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Advocating for Death with Dignity, Step 4: Build Infrastructure and Coalitions

July 29, 2014

In the first article of this series about passing physician-assisted dying laws, we discussed engaging with your family and friends in conversations about hastened dying. In the second article, we provided guidance about steps needed to learn more about the issue and build alliances. And in the third piece, we discussed the ABC’s of ballot initiative and legislative campaigns.

This, the fourth article in the series will discuss building organizational infrastructure and coalitions.

Find the Right Organizational Structure

In our bureaucratic world, a serious journey into state-based policy reform calls for some sort of organizational structure. There are many options from which to choose, and there is not one structural model used in every policy reform effort. In Vermont we worked with a locally-established 501(c)(4) advocacy organization, Patient Choices Vermont, acting as its 501(c)(3) partner and fiscal agent. In Washington, we established a coalition comprising four organizations with decision-making authority vested in a state-based political action committee (PAC). Another option is to find a local entity with an existing corporate structure and operate under its charter.

Factors both external, e.g. your state’s campaign finance rules and IRS limitations on political advocacy by non-profits, and internal, e.g. your planned goals, activities, and the developmental stage of your organization, impact on your choice of structure. If you are in an early organizing stage, loosely bringing people together for conversations, you can operate without a formalized structure or operate under another group’s umbrella.

There are several points in an advocacy cycle when knowledge of your state’s campaign finance laws and IRS limitations are important:

  • when you begin to raise funds for the intent of advocating for policy reform;
  • when you begin to talk to legislators about physician-assisted dying; and
  • when you start using words like “campaign”, “political campaign”, and “lobbying”.

These are all key words suggesting that you are getting very close to an artificially-drawn legal line mandating specific organizational structure and reporting. A word of caution here: You can get in trouble fast in this arena, so be careful and seek professional consultation or legal counsel.

Internally, questions like group culture (hierarchical or consensus-minded), mission and focus, capacity to meet the legal demands inherent in formal corporate structures, and level of experience with the nonprofit and/or political advocacy worlds will influence your decision-making.

The Alliance for Justice’s program, “Bolder Advocacy” has a thoughtful and thorough set of guidelines for setting up your organizational infrastructure. We recommend them for novices and experts alike, as the rules are not always straightforward.

For ballot initiatives, your Secretary of State’s Office is generally in charge of issuing guidelines. There are specific milestones after which PACs must report. Generally, political committees are formed after signatures are filed or when the ballot title language is being debated in the courts.

In the past eight years, we have formed or been instrumental in forming ten different corporate structures to achieve policy reform. That’s why a comprehensive understanding of various state and federal laws is essential. You do not need any formal training in corporate structures to set up an organization.

In addition to being an essential component toward facilitating change, corporate structure is an asset when you are forming alliances with other groups. Having a formal structure, be it a 501(c)(3) nonprofit corporation, a 501(c)(4) social welfare organization, or a political action committee, gives you legitimacy.

Coalition Building

If you want to run a successful campaign, you will have to cultivate relationships across many issue groups. There are natural allies, such as the ACLU, secular/humanist groups, the Unitarian Church, and local affiliates of the American Women’s Medical Association and the American Medical Student Association.

Another way to think about allies is to consider which groups have common political opponents. These are more difficult alliances to build because the idea of having a common “enemy” may not be enough to bring non-similar groups together.

To strengthen alliances with these groups, you must understand their policy reform agendas. Lending a hand or volunteering with their policy reform efforts goes a long way to building an alliance because for the alliance to be successful, it must be reciprocal. You are not only interested in how they can help your issue but how you can help theirs.

Featured image by Pittigliani2005.

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Afterword: Physician-Assisted Dying Concepts

More Advocacy Needed, Even in States with End of Life Options

If you are one of the 50 million Americans who live in a state where there is already a death with dignity law in place (Oregon, Washington, Vermont, or California), there is still work to be done. Though the laws are passed, many members of the public are still not aware of their rights. You can help build support among lawmakers for better information for patients about the existing laws. Get involved!