For Dementia & All Terminal Illnesses-Effective Strategic Advance Care Planning or Now Care Planning

Transcript (slightly abridged): Hello, I’m Dr. Stanley Terman. I am a psychiatrist and bioethicist. As a bioethicist, I help people attain the ultimate goal of a peaceful and timely final transition. We hope this will be in our distant future, but we must complete our plan while we still can. Advance Care Planning has an immediate goal, also: to give you peace of mind now. But many people hasten their dying because of FEAR. What fear? Getting stuck in a condition that is either extremely painful or is characterized by burdens and the indignity of total dependency on others for all their care. Some lament, “If I don’t arrange to die while I still can, then I won’t be able to die when I would prefer.” What makes this wrong is the option to complete Strategic Advance Care Planning. If you can feel confident your future physicians and others will honor your end-of-life wishes — even if you cannot speak for yourself — then there’s NO reason to consider premature dying. Hastening your dying is NOT necessary. Sacrificing months to years of reasonably good life with your family would be tragic. A slogan captures this goal: “Plan Now, Die Later® to Live Longer.” Advance Care Planning is for any terminal illness. But certain diseases are especially feared and challenging. Older people now fear dying from advanced dementia more than from cancer. Three challenges are: ONE: You could live 3 to 20 years if spoon feeding continues if you, like most Advanced Dementia patients, are not dependent on any life-support treatment; that is, if you have “No Plug To Pull”; TWO: Your Living Will may not be clear or specific enough to inform others precisely WHEN you would want them to implement your advance treatment decisions; and, THREE: Your proxy/agent might find it difficult to convince your future physicians to honor your specific end-of-life treatment requests. To overcome such obstacles, you can start with a decision aid called “My Way Cards.” Sorting the cards lets you make “one treatment decision at a time” for each of about four dozen particular conditions, and leads to a clear and specific Living Will. Next, record an interview of yourself on video where you explain your decisions and provide additional details. Then, if a time comes when you cannot speak for yourself, others can view your video to learn WHAT specific treatments you wanted and why, and precisely WHEN you want these wishes implemented. In addition to designating several trusted individuals as proxies/agents, you can sign a bilateral contract with each so they can implement effective strategies to motivate a future physician to write the orders you want. What does successful Advance Care Planning look like? Others will implement your wishes when you would want… without conflict… promptly, privately, and peacefully. At best, “peacefully” applies both to your loved ones and to you. That’s because when incapacitated patients such as those living with Advanced Dementia lose their ability to communicate, they may be unable to say, “Doctor, it hurts right here.” For this reason, patients may endure pain that is unrecognized and therefore goes untreated. Sadly, this occurs more often than previously appreciated. What if your close relative has already reached the advanced stage of dementia but did not complete an effective Living Will? You can implement “Now Care Planning” — a new ethical method designed to help patients avoid being forced to endure a prolonged dying with prolonged suffering. Each of several relatives, who knew the patient’s life values well, can sort My Way Cards to express what they believe the patient would have decided. If these people reach a Consensus of Substituted Judgment, they can state: “Our relative would never want life-sustaining treatment to continue, if she knew she would be living in her present condition, which would only get worse.” If you live far from Northern California, or if travel is very difficult, InterviewByInternet.com is an application that allows live video interaction that is private, secure, and HIPAA-compliant, as health insurance companies require. For those who can travel to one of my offices, the one in Sausalito, California is spacious, has six windows, and offers handicapped parking and wheelchair access. Call 415 237 0377 to make an appointment. If you or your relative has Medicare insurance, my staff can explain how you may still receive reimbursement for the amount that Medicare usually allows, even though I am voluntarily NOT enrolled in Medicare. For more information, visit the www.CaringAdvocates.org website, read one of my four books or several articles on end-of-life challenges, and/or view one of dozens of YouTube videos. I hope this brief introduction motivates you to complete your Advance Care Planning. Again, I’m Dr. Stan Terman and, if there is any way I can possibly help, please let me know.