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The National Rehabilitation Association.

Voluntary associations have been one of the unique characteristics of our American democracy. Through these organizations, people with common interests and goals may freely gather together and organize to carry out their purposes. The National Rehabilitation Association epitomizes the influence which voluntary associations have had in the development of our society and its institutions, for NRA has been one of the primary leaders in the development of rehabilitation in this country as it relates to legislation, programs, and attitudes. NRA is unquestionably one of the oldest and strongest advocates for persons with disabilities.

Purpose

The purpose of the National Rehabilitation Association as outlined in its constitution is to advance rehabilitation of all persons with disabilities by--

"(1) exercising leadership in identifying the needs of the

handicapped individuals, interpreting these needs to society,

planning and promoting programs designed to meet

these needs and translating such programs into services at

the community level. (2) Identifying the essential elements

in the practice of rehabilitation and fostering the development

and application of standards which will help to assure

effective services to people with disabilities. (3) Exercising

leadership in developing concepts and practices which will

foster inter-agency and interprofessional activity directed

toward helping individuals with disabilities increase their

ability to function. (4) Encouraging the entry of competent

and humanitarian individuals to the rehabilitation professions

and fostering training opportunities required to make

them effective practitioners. (5) Encouraging the search for

improved methods and techniques in the organization,

administration, and practice of rehabilitation and fostering

the dissemination and evaluation of such findings. (6)

Exercising leadership in removing environmental and legal

barriers and overcoming discrimination which keeps individuals

with disabilities from living normal lives and enjoying

the rights and benefits that should be the heritage of

every American citizen. (pg. 1)."

NRA advances the purpose of the Association by performing two important and related roles in rehabilitation. These may be described as an advocacy or social action role and a professional role. The social action role of NRA is, generally speaking, very well understood. Historically, NRA has studied the needs of people with disabilities on national, state and local levels, has attempted to educate the public with respect to such needs, and has recommended and promoted programs nationally and locally to help meet such needs. It continues to be the national organization in the best position to render this service, and its leadership in this area of activity is accepted by many other national organizations that are concerned with rehabilitation.

NRA has an equally important and unique professional role to meet in rehabilitation. It is to provide the support needed to assist individuals with various professional backgrounds become, in the truest sense of the word "professionals." In keeping with this role, NRA organizationally supports development of professions through its divisions, which have distinguished histories of impact. NRA financial and organizational support of these efforts is based on a commitment to provision of the best quality of service to individuals with disabilities.

A related aspect of these roles is to bring together rehabilitation professionals, persons with disabilities, business and industry and interested citizens so they may better understand their respective roles in rehabilitation and learn to work together to achieve their common goal.

History

The following provides a brief history of NRA much of which is paraphrased from the work of Lavis and Lavis (1975), Obermann (1975), and Sales (1981, 1983) which could be reviewed by the reader for more detail and a better sense of the impact of individuals on the Association. Organizations usually have their beginnings in attempts by groups to meet their needs or to solve their problems. If some difficulties are presented that cannot be resolved by individuals acting as individuals, group action is typically taken. The forming of the National Rehabilitation Association was no exception to this general rule. In the second decade of the present century, the new service of "vocational rehabilitation" was emerging as a formal attack on one of the most pressing problems stemming from disability. While the medical profession or the workmen's compensation movement or the voluntary organizations might have contributed to the beginnings of this new service, the education profession produced the combinations of interests and capabilities that most nearly met the vocational requirements of disabled people. The men and women that took up this work generally came from the field of education and the programs that were started in the several states were generally in departments of education and were a special function of divisions of vocational education.

The leadership of the vocational educators was limited in its ability to identify adequately the peculiar needs of a program for the rehabilitation of disabled people. It was too often assumed that these needs were not unique and that a conventional vocational education approach would meet them. Those who were specializing in the new work grew restless and discontented with the level of status and priority given their program. They felt that this new movement would have to develop its own identification. its own morale, its own curriculum, and its own leadership. While for many years the need would be felt to maintain the professional and administrative ties with departments of education in the states, some of the early leaders saw that vocational rehabilitation must combine many disciplines and must be free from too much domination by any of them.

The National Rehabilitation Association grew out of some of these convictions. It was founded by a group of workers in the State-Federal program of rehabilitation, but its reach has been greater than to the membership of a single administrative body in the movement of vocational rehabilitation.

The Beginnings

During the early years of the movement, administrators of state vocational rehabilitation agencies met nationally during attendance at national conferences of the National Society for Vocational Education. Many state administrators had a difficult time obtaining clearances and permission to attend these national meetings. In most of the states, the new State-Federal Rehabilitation activity was under the states' boards for vocational education. The delegations from the various states could include vocational rehabilitation workers only if the parent state divisions of vocational education were cooperative and could understand the necessity for their rehabilitation subordinates to meet with others to discuss common problems and techniques. In some of the states, there were general administrative rules that limited the number of state employees who might attend out-of-state meetings each year. If it developed that the quota for the department of education in a state would permit only one or two persons to attend the national meeting of the National Society for Vocational Education, the vocational rehabilitation administrator was often prevented from going to that meeting.

At the 1923 meeting of the National Society for Vocational Education in Buffalo, the specialists in vocational rehabilitation held a sectional administrative meeting where these issues and the possibility of a separate organization were discussed. At a luncheon meeting, Mr. W.F. Faulkes spoke in favor of forming a permanent national organization of persons engaged in vocational rehabilitation.

It was at the later business session (December 8, 1923) that a nominating committee brought in its nominations for the Rehabilitation officers for this new group within the National Society. It was agreed that the name of the new group would be the National Civilian Rehabilitation Conference.

The new National Civilian Rehabilitation Conference met in Indianapolis on December 11, 12, and 13, 1924 with a professional program offered as a part of the National Society for Vocational Education, but at this meeting there was more of a sense of separate identification. Many felt that the time was propitious to remove the Conference completely from the parent organization. However, there were practical matters of budget, staff time for planning and executing a national program that could stand independently of the broader offerings of the Society, and sufficient status to obtain administrative approvals of states to attend such a specialized meeting.

At the Indianapolis meeting in 1924, W.F. Faulkes was elected Chairman of the National Civilian Rehabilitation Conference. Eighteen states were represented by 24 rehabilitation directors and supervisors. During the meeting the following year at Cleveland, September 30 to October 2, 1925, held in conjunction with the annual meeting of the National Safety Council, a formal vote was passed to establish the Conference as an independent association.

At the meeting in Memphis in March 1927, the Conference voted that "this organization shall be known as the National Rehabilitation Association and shall be considered as having been in existence without formal constitution since the meeting of civilian rehabilitation workers in Buffalo in 1923."

The Sixth Annual Meeting of the Association was held in Milwaukee in September 1928. M.B. Perrin completed his term as President of the Association at the close of that meeting. Among the actions he was able to see taken was a slight relaxation of the requirement of employment within a state rehabilitation agency to be an active member of the Association. Membership was opened to permit persons who were "engaged in rehabilitation work under private auspices" to be invited by the Executive Committee to become active members. A further qualification was the payment of $3.00 annual dues.

In 1930 the Association took major responsibility for the renewal legislation for the State-Federal program. It drafted its own bill and succeeded in getting it introduced in the Congress. When it became apparent that close watch would have to be kept on this legislation, the Association made a special appeal to its members for funds to finance sending representatives to Washington as needed to lobby for passage of the required bills. A fund of $3,449.00 was raised by this special appeal. This was a phenomenal amount, considering that the normal budget of the Association was running at less than $200.00 a year.

At the 1930 Kansas City meeting, the matter of memberships was again reviewed and a radical change was made from the original structure. Memberships were to be of four types: individual, organization, contributing, and life. All members could vote. The individual members were to pay dues of $ 1.00 a year. This change in the membership structure allowed all to feel that they were functioning on a basis of equal basis. Any person "interested in the vocational rehabilitation of disabled persons in the United States or possessions thereof and the Dominion of Canada" could become a member by paying the required dues. Apparently the decision had been made that the National Rehabilitation Association was not to be a "professional" organization in the sense of qualification through training or vocational pursuit. The problem of providing a professional affiliation through the Association was one that was to be considered and a solution reached many years later. With the changes in the membership qualifications, the Association would be emphasizing social action and public education rather than professional upgrading and professional standard-making, except as these objectives could be accomplished through special projects sponsored by the Association.

Since legislative activities were claiming so much of the effort and funds of the Association, it was decided in 1930 to establish a headquarters in Washington, DC. However, financial support for these and many activities and interests of the Association was a continuing problem. The depression was at its greatest depth in 1933, and great ingenuity was needed to keep the organization functioning. The plans to employ an Executive Director had to be abandoned. At this time, H.B. Cummings, William Faulkes, and Louis Pizer were appointed to select a design for a seal for the National Rehabilitation Association, Incorporated.

In 1934, the National Rehabilitation News had been initiated, with Willis W. Grant as Editor. In 1935, proposals surfaced a new and free-from-advertising publication to be known as the Journal of Vocational Rehabilitation. This later was developed as the Journal of Rehabilitation and in 1945 it was designated as the "official" organ of the Association.

The interests and the activities of the Association continued to grow throughout the period of the years of depression in the 1930s. While the resources of the Association seemed to lag so far behind its opportunities and responsibilities, there was much good work done by the members of the Board and others in working out a better operational definition of vocational rehabilitation.

Through the Social Security Act, the funds available for the rehabilitation of disabled people were substantially increased in 1936 and in 1940. However, there was a growing need for a substantial change in the basic provisions of the law under which the State-Federal program operated. The Association gave its energies to securing legislation that would permit the program to grow and develop in accordance with the needs of disabled people and with the new capabilities of the workers in the field to deal more effectively with the problems incident to disability.

Organizational Growth

The increasing need for secretarial and staff support for the activities of the Association such as supervising the issuing of the publications of the Association, managing the membership campaigns, and preparing budgets and controlling funds, resulted in the Association developing to the point when it could no longer function effectively by using volunteer workers. On April 9, 1948 the Executive Committee recommended and the full Board approved Mr. E.B. Whitten of Mississippi for the position of Executive Secretary of the Association.

When E.B. Whitten first came to the position of Executive Secretary, the organization was relatively small and the involvements in programs were relatively limited. But the demands placed on him soon required that he have assistance in both the internal and the external administrative and professional tasks related to his office. The Association provided the position of Assistant Director and recruited Mr. A.D. Puth to fill it in 1954. With an Assistant to relieve him of many tasks and duties, Mr. Whitten was able to devote more of his time to public relations, legislative programs, interorganizational relationships and policy making.

As the Association continued to grow, new avenues for membership involvement and impact evolved which facilitated the ability of members to meet and deliberate on issues before them. NRA's first subunit to be established was the region (1948). The primary purpose for establishing the regions was simple. A relatively small proportion of the members of NRA could attend the national conference and participate actively in the affairs of the Association. The regions were to make possible wider participation. The actual establishment of the regions was left to the Board of Directors.

The responsibilities of the regions, as stated in the Constitution, are to conduct an annual conference and to elect a member representative to the national Board of Directors and a representative to the national Nominating Committee. Other activities are permissible, provided they are not in conflict with the purposes of the Association and do not prevent the successful execution of the enumerated responsibilities.

The organization of affiliates (chapters) was authorized in 1950, after the Michigan Rehabilitation Association had organized and was operating as an NRA unit in 1949. The nature of the chapter is entirely different from that of the region. Each member of the National Rehabilitation Association, without the payment of additional dues, is a member of a chapter. The chapter recruits membership and receives a proportion of membership dues rebates for its own use. The chapter provides for the representation of its members in the Delegate Assembly of the Association, which amends the Constitution and establishes broad policy through the adoption of resolutions.

The purpose and function of the chapter at the state or local level is the same as that of the National Rehabilitation Association at the national level. It is NRA in its geographical area. It should be emphasized that all NRA members in the chapters' geographical area are members of the chapter and have an opportunity, therefore, to participate in the government of the chapter and, through elected representatives, in the government of the national body.

The division is the newest organization unit in NRA, being authorized in 1957. Divisions recruit members nationally. They are "major scientific, professional, or other interest groups," organizing within the Association to promote the special interest and meet the special needs of their members. NRA has seven divisions now in operation.

Members of the divisions must be members of the National Rehabilitation Association. Members of divisions, are, of course, members of chapters. Members of divisions are as much concerned with NRA in general, its purposes, activities and problems as, any other members.

The formation of divisions advertises the growing complexity of the rehabilitation movement and the desire of the National Rehabilitation Association to serve it and lead it. The divisions must be permitted to satisfy their individual interests and to experience their individual development, but at the same time they must continue to see the advantages in an association with broader, social action issues. To continue to effect this merging and coordination of these seemingly divergent forces will take leadership of the highest order in the Association.

The Association has been dominated throughout the years of its existence by the persons engaged in the State-Federal program of vocational rehabilitation. It was founded by the representatives of that program in the states. Initially, it was an organization to serve the needs of the State-Federal group. Within a very few years after its organization, however, attempts were made to broaden the base of its leadership and its appeal. The more perceptive leaders in the organization were able to visualize the potentials and the responsibilities of the Association in meeting its social-action and professional roles in rehabilitation. While the membership grew and soon included many more persons who were engaged in rehabilitation work outside the State-Federal activity than were in that program, the leadership continued to come mainly from the directors of the state divisions of vocational rehabilitation. Only six persons have been elected to lead the Association whose occupational affiliations were outside the State-Federal program.

The political organization of the Association that permits the persistence of this narrow range of choice of leaders has often generated the charge of parochialism and has raised the question as to the desire or capability of the organization to lead the entire field of rehabilitation. However, the echelons of leadership represented by the Board of Directors and the standing committees have broad professional and agency representation. Furthermore, there is a persistent attempt to involve other association and other agencies in joint undertakings such as national institutes, legislative sponsorships, research sponsorships, and program planning.

From its beginnings in the early '20s, the Association has proven to be the initiator of major landmark legislation on behalf of individuals with disability--guaranteeing vocational opportunities, impact on attitudes and environment, rehabilitation research, rehabilitation professional development, civil rights advocacy for disabled. It has proven to be the major force behind every major rehabilitation initiative since the implementation of national rehabilitation legislative efforts at the turn of the twentieth century to include all Rehabilitation Act amendments since 1925 and the Americans with Disabilities Act.

The Last Twenty Years

The last twenty years have been reflective of a period of major change within the rehabilitation movement and within the National Rehabilitation Association. While much of this change has been positive for both the movement and the Association, several external and internal forces have impacted negatively upon the Association. These forces, to differing degrees, have resulted over the last twenty years in what would appear to be a fifty percent reduction in membership. It is easy to speculate that a large percentage of this membership loss can be accounted for in terms of over-inflated estimates of membership numbers when the all time high, 35,257 members in 1974, was tallied. Through that year, all members of Congress, the majority of Governors, and a significant number of dignitaries nationwide were listed as members at no cost. This practice, because of financial reasons, was discontinued during 1975-76. In addition to this "membership loss," duplicate listings of members was quite prevalent prior to the implementation of computer record keeping in 1979-80, following which a significant "loss" in members was noted. Regardless of the degree to which membership numbers were inflated in 1974, external and internal forces have resulted in an NRA membership loss of major magnitude over the last twenty years.

A. External Forces

It is a well-known fact that large numbers of active members in NRA and its chapters are dependent on the support and endorsement of employers. One of the major influences on recent NRA membership loss has been a major change in the organizational administrative structures within state agencies providing vocational rehabilitation services. Since 1973, the number of state agencies administratively housed in "Umbrella" state social service agencies has increased from only a few to twenty-eight. Within these states, NRA membership has dropped dramatically as many state vocational rehabilitation administrators lost their autonomy as well as their power to provide administrative support for state agency employees' participation in NRA chapter programming and activities. In addition, within states in which vocational rehabilitation services have been reorganized under umbrella social service agencies, many new state directors were appointed without work background in rehabilitation and without an appreciation for the benefits accrued to the agency through a strong and active state NRA chapter. In some of these states, membership has been discouraged because of various NRA legislative advocacy positions. A good overview of administrative issues related to change in state organizational structures for vocational rehabilitation is provided by Peter M. Jamero (1981).

While major positive gains have been attained in national legislative programming over the last twenty years, that time frame also has reflected a major onslaught on the Rehabilitation Act and its funding by several national Presidential administrators. The Act experienced its first veto by President Nixon in the 1970s. President Reagan's targeted destruction of the Act in the early 1980s through Block Grant and reduction in funding proposals highlighted just how fragile and at risk rehabilitation legislative gains were. NRA is credited through its Legislative Network with insuring the survival of the Rehabilitation Act during this time frame as well as insuring increases over Presidential requests for funding for the State Federal Vocational Rehabilitation Program.

Some point to major losses in state rehabilitation staff as a cause of loss of NRA membership. The federal loss of SSI-SSDI funding to rehabilitation has resulted in the loss of state rehabilitation manpower, however, during the last ten years, state reductions in financial contributions to rehabilitation service delivery have been the major cause of loss of manpower resources.

B. Internal Forces

A very studied attempt in 1973 by the NRA Board of Directors at reorganization of the governance structure of the Association, referred to an "Introspection -1973," indirectly and directly, resulted in several factors of major negative consequence to the Association. Not the least of these was the major financial burden this reorganization process placed on the Association at that time and in the future because of increased costs related to an increase in size and function of the National Board. While the reorganization effort valiantly attempted to ensure that the NRA Board reflected all components of its membership, the increase in numbers and special interest representation on the Board proved too often to result in lack of unity of purpose or direction for the Association, leaving the Association since 1973 often in a reactive versus proactive stance on many issues.

Within the time frame of this NRA Board reorganization, the Executive Director for twenty-seven years, E.B. Whitten resigned. Following a very lengthy and costly recruitment process, Diane Roupe was hired as Executive Director in 1974. During this time frame, the Council of State Administrators for Vocational Rehabilitation, an affiliate within NRA, severed their administrative linkage with NRA to become a separate and independent association. In 1975, NRA intervened through the court system in the well-known "Florida test case" over compliance issues related to service delivery within that state (Jamero, 1981). The first of significant yearly ongoing losses in NRA membership were experienced that year. Having limited financial reserves as a result of "Introspection-73" and the Executive Director recruitment procedure, and experiencing a loss of membership income, the legal financial costs of the Florida test case almost bankrupted the Association. These and related issues led to the resignation in 1976 of Diane Roupe as Executive Director. Amos Sales, NRA Director of Program, was appointed Acting Executive Director. Because of family health reasons, Dr. Sales resigned the position in 1977 (Sales, 1977). Susan Eggers served as interim manager of the NRA office until Richard Oestreich was employed as Executive Director. Mr. Oestreich's resignation was followed by the appointment in 1979 of David Mills, Executive Director. This five-year period of instability in the Executive Director position obviously had a profound impact on membership recruitment and retention as well as leadership and direction provided to the Board.

With increasing losses of members, cutback-management became the strategy for managing the Association. From 1974 to 1978, the National Office staff was reduced by fifty percent. The majority of funding in support of the work of Councils and Commissions had to be eliminated and final support of meetings of the NRA Board was reduced to providing for only one meeting per year. In addition, inflation began to shrink the buying power of the membership dues dollar.

Within this backdrop, limitations imposed on NRA Board functioning often made it appear unable to function or to function in a very fractionalized type of manner. As a result, leadership within the Association began to consider disaffiliation, as happened in the cases of the National Association of Disability Examiners (NADE) and National Council on Rehabilitation Education (NCRE), or develop new associations as happened with the American Coalition of Citizens with Disability (AACD) and the National Association of Rehabilitation Practitioners in the Private Sector (NARPPS). This period had a very broad and negative impact on membership retention and direction. Emener (1986) Journal notes that, between 1978 and 1979, with the loss of the NADE division, the NRA membership experienced a 3,159 membership reduction.

In January 1988, Dr. Robert E. Brabham became Executive Director and the Association embarked on an aggressive campaign to improve working relationships with other organizations and Associations and communication within the Association. Communication improvements within NRA included revamping NRA's publications and established a regular means of communicating with Presidents of the Association (chapters, regions and divisions).

These major efforts to revitalize and convey a spirit of enthusiasm began to show results relatively early. By the middle of 1988 membership began to increase modestly, the first reversal in the problem of declining membership in many years. During 1988, total membership increased. The Association expanded the size of the staff and purchased additional office space.

While progress was being made, the Association continued to struggle because of its diverse membership and organization structure with the reoccurring questions to "who are we and why do we exist?" A major initiative was begun in the summer if 1991 to answer these questions through reafffirmation of the association's mission and the development of a realistic long range strategic plan. Dr. Brabham resigned as the executive director of NRA a few weeks after this work was completed.

After a National Search, Ann Ward Tourigny, Ph.D., CAE was hired as the Executive Director in November 1991. Dr. Tourigny became the first certified association executive employed by NRA and was expected to bring to this position effective and efficient management.

The Association played a major role in 1992 in support of reauthorization of the Rehabilitation Act, perhaps the second most difficult reauthorization in the history of public rehabilitation. Also in 1992, under the leadership of the executive director, the association reversed a four-year trend of financial decline and achieved a positive balance of revenue over expenses. The year 1993 saw the revitalization of the strategic planning process. Primary efforts were directed toward identifying the association's shared values that identifies who we are and compels us to work toward a common mission. The continuation of this process will provide the blueprint for the National Rehabilitation Association to invent its own future. The political elections and climate in 1994-95 currently place the State-Federal Vocational Rehabilitation program as we have known it at risk for termination. Current national legislative efforts, guided by political commitments to reduce the national budget and return federal programs to state control, will undoubtedly result in major changes in scope and funding of vocational rehabilitation as we have known it. NRA continues to serve as one of the strongest Associations advocating for individuals with disabilities and is currently advocating for legislative assurances that national funding and programming will continue for vocational rehabilitation services for individuals with disabilities.

A Personal Perspective on the Present and Future

The external and internal forces which have negatively impacted on the Association have not gone unnoticed by numerous individuals in leadership positions within the Association. However, it has only been within the last ten years that consensus and a concerted effort has been reached by leadership on the Board to attempt to resolve the problems caused by these forces.

Board action during this time frame reflects a consensus and a commitment to redirect the Association to the broader issues, to develop proactive initiatives on issues of critical importance to rehabilitation, and to provide the leadership desperately needed to insure the future growth and development of the Association.

Recent Board activities include the development of a mission statement, "The National Rehabilitation Association is a member organization whose mission is providing opportunities through knowledge and diversity for people in the fields of rehabilitation." which delineates the Association as a professional member organization, a position at variance with NRA's history. Whether the NRA membership will embrace this mission statement is a question for the future.

The history of the Association's successes has been a distinguished history of effective leadership and impact. Its failures are similarly linked to leadership. The Association must benefit not only from its successes but also from its failures as its membership works together for a better future.

The Association must pursue its common purpose with unity and with as much vigor as it respects and applauds its unique diversity. What the future may bring depends on the Association's leadership. It is hoped that, in the future, the current NRA leadership will be remembered as being among those who helped insure that NRA attained its mandate of insuring that all children and adults with disabilities will have the opportunity and the resources available to achieve their maximum potential.

References

Constitution and Bylaws, National Rehabilitation Association Press, Alexandria, VA, 1985.

Jamero, Peter M. Organizational Configurations Affecting the Administration of Rehabilitation Services - The State of Washington's Experience, Chapter in Emener, William G., Luck, Richard S., and Smits, Stanley J. (editors).

Lavis, Leonard W. and Lavis, Diane R., (editors), Golden Anniversary of the National Rehabilitation Association - 1925-1975, Special issue, Journal of Rehabilitation, NRA, Topeka, Kansas, 1975.

Rehabilitation Administration and Supervision, University Park Press, Baltimore, Maryland, 1981. Obermann, C. Esco, A Brief History of The National Rehabilitation Association, NRA reprint, 1975.

Sales, Amos. Chapter President's Manual, National Rehabilitation Association Press, Alexandria, VA, 1983.

Sales, Amos. The Time Has Come, Journal of Rehabilitation, NRA, July-August, 1977.

Sales, Amos and Harcelroad, Fred, "Emerging Professional Organizations and Interest Groups in Rehabilitation," Chapter in Emener, William Luck, Richard S., and Smits, Stanley J. (editors), Rehabilitation Administration and Supervision, University Park Press, Baltimore, Maryland, 1981.

Sales, Amos, "The National Rehabilitation Association," Journal of Rehabilitation, NRA, July/August/September, 1986

Amos Sales, Ed.D., currently holds the position of Professor and Department Head, Department of Special Education and Rehabilitation, College of Education, University of Arizona, Tucson, Arizona. Since 1970, he has held a variety of chapter, region, and national offices within NRA, including serving as the national president. His research and service agenda for the last ten years has been related to prevention.
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Title Annotation:Special Anniversary Issue 1925-1995: National Rehabilitation Association
Author:Sales, Amos
Publication:The Journal of Rehabilitation
Date:Jul 1, 1995
Words:5305
Previous Article:How We Die: Reflections on Life's Final Chapter.
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