Now Care Planning Bundle


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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.