Our MISSION is to help YOU and your LOVED ONES avoid a prolonged dying with unnecessary suffering.

Don’t sacrifice years of relatively good living by hastening your death prematurely.

Complete “Strategic Advance Care Planning” to feel confident others will honor your plan.

Then enjoy living until a future condition causes severe suffering.

That’s what it means to Plan Now, Die Later®–To Live Longer.

All Plans Include Our
Money-Back Guarantee

If you don't agree your Natural Dying Living Will is clear and comprehensive enough to express your end–of–life wishes, we will refund your payment.

My Way Cards examples

For Most:
No Suffering

For Most:
Severe Enough Suffering

Condition 0.0 Condition 8.3
Condition 3.3 Condition 3.3

People’s judgments vary

Condition 4.5 Condition 5.5

Initial Plan

Complete your Clear and Comprehensive Living Will by using My Way Cards—on a computer, tablet, or cellphone. Your requests will be Compatible with usual physician orders.

  • Generate your living will online by using the revolutionary My Way Cards.
  • Use the criterion, “If you reach a condition that causes severe enough suffering” (the most compelling criterion that is used world-wide for physician–assisted dying).
  • Use your personal values to express your judgment about 50 conditions: state which would cause you severe enough suffering to want to be allowed to die.
  • Your responses can provide a clear answer to the Living Will “when question.”
  • The 50 conditions comprehensively include what people dread most about prolonged dying in any disease, including advanced dementia.
  • Living Will requests are compatible with how physicians usually write medical orders.
  • Receive your Natural Dying Living Will as a PDF by email, and printed, by US Postal Service.
  • Receive a Proxy Directive valid in your state, to legally designate your proxies/agents so they can advocate the treatment decisions YOU made (or make decisions on your behalf).
Natural Dying Living Will

To get your unique link to the online program and forms by email, order the “Initial Plan” for $49 by clicking here.

Diligent Plan

Refine your Clear and Comprehensive Living Will so it is Consistent and Convincing, and memorialize it by recording your interview on video.

Everything in the “Initial Plan” PLUS:

  • A clinician reviews your decisions, and...
  • You will receive a video critique of your Natural Dying Living Will that points out any inconsistencies that you could think about before starting your “FINAL” NDLW (or text, if you prefer).
  • Receive a form to clarify your refusal of spoon-feeding.
  • Receive a form to insist on relief from any type of unbearable suffering.
  • Receive a form to refuse thickened food and fluid in advance.
  • Receive an additional “physician-friendly” version of your Living Will that...
  • Warns physicians of possible legal consequences—
    if their orders do not honor your known wishes.
  • Receive a printed guide, “How to be convincing in your video interview.”
  • Memorialize your explanations and provide details about your wishes by recording your interview on video.
  • The extra fee for professional services to conduct the interview and to record it on video (a) depends on which Caring Advocate clinician you request; and (b) is usually partially reimbursed by health insurance. You can also use the printed guide, mentioned above, with the person of your choice.
My Way Cards sorting

Everything is sent by US Postal Service, ready for your and witnesses’ signatures.

Strategic Plan

Strengthen your Clear, Comprehensive, Consistent, and Convincing Living Will by adding Compelling Strategies.

Everything in the “Initial” and “Diligent Plan” PLUS:

  • Instructions on creating your working “Decision Committee” using strong bilateral legal contracts.
  • Use the Natural Dying Agreement’s legal/medical/logistical strategies to overcome 14 common challenges and potential sabotage.
  • Use the Natural Dying Affidavit to summarize your wishes in a legal document that can be admitted as evidence in a court of law.
  • Complete 3 Physician Orders for Life–Sustaining Treatment (POLST) forms with orders pre–printed for your physician to sign. (We provide a national template that you can discuss with us or your own physician.)
  • Consider 3 scripts to record on video, your brief instructions to emergency responders, to improve the accuracy of their response. (You can record these short videos yourself or ask a Caring Advocates clinician.)
  • Again, the professional fees involved for discussing your options, and for recording your instructions on video, are usually partially covered by health insurance.
Doctor writing orders

Receive your Living Wills printed on heavy stock bright yellow paper, and your videos on a thumb drive by 2–Day Priority Mail.

Optional Read: “Six Steps to Strategic Advance Care Planning” (pdf) or (HTML)

Want to UPDATE and strengthen your previously completed “Final” Natural Dying Living Will? Click here.

Consider the “Diligent Plan”

Your efforts to be consistent and convincing may be necessary but not sufficient.

Consider the need for strategies to overcome 14 common challenges: click here.

Click here for a 10-minute slide show that reveals the opposition and its dire consequences.

Consider “Strategic Plan”

Click here to learn why you should consider uploading to a registry.

Recommended: Upload all your forms and videos to a national registry such as where physicians and others can quickly retrieve them.


Click for brief list

Together, these 50 conditions comprehensively include what people dread most about prolonged dying in Advanced Dementia and other terminal illnesses.

The key question: If you reached any condition that would cause severe enough suffering—do you want others not to prolong your dying and suffering?

The online decision aid My Way Cards works on your computer, tablet, and cellphone.
First, it informs you about each clinical condition.
Then it asks: “Would it cause severe enough suffering for you to want to be allowed to die?”
If “Yes,” you can choose Natural Dying—a way to die that is effective and peaceful; and that strives for others’ acceptance.

We send you a state–specific Proxy Directive so you can legally designate one person and alternates to speak for you—if you lose your ability to make medical decisions. We also send a guide on how to select and to empower your proxies/agents.

From your responses to My Way Cards, we generate and email you, your “Initial” Natural Dying Living Will. If you want to use it as your current Living Will, we print it and mail it to you by USPS, ready for signatures so that it can be legally valid.

We recommend using this Living Will as your initial draft and continuing your advance care planning efforts by reviewing your responses with diligent deliberation and discussion.

Click for brief list

Includes the “INITIAL PLAN” plus...

First we review your responses to the My Way Cards. Then a clinician discusses them with you on a phone call of about 10 minutes. We ask: Are your decisions consistent with “severe enough suffering”?

Using the responses you may have revised, we generate your “Final” Natural Dying Living Will and send you a second, “physician–friendly” version that is strategic. It warns future physicians about 3 dire legal consequences—if they write orders that do not honor your known end–of–life wishes.

We send you 3 forms to add to your Living Will. They clarify your refusal of force–feeding; let you refuse thickened food and fluid in advance; and let you consent to treatment to totally relieve unbearable end–of–life pain and suffering—even if medications must put you to sleep.

We print your Living Will on brightly colored, heavy stock paper and mail it by USPS, ready for signatures so it can be legally valid.

To make your wishes convincing——we recommend you respond to an interview that you record on video, where you explain the reasons WHY you made these advance treatment decisions. If you do not select one of our trained clinicians to interview you, we mail you a short “How To” guide so your responses for your oral Living Will can strive to be convincing. (Our clinicians can record on video, their opinion: Did you have enough mental capacity to make these advance treatment decisions?)

Click for brief list

Includes the “DILIGENT PLAN” plus...

You add strategies designed to overcome common challenges and sources of sabotage—so you can avoid conflict, or at least promptly and privately resolve conflicts—without going to court.

For more information about why even Living Wills that are clear, consistent, and convincing may be only necessary but not sufficient to be compelling so you can attain your end–of–life goals, click here.

One strategy further empowers your proxies/agents by asking each to sign a binding bilateral contract and to form your Decision Committee. Another strategy insists on using your high standards of evidence presented by opposing experts—if others claim that you changed your mind, no longer want Natural Dying, and revoked your Natural Dying Living Will—even though you have reached a condition that you had judged would cause severe enough suffering.

One especially challenging conflict is: Your “future demented self” indicates the desire for others to help spoon–feeding but you (as expressed in your Living Will) had decided on Natural Dying for your current condition. This “Strategic Plan” lets you invoke a strategy to resolve this potential conflict now!

Includes 3 “physician–friendly,” comprehensive Physician Orders for Life-Sustaining Treatment (MOLST, POST, etc.) forms that have pre-printed physician orders. The first can ask for cardiopulmonary resuscitation(CPR). The second can refuse only CPR (“Do Not Attempt Resuscitation or DNR.”) The third can request “DNR plus Natural Dying.” We can provide suggested scripts so you can record 3, shorter than one–minute videos to rapidly inform emergency first responders and physicians what treatment you do, or do not want.

Bil of Health Logo

Meeting the Challenges of Advance Care Planning for Advanced Dementia – A Social Justice Imperative.

Posted: 20 Mar 2020 05:36 AM PDT

By Dr. Stanley Terman

It is not easy to die of advanced dementia. Yet almost everyone has this goal: a dying that is private, peaceful, and timely.

Dementia patients cannot qualify for Medical Aid in Dying (Physician-Assisted Suicide). Usually, their only legal, peaceful option is to stop ingesting food and fluid. Yet some authorities strongly oppose this way of dying. Knowing that traditional advance directives are not effective, and learning that authorities may oppose newer “dementia-specific” directives/living wills, many patients harbor the “Dementia Fear.” They have reason to worry that others will force them to endure prolonged dying, possibly with increased suffering, perhaps for years.

Some patients strive to make their ultimate existential decision at “five minutes before midnight”—to live as long as possible. But they live with this source of daily anxiety, which decreases their ability to enjoy life: “If I wait too long, I will miss the opportunity to kill myself by losing my mental or physical capacity.” Some commit preemptive suicide, an option that requires sacrificing up to years of good living that is not only sad but tragic. Premature dying would not be necessary if patients could trust others to honor their end-of-life wishes.

End of Life Choices of New York’s directive attempts to overcome opposition by offering an “aggressive” option that totally dismisses patients’ feeding behavior as criteria to stop assisted feeding. But their alternative—reaching Stage 6 of any version of the Functional Assessment Staging Tool—brings up another problem: most physicians will continue assisted feeding even if patients manifest all the tool’s listed behaviors: patient needs help putting on clothes, bathing, and toileting; and has urinary and fecal incontinence.

Compassion & Choices’ Dementia Values and Priorities Tool lets planning principals choose one or two of 15 conditions as sufficient to be allowed to die naturally, and a separate list of 7 behaviors as sufficient to stop assisted feeding. Yet treating physicians and their organizations may insist patients’ best interest is to continue assisted feeding unless they manifest distress.

To overcome physician refusal, one could insist on the criterion, severe enough suffering. But clinicians recognize it is difficult to determine if non-verbal advanced dementia patients are experiencing severe suffering—especially with the certainty needed to allow patients to die.

Strategic Advance Care Planning could offer a possible solution: During advance care planning, planning principals judge each condition by responding to: “Would this condition cause severe enough suffering for you to want to die of your underlying disease?” To determine if it is time to stop assisted feeding, treating physicians then need only assess if their patients have contemporaneously reached at least one of these pre-judged clinical conditions.

The online patient decision aid informs planning principals what it is like to live with advanced dementia using 50 illustrated descriptions at a level of reading comprehension of grade 4, which many early stage dementia patients can understand. It achieves this by broadening the concept of suffering to comprehensively reflect what people dread most about prolonged dying in advanced dementia and other terminal illnesses. In addition to physical and emotional suffering, it considers existential suffering (loss of meaning in life and the ability to relate to others); suffering due to disruption of life narrative; suffering the disease causes loved ones; and moderate suffering from several conditions that add up to severe.

Recording planning principals’ semi-structured interviews on video can: memorialize their advance decisions; demonstrate if they possessed decision-making capacity; let them add personal details about their end-of-life wishes; and, most importantly, give them an opportunity to be convincing.

In cases of advanced dementia, clear, comprehensive, consistent, and convincing directives/living wills may not, by themselves, be effective. It is important that an advance directive include over a dozen strategies in order to compel physicians to honor, and to prevent third parties from sabotaging planning principals’ end-of-life goal.

The post Meeting the Challenges of Advance Care Planning for Advanced Dementia – A Social Justice Imperative appeared first on Bill of Health. Bill of Health was launched in September 2012 by the Petrie-Flom Center at Harvard Law School to provide a one-stop shop for readers interested in news, commentary, and scholarship in the fields of health law policy, biotechnology, and bioethics.

Why Can’t Advanced Dementia Patients Qualify for Physician—Assisted Dying / Medical Aid in Dying?

Reason One: Although they have a terminal illness, they usually live longer than 6 months.

Reason Two: They do not have sound enough judgment to decide when they want to die.

Strategic Advance Care Planning is the Alternative

After their brain disease causes patients to irreversibly lose their ability to self–feed and drink, they can qualify for Natural Dying. One of Natural Dying's physician orders is to always offer patients food and fluid.

So if their Living Will adequately informs others when they would want to die, it will then be arguably illegal to force–feed them.

The Top Five Reasons Your Living Will (Advance Directive)
Will Fail—If You Reach Advanced Dementia

  1. It ceases only life–prolonging medical treatment, which fails because you must also stop oral feeding since you have “No Plug to Pull.” (Sustaining your life does not depend on any high–tech treatment).
  2. It specifically asks others to withhold oral food and fluid from you, which fails because euthanasia is not legal. (Withdrawing assistance of spoon–feeding is legal.)
  3. It relies on your reaching a set of symptoms or behaviors or stage of dementia, which fails because these criteria are vague and subject to possible misinterpretation by your physician.
  4. It relies on judging your “quality of life” is low, or your “indignity” is high, which fails because physicians are likely to feel compelled to allow you to die only if your suffering is “severe enough.” (Also: these terms are dangerous because they may lead some people to presume they can judge whether the lives of others are worth living.)
  5. It fails to give you the opportunity to put extra effort into advance care planning so your requests are convincing and include strategies to overcome the resistance of physicians and to prevent sabotage by third parties.

Note: Case law has shown that proxies/agents are NOT EFFECTIVE without an adequate, effective, and acceptable living will.

 To send this video to others, click here If clicking the link does not work, click on the "Copy Link" button below to paste the web address into your email.
Or send them this link so they can view the video on our home page:

 If you prefer to read the slides (about 15 minutes), click here
To send the slide show to others, click here If clicking the link does not work, click on the "Copy Link" button below to paste the web address into your email.
Or send them this link:

Special, time-limited offer:

Send us a copy of your living will so we can offer our opinion.
Email your form to Dr. Terman:
Or FAX your form to 888-767-6322
For electronic files that are too large to email, click here to upload.

More About the Natural Dying Living Will

 Easy to complete: Illustrated and written at the 4th grade of reading comprehension, My Way Cards* can be used by many patients in early dementia to make judgments about future possible conditions.

 Straightforward to interpret: Physicians do NOT need to assess patients’ current suffering. Instead, physicians only need to determine if patients have reached a clinical condition that patients had previously judged would cause “severe enough suffering” for them to want to be allowed to die of their underlying disease.

 Acceptable: The intervention “Natural Dying” aspires to be accepted by authorities who can view it as clinically appropriate, legal, ethical, moral, and consistent with the teachings of conservative religions. (Explained in detailed, elsewhere.)

 Respectfully strives to avoid conflict that could lead to either prolonged or premature dying.
(A) Does not use observed feeding behavior, whose interpretation can lead to mistakes and either premature or prolonged dying;
(B) Does not use “stage of disease,” which can be arbitrary or irrelevant, and/or discriminatory;
(C) Does not impose what physicians believe is in patients’ “Best Interest,” which can be paternalistic and not reflect patients’ values; and,
(D) Does not rely on vague terms such as “indignity” and “quality of life,” which can be ambiguous and may begin a dangerous slippery slope that ends with one group of people presuming they can judge whether or not other people’s lives are worth living.

*My Way Cards to generate living wills for advanced dementia & all terminal illnesses—mostly online, with one exception.

Concerned about a loved one who reached advanced dementia lacking an adequate and effective living will?

Now Care Planning is a program that offers you and others who knew the patient well, a way to see if you reached a “Consensus of Substituted Judgment” regarding what treatment your currently demented loved one would certainly want NOW.

The goal of Now Care Planning is to motivate your loved one's current physician to write orders to prevent a prolonged dying with increased suffering.

Click to learn about Now Care Planning.

General information

Both Protocols are protected by trademarks, copyrights and by applications for patents pending with the USPTO.

Professional fees are typically covered in part by Medicare and other health insurance policies. Our staff can help estimate your net cost.

We offer HIPAA–Compliant Internet Video chatting and recording—if you prefer not to travel to our offices.

Your thoroughness on the legal matters, humor, and seriousness in facing this subject is astoundingly precious for me. My step-father’s ending was a nightmare over which we are still battling in court two years after his passing. His horrible ending with feeding tubes that he never wanted was due largely to the ignorance of his power of attorney. Your emphasis on completing a clear and specific Living Will is so right on…

Robin Alderman Zide:

Your identity is confidential and unknown to us--unless you provide an email or phone number for us to get back to you.