About EngagewithGrace.org

Contemplating End-of-Life Dignity

[By Staff Reporters]

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According to the website, Engage with Grace, we make choices throughout our lives — where we want to live, what types of activities will fill our days, and with whom we spend our time, etc. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent.

Somehow when we get close to death, however, we stop making decisions. We get frozen in our tracks and can’t talk about our preferences for end of life care. 



Death Studies

Studies loom out there — 73% of Americans would prefer to die at home, but anywhere between 20-50% of Americans die in hospital settings. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they’ve talked to them about their preferences.

But, end of life experience is about a lot more than statistics. It’s about all of us.

Genesis and Epiphany

In the summer of 2008, Matt Holt (Founder of Health2.0) and Alexandra Drane (President of Eliza) met with some friends for dinner. Over their second cocktail, they got deep into conversation about these very topics. Many of us live with such intent — why do we put the end of our lives in someone else’s control?  Why isn’t this topic a conversation that people are having? How could we help start it? And it hit them — What if we could work together to start a viral movement — a movement focused on improving the end of life experience?  What if we took responsibility for starting a national (even global) discussion that, until now, most of us haven’t had?

Engage With Grace

The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it.  Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide — wherever and whenever they can… at a presentation, at dinner, at their book club. Just One Slide with five questions to help get all of us talking about death. Just One Slide that we as a community could collectively rally around sharing — in meetings, at a conference, or over a drink.

This is the link to the slide, and this is what we are asking you to do …

Download the One Slidehttp://engagewithgrace.org/about/

Share it any time you can — at the end of presentations, at dinner, or at your book club. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself and for your loved ones. Then commit to helping others do the same. Get this conversation started.


Let’s start a viral movement driven by the change we as individuals can affect …and the incredibly positive impact we could have collectively. Donate just two minutes to adding just this One Slide to the end of your presentations. Get others involved. Help ensure that all of us — and the people we care for — can end our lives in the same purposeful way we live them.

Just One Slide, just one goal. Think of the enormous difference we can make together.


Your thoughts and comments on this ME-P are appreciated. Feel free to review our top

-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com


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28 Responses

  1. Dying More Efficiently – or- Death is Not the Restaurant Business Model

    Al Lewis, blogging elsewhere, offers this scenario when it comes time to die.

    “A restaurant which insisted on giving us more food than we wanted, and wouldn’t let us leave until we ate it all, and sent the other diners the check for our extra portions, would go out of business within hours.”

    In other words, except in the states of Oregon and Washington, we are not allowed to say, it’s time to leave no matter how ill we are. We have to wait for nature to take its course, at taxpayer or health insurance policyholder expense. And that’s the best-case scenario.

    The worst-case scenario is that we are kept alive against our will because we forgot to complete a form, or completed it but didn’t get two witnesses, or lost it, or the hospital can’t find it; or our loved-ones disclaimed it and changed the rules.

    Link: http://www.thehealthcareblog.com/the_health_care_blog/2009/02/dying-more-efficiently.html#comments



  2. Allow Natural Death

    This new AND concept has been presented to only several hundred hospitals throughout the United States as well as many hospices and nursing homes.

    Many are considering adding AND to their language, in order to reflect better the needs of their terminally ill patients. The Hospice Patients Alliance group supports the creation of this new end of life care designation (A.N.D.) which is designed to increase the number of terminally ill patients who are allowed a death with dignity.

    For example, AND is currently being used at the Round Rock Medical Center within the St. David’s Medical Center health system. For more information on A.N.D., please contact Chaplain Amy Donohue-Adams by phone at 512-341-6493, and by e-mail at: amy.donohueadams@stdavids.com

    Source: http://www.hospicepatients.org

    Dr. David Edward Marcinko; MBA


  3. For more on the consequences of end-of-life-care, especially in the current politically charged envioronment:


    Hope Hetico; RN, MHA
    [Managing Editor]


  4. National Health Care Decisions Day

    Last Friday April 16th, 2010 was National Health Care Decisions Day; and the ME-P missed it!

    This national campaign aims to encourage people to complete advance directives or living wills to document end-of-life-wishes. Fortunately, there is still time to participate and engage with grace.

    Just visit this link:




  5. Bringing MDs to the Bedside of the Dying

    A new initiative, started with a $3.2 million grant from the Healthcare Foundation of New Jersey, is part of what many believe is an expanding movement in medical education – a growing emphasis on the human side of medical care.


    Gosh; isn’t it about time?



  6. Ars Moriendi

    More on the “The Art of Dying,”


    Dr. David Edward Marcinko MBA


  7. Association for Death Education and Counseling (ADEC)


    Hope R. Hetico RN, MHA
    [Managing Editor]


  8. Speaking Up about End-of-Life Issues


    Hope R. Hetico RN, MHA
    [Managing Editor]


  9. The Obama End of Life Plan Ressurected
    [Section 12334]

    When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1st 2011.

    Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.


    Ann Miller RN MHA


  10. Don Berwick MD of CMS

    Is he the initiator of this annual – formerly every 5 years – regulatory, mandatory and compensated proposal?

    Shameful ObamaCare and Berwick?

    Dr. David E. Marcinko MBA


  11. CMS Death Panels Reversed?

    Citing procedural reasons, the Obama Administration announced yesterday that it would delete all references to end-of-life planning from the Medicare regulation that had already gone into effect, according to the New York Times.


    The news followed closely on the heels of the GOP’s proclamation that it planned an early vote this month to repeal the Affordable Care Act signed in March.



    Any thoughts?



  12. Saying Goodbye

    Thanks to medical advances and extended grieving periods, the process of saying goodbye requires a new approach. Welcome to a conversation focused on helping you and your family deal with new grief.


    Dr. David Edward Marcinko MBA CMP™


  13. Excellent post with comments, and your concerns are certainly warranted. More than one in four elderly Americans curently lacks the capacity to make their own medical care decisions.



  14. Medical Students and Patient Death


    Ann Miller RN MHA


  15. The End of Life Conversation

    “Consider the Conversation” is a documentary about end of life care. There is a great deal of buzz in the hospice and palliative care communities about this film because of its joining of expert perspective with patient stories that have not been sugar coated.

    Here is a review of the film at Pallimed, a hospice and palliative medicine blog.


    Dr. David Edward Marcinko MBA


  16. Rationing Care for the Elderly

    In 2009, Ezekiel Emanuel, M.D., who until recently was advising the Obama administration on ethics issues, published, along with two colleagues, a proposal that scarce health care resources be allocated on the basis of a “complete lives” system, which would give priority to younger patients, because older people had lived longer.

    (Persad, G., Wertheimer, A., and Emanuel, E. “Principles for allocation of scarce medical interventions.” The Lancet, Jan. 31, 2009, pp. 423-431)




  17. R.I.P. Dr. Kevorkian

    On June 3rd 2011, Jack Kevorkian MD (aka, Dr. Death) died due to a blood clot in his heart. A man who claimed to have assisted with the deaths of more than 100 terminal patients, has left a lasting legacy.

    Kevorkian defended his actions and once stated, “I didn’t do it to end a life. I did it to end the suffering the patient’s going through. The patient’s obviously suffering–what’s a doctor supposed to do, turn his back?”

    With Kevorkian’s death, physician assisted suicide is back in the news. There is such a clear divide in the support of such an act, it is obvious that this controversial topic will not go away any time soon.

    And so, what was your initial reaction upon hearing about Jack Kevorkian’s death?

    Do you agree with his opinions and actions about physician assisted suicide?

    Please tell us what you think?

    Hope Rachel Hetico RN MHA
    [Managing Editor]


  18. Advance directives respected most of the time

    Elderly patients’ wishes regarding life-sustaining treatments are respected most of the time, according to a new study published in the Journal of the American Geriatrics Society.




  19. Discussing end of life issues with a teenager

    Marcie transitioned to my care when she turned sixteen. But she wasn’t doing well. Her pediatrician had suspected the problem shortly after birth. She wasn’t growing normally, had nasal congestion, and more respiratory infections than usual. A sweat chloride test was ordered which was positive. The diagnosis was cystic fibrosis (CF).




  20. Choices at the End of Life

    According to David Ollier Weber, ethics, clinical expertise and emotional support come together in advanced illness management.


    Here is an example of four hospitals’ programs to ensure the patient’s voice is heard.

    Hope Rachel Hetico RN MHA


  21. Graceful Exits

    Vermont is poised to become the fourth state to allow doctors to help terminally ill patients die.




  22. Joe Caramadre Gets Six Years for Investment Scheme Involving Terminally Ill

    Judge cites “very real emotional and psychological victimization” of dying participants who took cash for assigning their death benefits to investors.




  23. Robin Williams and The Right to Die?
    [The Suicide Checklist]

    An essay on Physician–Assisted–Suicide defined as the collaboration of two, through a professional relationship, to cause the death of one.




  24. New report urges sweeping change to end-of-life care system in U.S.

    All-encompassing change to the U.S.’s end-of-life care system is urgently needed, according to a new report from the Institute of Medicine (IOM).




  25. Honoring life: Thoughts on the IOM’s end-of-life care report

    The Institute of Medicine of the National Academies has released their long anticipated 500-page report, titled,”Dying in America – Improving Quality and Honoring Individual Preferences near the End of Life.”

    This is a critical addition to the ongoing conversation about health care in the United States and makes observations and conclusions, which we need to consider and understand.


    They conclude, that we waste precious resource’s as we fail to give good end-of-life care, millions suffer needlessly, and that we can and must do much better; it is time we opened ourselves to the conversation and our obligation to one another.


    Hope R. Hetico RN MHA


  26. RIP

    Senator John Sidney McCain III, who has been battling brain cancer for more than a year, will no longer be treated for his condition. This was a sign that the Republican war hero entered his final day, on August 25th., 2018 …. with “Grace.”

    Ann Miller RN MHA


  27. Back in the News!
    R.I.P = Corona Virus.
    Dr. David E. Marcinko


  28. Engage with Grace

    The conversations around the end of life or something that is completely neglected in my experience and is something that should be a focus or even a point of value for financial advisors and planners. I’ve been a part of situations where a state planning was handled properly and well ahead of time and made the experience much better for the person who was leaving this life and everyone had a much better experience around that especially those surviving family.

    I’ve also been a part where this was completely neglected and things were disorganized, stressful, and the soon-to-be Departed had late stages in that were uncomfortable and unnecessary.

    I plan to create a slide like this to incorporate into my conversations!!



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