"Death with dignity" is a polarizing, controversial slogan among the American public. But to Mickey MacIntyre it's an article of faith. MacIntyre is the chief program officer for Compassion & Choices, which works to improve care and expand choice for people who feel they should have the right to decide at which point death is a better choice than paying the high costs — both physical and emotional — of remaining alive.
C&C is headquartered in Portland, Ore., and Denver, and currently has 40 affiliate groups. The organization is a huge and, at first glance, unlikely success story.
"It's pretty significant that we've grown during the economic recession," MacIntyre says. "In 2010 we had 32,000 donors. In fiscal 2011, we had 38,000."
During roughly the same period, C&C's operating budget went from $5 million to its current level of $8.2 million — more than a 60 percent growth rate. This happened despite the fact that it has no government or corporate support, and is entirely dependent on contributions from individuals, planned giving and foundations.
"We've expanded our development work. We received support from longtime foundation friends who invested in that work to make sure we were able to do the work," MacIntyre says. "And we were smart in limiting our risk of exposure as we were expanding."
Limiting risk at C&C meant choosing the least costly way to enhance funding. It involved working on an aggressive major-donor acquisition program, one that included a tremendous emphasis on reclaiming lapsed donors.
But still — how to account for C&C's high growth rate, especially in a country where there is strong organized opposition to the idea that terminally ill, mentally competent people should be permitted to play a major role in deciding how and when to end their own lives?
MacIntyre points to two major factors, the first being that increasing numbers of aging Americans and their families feel they should be in control of their own end-of-life decisions.
"A substantial majority believe they should be able to acquire a prescription for a life-ending medication from their doctor," MacIntyre says. (A Harris Poll released in January 2011 indicted that 70 percent of adults nationwide agree that terminally ill patients should be able to choose aid in dying.)
Multichannel and beyond
The other factor is C&C's use of an "omnichannel" marketing model that incorporates fundraising into all operational aspects of the organization.
"The genesis of our approach involved a reorganization, from 2007 to 2009, of the way we think about donors," MacIntyre says. "It became clear that our donors, volunteers, activists, and clients and their families are all the same people. They're all supporters. We realized it was important that we coordinate our messaging into one set of messages to all of them."
For example, C&C has the e-mail addresses of 20,000 of its 38,000 24-month donors. The organization can go directly to those 20,000 donors when it asks people to send e-mail to their representatives in Congress regarding an end-of-life initiative.
"You have to think of activists and donors as the same group of people," MacIntyre says. "You can't separate those two actions from one another. You have to coordinate. This is difficult for some folks to understand, because the entrenchment between programming and development and communications in most fundraising organizations is deep.
"The program work in most organizations is considered the work of the organization, with development and communications supporting the program work," he adds.
Not so at C&C. Integrated, omnichannel marketing is the cornerstone of an organizational philosophy that addresses more than communications and development functions.
"We've gone a step further by making programming part of the picture," MacIntyre says. "We're organizing our development people to achieve the same goals that our program people are seeking. In our organization, we say program, development and communications are the same — all program work.
"We strive for programming to be ingrained in every aspect of the organization. Programmatic messages are now looked at as how they impact fundraising," he adds. "Programmatic decisions are made that entail fundraising. We don't just acquire donors; we acquire supporters, and not simply through direct mail or by asking people to sign a petition. Once a supporter comes in through one door, we offer him or her a full range of participation in the organization."
For example, let's say you become a C&C donor or sign a C&C petition asking legislators in a certain state to pass a bill allowing aid in dying. You might then be prompted to click on a banner ad to receive further information.
"The initial message might be 'welcome to the organization; you participated in one part, now we'll give you an overview and let you decide what you want to do,'" MacIntyre says.
The "welcome period" gives supporters time to consider a variety of ways to engage with C&C the next time around. It's part of a process through which lapsed supporters may be brought back, new supporters recruited and current supporters converted into "super-supporters" — MacIntyre's term for those supporters who are acquired through one action and then proceed to engage in several others, such as petitions, contribution, accessing services, referring others to the service, etc.
Set up for success
C&C is set up to encourage its supporters to become super-supporters. Structurally, the organization has three senior-level managers, including MacIntyre, and six other managers who preside, respectively, over the six departments that do the organization's work. Three of the departments handle advocacy functions — legal, legislative and field — and the other three deal mainly with development, communications and client support, through which thousands of clients are provided with guidance by C&C's staff and trained volunteers in their search for peaceful, humane death.
Each one of the six department leaders has his or her own staff. These six plus the three senior-level managers meet weekly to discuss challenges and make decisions involving all the work of the organization.
"We use cross-disciplinary implementation teams that work together on various campaigns or programs," MacIntyre says. "For example, individuals from client support, media and advocacy might all be on the same team. This ensures we'll take a coordinated, integrated approach to supporters."
In fact, C&C's omnichannel approach is, almost by definition, an alternative to simpler models that can turn off more people than they attract.
"We appeal to different sides of people who are in contact with us," MacIntyre says. "They may know other people who might want our services. They may become online advocates. We try to find multiple opportunities for them to engage, as opposed to saying 'you can either be a volunteer or give us money.'"
C&C's business model stresses the importance of input from all facets of the organization. MacIntyre cites C&C's highly successful role in a 2009 case in which the Montana Supreme Court ruled that the right to choose medical aid is permitted for terminally ill adults.
"After the ruling, we had to put a practice in place to make people understand it's legal to engage in life-ending care," he says. "At the same time, we had to fight the state legislature, to keep them from creating a new law. We had to raise money; deal with the media; issue action alerts; produce TV commercials, written ads and video for public events. The same messaging was often involved in several different actions. We treated everyone involved as supporters rather than just donors, activists or clients. We asked them to attend public hearings, sign petitions, make contributions — every action that might be of help."
Stories at and of the heart
"The messaging always involves storytelling," MacIntyre notes, largely because personal stories are the best way to connect with potential supporters, all of whom have faced, or might face, end-of-life dilemmas.
For example, in the successful Montana campaign, C&C integrated personal end-of-life stories into all of its direct-mail appeals, advertisements and all other actions. The first element of the campaign, "Join Steve," reiterated the story of Steve Johnson, a Marine veteran suffering from terminal brain cancer whose plight prompted the Supreme Court ruling, in all of its channels — from print ads and direct mail to Web pages and social media.
"Everyone you talk to can tell you a story about somebody they know whose condition is relevant to our mission," MacIntyre says. "People become involved in what we're doing because we've connected to them by sharing end-of-life stories that are personal but involve universal emotions."
MacIntyre could fill a book with personal end-of-life stories he witnessed as a young gay man living in New York City in the 1980s, during the height of the HIV/AIDS pandemic. He remembers patients on gurneys, asking people to kill them because they couldn't get any effective treatment to relieve their suffering.
"I went to a funeral a week," he says. "The way I saw people die was horrific, and I know many people across the country are still dying that way, often elderly people who ought to be receiving better care."
Throughout his career, MacIntyre has helped build nonprofit civil-rights organizations and advocated for social change. It's no accident he now works and plans for an organization whose mission includes making sure people know about and understand end-of-life options. It's a job that involves consultation with clients and their families, and persistent advocacy. The rewards include playing a role in actions that have led to the Montana Supreme court ruling, and to the Death with Dignity Act in Oregon, which enables a terminally ill person to acquire a prescription for life-ending medication and thereby control his or her own time of death.
MacIntyre says he's pleased with C&C's progress in battling entrenched opposition from Catholic bishops, religious owners of hospitals and right-to-life groups. But he adds that one of the biggest challenges the organization faces is in development.
"We're doing the right things, but we want to get even more professional about it," MacIntyre says. "We want to get the best and brightest advertising minds to reach more people who support access to aid in dying. In some states that includes as much as 77 percent of voters.
"I'd like better technology that integrates all aspects of the organization more seamlessly," he adds. "We're still not there yet. The integrative technology is still not there internally, or for the field."
MacIntyre is confident that C&C will do what it has to do to reach more people because its message points are so compelling: Too many people suffer needlessly. Too many endure unrelenting pain. Too many turn to violent means at the end of lives.
People have no trouble understanding that these message points easily could refer to members of their own families and to themselves, and MacIntyre is sure many more of them will be drawn to Compassion & Choices and its mission: to support, educate and advocate for those facing end-of-life issues.
"We need to get more supporters talking to doctors and counselors, and to legislators, and for contributors to fund all of our efforts," MacIntyre says. "We want everybody involved to be part of decision making and implementation." FS