Closure II


group_settingClosure II was held from January 2009 through June 2009. The goal of the second series was to focus on the barriers to quality care at end-of-life by engaging professionals to examine solutions to overcome those barriers.


Closure II engaged a diverse range of people: clergy, hospice workers, lawyers, long-term care workers, medical professionals and social workers.


  • Dr. Sherwin Nuland, author of How We Die and a surgeon, who teaches bioethics and medicine at Yale, opened the series with a discussion on how to open conversations at end-of-life and engage providers in changing the culture in hospitals, practices and long-term care facilities. 
  • Guided conversations with topic experts covering:
    • End-of-life issues from the provider perspective/challenges and opportunities
    • Jewish values at end-of-life and grappling with medical futility
    • End-of-Life Planning Tool-Kit I (advance planning, delivering news to families on diagnosis and prognosis and the social determinates of end-of-life decisions)
    • End-of-Life Planning Tool kit II (hospice benefits, hospice care, focusing decision making on “care” instead of “cure” and grief)
    • Encounters with death and dying



After six sessions, the group categorized the barriers that they felt were preventing quality care at end-of-life: training issues, planning issues, systems issues and attitudes. They also highlighted the need for a public awareness campaign that emphasizes preparation, practice and policy structuring designed to change the default from doing everything to doing the right thing.