Our MISSION is to help people attain a private, peaceful, and timely dying based on their values.

We try to reduce how long and how intense patients and their loved ones must suffer from any terminal illness, especially those living with Advanced Dementia.

We recognize the possible dire consequences of the “Dementia Fear”: after losing competence, others will force you to endure a prolonged dying with suffering.

We provide a method that strives to be “ironclad” solution so dementia patients never need to consider premature, preemptive suicide.

We provide a method for loved ones so they never need to consider prematurely hastening the patient’s dying by withholding treatment, or worse, by “mercy killing.”


One way to express this goal is:

Plan Now, Die Later®—to Live Longer

Caring Advocates consists of a team of clinical, legal, and pastoral professionals who are dedicated to help people attain private, peaceful, and timely transitions.

We offer Advance Care Planning that includes:

  • A unique patient decision aid—My Way Cards—that facilitates making decisions that reflect your values,
  • An end–of–life intervention—Natural Dying—designed to be both effective and acceptable to those in authority, and
  • Strategies to motivate physicians and others to honor your end–of–life wishes by writing the orders you need and by preventing others’ sabotage.

   

More about Natural Dying

Natural Dying can be effective even for patients who have “No Plug to Pull”; that is, for those whose living does not depend on medical treatment that is “higher–tech” than spoon–feeding.

Natural Dying strives to be accepted as clinically appropriate, legal, ethical, moral, and consistent with the teachings of most religions.

“Strategic Advance Care Planning”

  • Complete your Natural Dying Living Will to clearly express WHEN you want others to allow you to die of your underlying disease;
  • Use severe enough suffering as the single compelling criterion;
  • My Way Cards describe and illustrate 50 conditions. They are easy to understand and comprehensively reflect what people dread most about prolonged dying in Advanced Dementia and other terminal illnesses.
  • Add strategies to motivate future to write orders that honor your wishes, and to prevent others from sabotaging your plan.
  • Upload all forms and videos to a national registry from which physicians, emergency personnel, and others can readily retrieve them when needed.

Natural Dying is the alternative to Physician-Assisted Dying (Medical Aid in Dying) for patients who want to avoid prolonging dying with suffering in Advanced Dementia and other terminal illnesses.

A) Natural Dying does not actively cause patients' dying. Instead, patients die of their underlying disease. Example: patients die from severe impairment of mental functioning due to their brain disease, Advanced Dementia. (The physician orders for Natural Dying include stop assisting hand-feeding and hand-hydrating, but always offer food and fluid by placing them in front of patients and within patients’ reach.)

B) Natural Dying does not require alert patients to make a one–time, irreversible decision. Instead, they can change their mind after fasting for a few days;

C) Natural Dying and VSED (Voluntarily Stopping Eating and Drinking) are legal almost everywhere and do not necessarily depend on finding a physician who is willing;

D) MAiD—even where legal—cannot let patients die after they reach Advanced Dementia. Why? Two reasons: Patients usually live longer than 6 months, and their minds are not sound enough to make this extremely important decision: Do they want to continue to live in the face of severe suffering?

Strategic Advance Care Planning lets you express your end-of-life requests based on your values in a way that is clear, comprehensive, consistent, convincing, and compelling.


The Natural Dying Living Will is Unique:

 Compelling: Severe enough suffering is the single criterion used to determine when patients want to die of their underlying disease.

 Comprehensive: Patients (or their proxies/agents) judge over four dozen conditions that include what people dread most about prolonged dying in advanced dementia and other terminal illnesses.

 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 be allowed to die of their underlying disease.

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

 Respectful: Avoids conflict that could lead to either prolonged or premature dying by:
(A) The interpretation of observed feeding behavior can lead to mistakes and either premature or prolonged dying;
(B) Use of “stage of disease” can be arbitrary and/or irrelevant;
(C) Physicians imposing what they believe is in patients’ “Best Interest” can be paternalistic and not reflect patients’ values; and,
(D) Relying on such vague terms as “indignity” and “quality of life” could be ambiguous and lead to prolonged conflict, or worse: it could begin a dangerous slippery slope where one group of people assumes they have the right to judge if the lives of other people are worth living.

 Effective: Strategies can be added that strive to overcome more than 14 common challenges, rather than assuming—or hoping—that others will honor patients‘ clear and specific wishes.

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

 

Is your (or your loved one’s) living will adequate, effective, and easy to understand and complete?


Caring Advocates offers this time-limited, free service:
Send us your living will so we can offer our opinion.
Email your form to Dr. Terman: livingwillsdementiaetc@gmail.com
Or FAX your form to 888-767-6322

For electronic files that are too large to email, click here to upload.


General information:

Both Protocols are protected by trademarks, copyrights and 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 cost.

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

Dr. Terman devised a set of strategic solutions including ingeniously coupling a specially designed Advance Directive and a set of physician orders with adequate safeguards that reflect Dr. Terman's strong advocacy against ending life prematurely. Ironically, learning how to end life really empowers us to prolong our meaningful and enjoyable life.

Ronald B. Miller, MD, FACP, Founding Director of the Program in Medical Ethics, University of California Irvine