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 intend or cause the dying of patients. Instead, it makes sure patients‘ loss of ability to feed and drink is irreversible and due to severe impairment of their brain functioning. Physicians write two orders: one to stop assisting hand–feeding and hand–hydrating, and one to always offer food and fluid by placing them in front of patients and within their 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) Physician-Assisted Dying (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 critical decision: Is your current suffering severe enough to want to forego all life–sustaining treatment?

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:

 Clear: Descriptions strive to reduce ambiguity in interpretation.

 Comprehensive: Over four dozen conditions include what people dread most about prolonged dying in advanced dementia and other terminal illnesses.

 Consistent: Planning principals responses are reviewed so they can be
(a) consistent with general medical practice that focuses on “severe enough suffering”;
(b) internally consistent when compared with other responses; and,
(c) consistent over time.

 Convincing: Planning principals are interviewed so they can record on video, exactly WHAT they want WHEN, and WHY—in their own words, with as much detail they want.

 Compelling: Starting with “severe enough suffering,” one set of strategies is designed to make physicians feel compelled to write orders that honor patients’ end-of-life wishes. Another set of strategies is designed to prevent third parties from sabotaging patients’ goals.

 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.)

 Respectful and 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 such vague terms as “indignity” and “quality of life,” which can be ambiguous may also begin a dangerous slippery slope that ends with one group of people presuming they can judge if other people’s lives are worth living.

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


Dr. Terman has accurately and respectfully presented the Catholic position(s). I agree with the values he holds most dear: To do everything possible to learn directly from the patient what she or he wants; and to appreciate that one of life’s greatest joys—to be heard and respected—is especially true for needy and vulnerable patients in the last chapter of their lives.

John Gillman, Ph.D., ACPE Supervisor of Clinical Pastoral Education; VITAS Innovative Hospice Care, San Diego, California