About Caring Advocates: The Mission, the Means, and the Professional Staff
The Means: How we help
Our policy of respect for your local advisors
- The Mission:
- To educate professionals and the public about what seems revolutionary now but had been for eons, the conventional way that most people died. People who were extremely ill simply no longer ate or drank. Cancer patients often completely loose their interest in Food & Fluid, and their wishes are respected since they can still speak for themselves. But for those patients who cannot currently voice their wishes, however, others sometimes impose their view of what is “right” on them. The only way to prevent this from happening is to strategically create effective documents while patients still have the capacity to make their own medical decisions.
- To help competent individuals exercise the option of Voluntary Refusal of Food & Fluid—which is legally available everywhere, which is peaceful if thirst is controlled, and which all competent patients can use (even those with extreme physical limitations such as paralysis).
- To promote a culture of extended quality of life based on the ironic fact that when people know they can control WHEN they will die, they can and often do decide to live longer. This is especially true for patients who have been diagnosed with early dementia. If those patients can feel certain that an effective plan has been created that others will honor in the future, then they can avoid the tragedy of premature dying—a choice they might otherwise make only because they CAN, rather than because they WANT to die earlier.
- The Means: We can help you explore the options, create documents to empower your Proxy, and help implement your choices of what you consider BEST. Working with you, your family members, and your professional advisers, we can offer our advice and support if you are faced with tough decisions such as when to change the goal of treatment from hoping for a cure to seeking to heal and to comfort, or when to ask your local hospice for help. Discussions with us may lead to implementation by licensed professionals in your home state.
- Permit Natural Dying: A "must" topic to discuss: We encourage dialogue of all points of view to consider whether or not we need to change our state laws about the “best way” to treat patients who have (in lay terms) “lost their minds” —in other words, who have or will soon lose all personhood. The professional term, "Devastating Irreversible Brain States" refers to three diagnoses: 1) permanently unconscious coma, 2) Persistent/Permanent Vegetative State, and 3) end-stage or advanced dementia. Currently, physicians must presume that these patients wish to indefinitely receive artificial nutrition and hydration. We encourage discussions to consider this alternative: Should doctors be required to “Permit Natural Dying”; that is, should new laws require doctors to withhold or withdraw treatment that reflects the presumption that patients in Devastating Irreversible Brain States wish to NOT prolong their biologic existence?
- Our policy of respect for your local advisors: The information provided on the Caring Advocates website is intended to support, not replace, the relationship that exists between a patient/site visitor and his/her physician, attorney, hospice provider, religious or spiritual advisor or other professional.
Stanley A Terman, PhD, MD
Executive & Medical Director
Stanley A. Terman received his B.A. from Brown University, his Ph.D. from M.I.T., and his M.D. from U. Iowa. A board-certified psychiatrist, he was on the faculty of the University of California, Irvine. Now he heads Peaceful Transitions® and Caring Advocates®, whose staffs of clinical, legal, and spiritual professionals assist patients and families facing end-of-life challenges. Dr. Terman has participated actively in three bioethics committees in San Diego, and is on the consulting staff of the San Diego Hospice. He has appeared before California's Law Revision Commission and has served as chief of staff at a local psychiatric hospital. He sometimes testifies in civil cases as an expert. In his clinical practice, Dr. Terman assesses patients' judgment when they wish to create Advance Directives, appoint a power of attorney for medical or financial decisions, or Refuse Food & Fluid.
In these days of political polarities, Dr. Terman tries to maintain a balanced approach. He provides advice to those who wish to avoid prolonged, unnecessary end-of- life suffering or the progressive indignity and dependency of Alzheimer's disease and other dementias by exercising the legal peaceful choice of Voluntary Refusal of Food & Fluid (sometimes, by Proxy). Yet he has also criticized the actions of Dr. Kevorkian and declined to join the former Hemlock Society. If asked what beliefs he holds most dear, his answers are, "We are morally obligated to honor a patient's previously expressed wishes," and "Do everything possible to learn directly from the patient, what she or he wants." In the latter context, Dr. Terman's declaration was submitted to Florida Judge George Greer in the fiercely litigated case of Terri Schiavo.
Dr. Terman has written a medical thriller, Lethal Choice, which is based on a conspiracy theory of Physician-Assisted Suicide that explores end-of-life ethical principles, and is the primary author of The Best Way to Say Goodbye: A Legal Peaceful Choice at the End of Life. This "book-within-a-book" strives to meet the needs of both general and professional readers with memoirs, humorous tales, cartoons, practical guidelines, and over 250 medical references and legal citations. Dr. Terman is also the contributing editor to Last Wishes: Memoirs and Professional Advice on Peaceful Transitions, a forthcoming anthology.
Dr. Terman's interests in part are reflected by the titles of his lecture offerings: "Do We Need to Legalize Physician-Assisted Suicide" "Why Refusing Food and Fluid may be the BEST WAY to say goodbye" "How to plan ahead for a dignified death if the diagnosis is Alzheimer's" "A Critique of The President's Council on Bioethics report, Taking Care" and "Does art accurately reflect the last chapter of life?" (in which he discusses Hollywood's depiction of end-of-life decisions and dementia). Dr. Terman's family includes Elias and Alex (his sons); Sharon (his daughter); Alex's wife, Nadine; and Emily and Lauren (Beth's daughters). He lives in Carlsbad-by-the-Sea with his wife, Beth Gardner, and two Pomeranian dogs.
(Nurses and professionals from other fields will be added.)