Dr. Stanley A. Terman. Dr. Terman is board-certified in psychiatry and a “grandfathered-in” bioethicist based on his writing and teaching. He is a former member of the faculty at University of California, Irvine. He founded and continues to lead the not-for-profit organization Caring Advocates. Since 2005, his career has focused on developing advance care planning protocols whose goal is to reduce end-of-life suffering of patients and their loved ones from all terminal illnesses, especially advanced dementia. Some of his recent publications are available on his author page at SSRN: www.tinyurl.com/TermanDementiaArticles .
Dr. Terman’s presentation is entitled, Traditional Advance Care Planning May Not Work, So Consider a Heretic’s Innovative Strategic Protocol.
(Dr. Terman notes thata secular heretic is a person who holds opinions about ideas, principles, or practices that differ from widely accepted, conventional, and/or established ones.)
First, Dr. Terman will explain why one cannot rely on the requests in living wills or the healthcare instructions of surrogates to determine end-of-life care – especially for patients living with advanced dementia.
Second, he will explain how he interviews and records on video, people’s preferences for future treatment that depend on the conditions they reach. Planning principals (persons engaged in ACP) can use the illustrated patient decision aid, “My Way Cards” that he created in 2009, which can be understood by people who have a grade-three level of reading comprehension, to generate their “Natural Dying Living Will.”
Dr. Terman will then expand on the role of the planning principal during his presentation. For example, if a planning principal judges a future condition would cause irreversible, severe suffering, she can decide to request the cessation of assisted oral feeding and hydrating, which order is added to Comfort-focused Care orders. If the future condition would cause moderate suffering, then Selective/Limited Treatment may be appropriate.
The resulting requests are designed to be easily translated into POLST orders. Planning principals can make their advance decisions and sign three to seven “Future POLSTs” during ACP as they engage with their provider in one POLST Conversation. Planning principals do not need to be seriously or terminally ill, frail, or expected to die within a year). They just need to fulfill the requirements to complete ACP.
Strategic Advance Care Planning requires more effort than traditional ACP, but it will likely be more effective than traditional ACP in fulfilling patients’ end-of-life goal-concordant care.
Dr. Terman’s approach emphasizes the right of each person to express her autonomy by refusing treatment that has become non-beneficial or that will cause harm as it considers the fair distribution of family and society financial and medical resources. (Note: this sentence reflects the four principles of bioethics.)