attached: a color brochure that succinctly describes Caring Advocates' new "Training Program for HealthCare Professionals to Provide Effective Advance Care Planning Counseling"

For further information, here is our contact information.

Linda Meyers
Executive Assistant & Community Events - Speaker Coordinator
Caring Advocates
800-647-3223  or  760-431-2233


Stanley A. Terman, PhD, MD
Board Certified in Psychiatry
Medical Director and CEO of Caring Advocates
32240 Encinitas Blvd. Ste. D, #334 Encinitas, CA 92024-4345
FAX: 888-767-6322
SKYPE: stan_terman (or 760-456-5633)
UK direct phone: 44 20 8123 7106
Australia direct phone: 61 03 9016 4284