Caring Advocates: to plan and honor end-of-life decisions

An alternative to changing laws and fighting over names:
Individual Peaceful Transitions

by Stanley A. Terman, Ph.D., M.D.

In 1999 I was asked to lecture at the first Caring Friends organizational meeting of Hemlock of San Diego. I compared reasonable end-of-life depressions for which “self-deliverance” could be a rational decision to end pain and suffering, versus psychotic depressions that could lead to suicides that were emotionally based and possibly treatable. As I attended the meetings, I found a disparity between the name and the means of the Hemlock Society. Rather than educating members on the use of Hemlock or more modern kinds of poisons to hasten dying, they promoted the use of plastic bags. I learned some things that caused me great concern: A) Do plastic bags always work? (Two were reported to have failed.); and, B) Is dying with a plastic bag peaceful? (The cause of death is SUFFOCATION, which increases the level of carbon dioxide and can lead to the greatest anxiety humans can ever experience.)

Some (but not all) of my concerns were resolved by the innovation to use inert gases to replace oxygen. The change to dying by ASPHYXIATION would NOT be anxiety-provoking since there is no buildup of carbon dioxide. Yet it was still possible that this method was not peaceful. Introducing a blast of pure Helium into the cells of the brain and lung could cause them to explode like balloons, and might result in intense (although) brief pain. By the time this method of self-deliverance was introduced, however, I had become aware of another option to hasten dying; one that is definitely both legal and peaceful. That became the subject of a book, “The BEST WAY to Say Goodbye: A Legal Peaceful Choice at the End of Life.” Voluntary Refusal of Food & Fluid is a revolutionary but conventional choice to hasten dying.

Part of the book explains my personal experiment as I refused all Food & Fluid for four days. I learned a variety of ways to control the symptom of thirst and that hunger was not a problem. After the book was printed, two members of my family died by Refusing Food and Fluid this way. Both died peacefully. (The book has several additional stories.)

I believe people should have a choice, which should include Physician-Assisted Dying, but they must first be fully informed. The failure to change the law to legalize Physician-Assisted Dying does not necessarily leave patients with NO CHOICE but to endure prolonged pain and suffering. In my experience, about nine out of ten patients can refuse food and fluid, and this method to hasten dying offers several advantages including these: The additional few days of lucidity can allow the patient to change his or her mind and postpone the time of dying. It also allows for the exchange of healing goodbyes with loved ones, to resolve some individual spiritual issues, and to heal old relationship wounds. I have seen this process benefit my patients as well as members of my family.

I started the non-profit organization Caring Advocates in 2004 to help people decide what end-of-life choices seem best for them and to help them create strategic Advance Directive documents so that their Last Wishes would be honored in the future. I have since been delighted to have join the staff, professionals who had experience and respect for each person’s end-of-life choices and who could provide sound advice in their fields of expertise. They are leaders in three general areas: bioethics and clinical medicine; elder and end-of-life law; and spiritual and pastoral counseling.

The issue of reducing symptoms of dry mouth prompted the development of a second web site to inform people about ways to reduce thirst control (still a work in process: www.ThirstControl.com). Yet members of Caring Advocates can now request sending a TRAK (Thirst Reducing Aid Kit) by calling 888-Thirst-0 (888-844-7780). Members of Caring Advocates also receive discounts on the book. (At higher levels of memberships, the book is included.) Caring Advocates is recognized as a 501(c)(3) non-profit organization and its web site, www.CaringAdvocates.org, is certified by the Swiss organization, Honor On the Net Foundation (HON), which establishes and monitors web sites as meeting “standards for trustworthy health information.”

Given the amount of current discord among right-to-choose-to-die organizations (e.g., who owns what name), the staff of Caring Advocates recently decided to offer memberships not only to individuals and to families but also to other ORGANIZATIONS. Caring Advocates focuses its energy on providing service to its members, on educating the general public and the professions, and on engaging in research. Little energy is devoted to changing existing laws. In serving individuals who are facing the challenges of the last chapter of their lives, the goal of Caring Advocates is to quietly but strategically transcend political or territorial conflicts. Our goal is to facilitate peaceful transitions.

Caring Advocates appreciates that while existing local chapters of other organizations may welcome additional clinical, legal, and pastoral counseling or advice, they still want to retain their OWN NAMES and IDENTITY. Hence Caring Advocates now offers “Affiliation Memberships.” In other words, an organization called [“YOUR NAME”] can become an “Affiliated Member Organization” of Caring Advocates. Caring Advocates is NOT a 501(c)(4) political action organization; it is NOT interested in taking over other organizations; but it IS interested in providing service, education, and research to make our final transitions peaceful and consistent with our previously stated preferences. For more information, visit the web site, www.CaringAdvocates.org, and then call 800 64 PEACE (647 3223) and ask for Caring Advocates’ Medical Director, Stanley A. Terman, Ph.D., M.D.