Where You Can Start: How to Get Involved:

Here are some of the ways we can help:

  1. Your Caring Advocates Certified Planning Professional will evaluate you regarding whether a Physician Order for Life-Sustaining Treatment (POLST); and/or the combination, Advance Directive to Permit Natural Dying and Physician's Orders to Permit Natural Dying (AD/PO-PND) are appropriate for you. Click here to download an Evaluation Copy. (Many people find it a good idea to look this over before visiting with your Planning Professional or Physician.)
    1. Did you have mental ability to make end-of-life medical and care decisions?
    2. Were you fully informed about the Physician's Orders to Permit Natural Dying?
    3. Did you willingly give competent, voluntary consent to the Physician's Orders to Permit Natural Dying? (Opinions A, B, & C must be confirmed by your personal Physician.)
    4. Did you want to invoke an irrevocable (Ulysses contract) for withholding food and fluid so that your dying and suffering will not be prolonged? (We can clarify this option.)
  2. Caring Advocates will provide you with a DVD of your interview above so the video can be used as proof in the event others challenge your wishes after you are no longer competent.
  3. Your Planning Professional will help complete your Advance Directive to Permit Natural Dying and guide you to making it legally valid by the signatures of qualified witnesses.
  4. Your Planning Professional will also explain why you might want to consider signing and distributing a Patient/ Proxy Contract of Agreement while you wait to copy and distribute your AD/PO-PND until it is time to Permit Natural Dying.
  5. With your permission, your Planning Professional can send a Physician a letter to become your Implementing Physician. It asks him/her to sign your PO-PND, cites laws that provide your Physician legal immunity, and states that distributing PO-PND complies with HIPAA.
  6. Caring Advocates will create a life-time registration of your AD-PND/PO-PND and provide you with a wallet card so that others can retrieve your documents by Internet download or by FAX on a 24/7 basis. Then, others can immediately learn about your end-of-life wishes. We can help you order "alert jewelry," which will reflect the order that first responders need to know, including DNR (No CPR; Do Not Attempt Resuscitation), but which you should NOT wear until your Proxy or your Physician determines that it is time to Permit Natural Dying. In California, two other orders are important and should be included: "No IVs or Oral Hydration," and "Palliative Sedation-OK" since both items were "gutted" from California's "Terminal Patients Right to Know Act." (See Chapter 2 in the book Peaceful Transitions.) An alert bracelet, charm, or necklace with a medallion is highly recommended for all states since many EMTs and paramedics are trained to respond to its orders if your PO-PND cannot be immediately found on the refrigerator door.
  7. Caring Advocates will send you the following books, CDs, and DVDs:
    1. The BEST WAY to Say Goodbye: A Legal Peaceful Choice at the End of Life by Stanley A. Terman, PhD, MD, with Michael Evans, JD, MSW, and Ronald Miller, MD's book-within-a-book self-help manual and comprehensive resource.
    2. On Natural Dying, a 2-CD, 2- DVD set that includes radio interviews, patient stories and discussions of Advance Care Planning, thirst control, autonomy, and social justice.
    3. Peaceful Transitions: An Ironclad Strategy to Die When and How YOU Want by Stanley A. Terman, PhD, MD's guide to successful planning your final navigation.
    4. Dying Wishes documentary DVD: a pancreatic cancer patient's peaceful transition.
    5. Graceful Passages: A Companion for Living and Dying, a book and 2-CD Set by Michael Stillwater and Gary Malkin that includes calming music and spiritual narrations.
  8. Caring Advocates' team is available to provide advice and support for your Proxy when the time comes to implement the Physician's Orders to Permit Natural Dying.
  9. Caring Advocates team will send you a Thirst Reduction Aid Kit (TRAK) to effectively reduce or eliminate the symptoms of dry mouth.
  10. Optional: Caring Advocates will consider requests to designate two people on our team as your legally designated Proxies (Agent/Surrogate/Durable Power of Attorney) so you can be certain that someone will be there to speak for you, if you cannot speak for yourself.

Click here for information about your free, 5-minute telephone conversation, or call Stacy at 1.800.64.PEACE (647.3223) to discuss your options for help.




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Which of these categories characterizes you: Patient, Proxy, Health Care Provider, Attorney, Pastoral Counselor, Policy/Law Maker, Advance Care Planner, Ombudsman, Nurse, Social Worker, Bioethicist, Caregiver, Psychologist, Caregiver, Physician Assistant, other? (If listing more than one, do so in order of current importance.)
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Interview By Internet...
to create and to memorialize prudent end-of-life decisions
Download PDF

What: A free interactive webinar to introduce a new technology that can facilitate and memorialize discussions with patients about their end-of-life preferences.

When: To be announced.

Where: Type www.inbyin.info in your internet browser shortly before the conference begins. Listen through your headset or your speakers. To interact by audio, plug your microphone into your computer. NOTE: Plugging in your microphone means you consent to recording your voice on this webinar. You can just listen in, although your name will be listed as a participant. (See confidentiality statement, below.)

Who: Stanley A. Terman, PhD, MD, Medical and Executive Director of Caring Advocates, a nonprofit organization in Carlsbad and San Francisco, California.

Why: People's two greatest end-of-life fears are prolonged pain and suffering, and enduring months to years of lingering in total dependency and increasing indignity--a state quite common in Alzheimer's disease. Only 29 percent of American adults have Living Will-type documents, according to studies cited by the American Bar Association. Interview by Internet combines innovative Internet technology with years of clinical experience to make people aware of the importance of clearly expressing their end-of-life choices. Our goal is to encourage more people to create more effective Advance Health Care Directives (Living Wills and Proxy Directives).

  • For patients, Interview by Internet offers an inexpensive, convenient way to explore and record their values and preferences. Patients need not even leave the comfort of their residence. Caring Advocates, a nonprofit organization, provides services based on need; fees are based on the patient's ability to pay.

  • For Proxies/Surrogates/Agents, Interview by Internet can increase their awareness that end-of-life decisions can be complicated while it broadens their range of choices. Often, physicians ask a patient's loved ones to make a life-or-death determining decision when these surrogates have little or no specific prior experience, training, or knowledge. Interview by Internet provides people with an opportunity to explore some typical challenging situations with a Planning Professional who has extensive experience in this area.

  • For Planning Professionals, Interview by Internet provides a means to learn their patients' end-of-life preferences. It also provides a means to assess and document whether or not their patients possess the mental ability to make sound medical decisions. Determining competence can be critically important for patients in the early stages of dementia who want assurance that their end-of-life decisions will be honored by others in the future. In the absence of assurance, patients who fear they will suffer greatly or be a burden to their families sometimes opt to end their lives prematurely or violently. Not knowing what legal options are available to avoid an unnecessarily prolonged dying may lead some loving spouses to commit the crime of mercy killing after which they suffer life-long guilt and painful memories. A few have even been imprisoned. Knowledge from Interview by Internet may help prevent such tragedies. On a wider scale, its goal is to honor patients' choices for end-of-life interventions.

    How: During the interview, a Caring Advocates Planning Professional explains the clinical points of a challenging case while the screen displays a summary of its main features. (Note: A recording of the most recent presentation is available at www.I-B-I.org.) The recording captures the patient's voice and face as the Planning Professional and patient discuss the patient's reasons for choosing or not choosing one of the several options presented. To memorialize the patients' end-of-life treatment preferences, Caring Advocates staff will burn a DVD and send it the patient who can then attach it to his/her Advance Directive as a legal exhibit. After further discussion about the patient's final end-of-life choices, the patient can ask the Planning Professional to send their personal physician a document that summarizes these choices. Once signed by their physician, this form will likely be accepted in all treatment settings. Called the Physician's Orders to Permit Natural Dying, this form incorporates safeguards that err on the side of life; yet it also informs patients about the most aggressive methods of Comfort Care and the most peaceful ways to avoid prolonging the process of dying.

    Goal: The ultimate goal of Interview by Internet is to assure patients and families that their final wishes will be honored so their transitions will be as peaceful as possible. Creating effective Advance Directives, including Living Wills and Durable Powers of Attorney is very important, but these documents cannot always be found in an emergency, and sometimes they are not as clear as they need to be when the time comes to make final choices. For these reasons, Caring Advocates offers to record patient's Interview by Internet and to send patients' physicians the Physician's Orders to Permit Natural Dying. This first of its kind comprehensive service for Advance Care Planning is available now throughout California. Caring Advocates will expand to other states this year.



    Note: A recording of the most recent presentation is available at www.I-B-I.org.

    About us: Caring Advocates' core team consists of 18 professionals in 6 states. Representing three areas -- clinicians, attorneys, and spiritual leaders -- their mission is "To Plan and To Honor End-of-Life Decisions."

    Dr. Terman is the author of two recently released books: a self-help book, The BEST WAY to Say Goodbye: A Legal Peaceful Choice at the End of Life, and a medical thriller, Lethal Choice.

    More information: www.CaringAdvocates.org; Ph: 800-647-3223; FAX 800-919-3613; email: drterman@gmail.com.

    For additional information and to schedule interviews, contact us below.

    Email:
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    Which of these categories characterizes you: Patient, Proxy, Health Care Provider, Attorney, Pastoral Counselor, Policy/Law Maker, Advance Care Planner, Ombudsman, Nurse, Social Worker, Bioethicist, Caregiver, Psychologist, Caregiver, Physician Assistant, other? (If listing more than one, do so in order of current importance.)
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    Statement regarding confidentiality: Some of the information below was provided by T.J. Davis of InstantPresenter. 5011 Argosy Ave, Suite 9; Huntington Beach, CA 92649; 714-890-3008; Fax: 714-362-3134; thomasd@instantpresenter.com or support@instantpresenter.com.

    InstantPresenter platform is provided by CosNet, Inc. It is built within Flash, a world-wide used plug-in for all browsers. Flash Player is owned by Adobe. Adobe publishes extensive security information to answer all questions regarding their plug-in. Information is at http://www.adobe.com/products/flashplayer/security/. The link states the specific security aspects of the Flash Player. More specific to the InstantPresenter platform, Davis stressed that their staff never accesses the user's hard drive except through the browser's "File Browse" method, to allow uploading of files. This is a secure and accepted method of accessing the hard drive. Also, the only things written to a user's hard drive are small Flash "cookies" to store settings. All of these "cookies" are well documented in the above link.

    Additionally, all archived recordings are 100% secure and are not viewed unless specifically requested by a customer. All CosNet, Inc. employees sign a confidentiality agreement to the effect that any misuse of intellectual property or client records will result in immediate termination and prosecution by governing State laws.

    Caring Advocates Planning Professionals will use the password option to help maintain the confidentiality of recordings. Caring Advocates provides patients and their Proxies these two options:
    A) They can retain their on-line recording keeping confidential their knowledge of the identifying name (URL) of the recording, which URL they can reveal only to their selected other concerned professionals, close friends, and relatives so they can access and view these recordings after they are first created and then, as critical decisions must be made. Log-in requires the viewer's name and e-mail to keep track of who viewed their recording; or,
    B) They can write the staff at Caring Advocates to request that they permanently delete the recording from InstantPresenter, knowing that once deleted, their recording cannot be restored. If this option is chosen, patients and Proxies must subsequently depend on their own secure storage of the DVD that Caring Advocates staff previously provided.

    For additional questions regarding InstantPresenter, email support@instantpresenter.com, or call toll free at (800) 706-6762. PowerPoint is a registered trademark of Microsoft, Inc. Flash is a registered trademark of Macromedia, Inc. Copyright 2005, CosNet, Inc. All Rights Reserved.

    For other questions regarding security, call Caring Advocates at 800 647 3223.