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The Death Book for Veterans

Posted by on Aug. 22, 2009 at 1:45 AM
  • 9 Replies

If President Obama wants to better understand why America's discomfort with end-of-life discussions threatens to derail his health-care reform, he might begin with his own Department of Veterans Affairs (VA). He will quickly discover how government bureaucrats are greasing the slippery slope that can start with cost containment but quickly become a systematic denial of care.

Last year, bureaucrats at the VA's National Center for Ethics in Health Care advocated a 52-page end-of-life planning document, "Your Life, Your Choices." It was first published in 1997 and later promoted as the VA's preferred living will throughout its vast network of hospitals and nursing homes. After the Bush White House took a look at how this document was treating complex health and moral issues, the VA suspended its use. Unfortunately, under President Obama, the VA has now resuscitated "Your Life, Your Choices."

Who is the primary author of this workbook? Dr. Robert Pearlman, chief of ethics evaluation for the center, a man who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before the U.S. Supreme Court and is known for his support of health-care rationing.

"Your Life, Your Choices" presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political "push poll." For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be "not worth living."


The circumstances listed include ones common among the elderly and disabled: living in a nursing home, being in a wheelchair and not being able to "shake the blues." There is a section which provocatively asks, "Have you ever heard anyone say, 'If I'm a vegetable, pull the plug'?" There also are guilt-inducing scenarios such as "I can no longer contribute to my family's well being," "I am a severe financial burden on my family" and that the vet's situation "causes severe emotional burden for my family."

When the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel?

One can only imagine a soldier surviving the war in Iraq and returning without all of his limbs only to encounter a veteran's health-care system that seems intent on his surrender.

I was not surprised to learn that the VA panel of experts that sought to update "Your Life, Your Choices" between 2007-2008 did not include any representatives of faith groups or disability rights advocates. And as you might guess, only one organization was listed in the new version as a resource on advance directives: the Hemlock Society (now euphemistically known as "Compassion and Choices").

This hurry-up-and-die message is clear and unconscionable. Worse, a July 2009 VA directive instructs its primary care physicians to raise advance care planning with all VA patients and to refer them to "Your Life, Your Choices." Not just those of advanced age and debilitated condition—all patients. America's 24 million veterans deserve better.


Many years ago I created an advance care planning document called "Five Wishes" that is today the most widely used living will in America, with 13 million copies in national circulation. Unlike the VA's document, this one does not contain the standard bias to withdraw or withhold medical care. It meets the legal requirements of at least 43 states, and it runs exactly 12 pages.


After a decade of observing end-of-life discussions, I can attest to the great fear that many patients have, particularly those with few family members and financial resources. I lived and worked in an AIDS home in the mid-1980s and saw first-hand how the dying wanted more than health care—they wanted someone to care.

If President Obama is sincere in stating that he is not trying to cut costs by pressuring the disabled to forgo critical care, one good way to show that commitment is to walk two blocks from the Oval Office and pull the plug on "Your Life, Your Choices." He should make sure in the future that VA decisions are guided by values that treat the lives of our veterans as gifts, not burdens.

Mr. Towey, president of Saint Vincent College, was director of the White House Office of Faith-Based Initiatives (2002-2006) and founder of the nonprofit Aging with Dignity.

http://online.wsj.com/article/SB10001424052970204683204574358590107981718.html

by on Aug. 22, 2009 at 1:45 AM
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Replies (1-9):
mamapotter
by Member on Aug. 22, 2009 at 2:08 AM

I have many health issues and have been near death several times.  The topic of when to "pull the plug" or cease care has come up as well.  I was thankful I had the option of dying with dignity, relieving the burden on my family, and knowing what to expect if and when the time came.  Some people would rather die in peace than prolong thier suffering in this world.  However, I can see this being a bad thing when presented to patients exhibiting strong signs of depression and stress.  So, I'm sorta on the fence for right now.

Dr. Phil said that the secret to inner peace was to finish everything you started.  So I looked around the house, finished the book I wanted to read, my old Prozac prescription, the rest of the cheesecake, and a bottle of Jack Daniels.  You wouldn't believe how calm I am now.
stormcris
by Christy on Aug. 22, 2009 at 2:11 AM

I feel that way about it. If you present it to a person who already thinks they are a burden then it could push them to a decision to end their life under that assumption rather than what they truly want.

Quoting mamapotter:

I have many health issues and have been near death several times.  The topic of when to "pull the plug" or cease care has come up as well.  I was thankful I had the option of dying with dignity, relieving the burden on my family, and knowing what to expect if and when the time came.  Some people would rather die in peace than prolong thier suffering in this world.  However, I can see this being a bad thing when presented to patients exhibiting strong signs of depression and stress.  So, I'm sorta on the fence for right now.


Scorpio359
by on Aug. 22, 2009 at 2:15 AM

Thank you so much for that valuable piece of information and for the concern and care and dedication you have put forth for our veterans. It is unreal how such a death book could even be published for our heroes who have served and volunteered to defend this great country. We owe so much to these brave men and women and to think they should be treated like discarded rubbage. This administration needs to think long and hard what it is doing for the morale of our troops and their families

stormcris
by Christy on Aug. 22, 2009 at 2:27 AM

My dad is a veteran. I never want him to feel that he is a burden to me no matter what.

Quoting Scorpio359:

Thank you so much for that valuable piece of information and for the concern and care and dedication you have put forth for our veterans. It is unreal how such a death book could even be published for our heroes who have served and volunteered to defend this great country. We owe so much to these brave men and women and to think they should be treated like discarded rubbage. This administration needs to think long and hard what it is doing for the morale of our troops and their families


blondekosmic15
by on Aug. 22, 2009 at 6:12 AM

 

Quoting stormcris:

My dad is a veteran. I never want him to feel that he is a burden to me no matter what.

Quoting Scorpio359:

Thank you so much for that valuable piece of information and for the concern and care and dedication you have put forth for our veterans. It is unreal how such a death book could even be published for our heroes who have served and volunteered to defend this great country. We owe so much to these brave men and women and to think they should be treated like discarded rubbage. This administration needs to think long and hard what it is doing for the morale of our troops and their families


 

                        


Thank you Scorpio & Storm. This makes me very angry! I cared for my father 24/7 til he passed away & if I had not been there for him they would have pulled the plug on him before his time. He was in the Air Force for 25 yrs. * a bombardier in WWII & a soldier in the Korean War. This administration is opening the door to this injustice! This is very disturbing... to say the least~

                       angry

blondekosmic15
by on Aug. 22, 2009 at 7:12 AM

 

Quoting stormcris:

If President Obama wants to better understand why America's discomfort with end-of-life discussions threatens to derail his health-care reform, he might begin with his own Department of Veterans Affairs (VA). He will quickly discover how government bureaucrats are greasing the slippery slope that can start with cost containment but quickly become a systematic denial of care.

Last year, bureaucrats at the VA's National Center for Ethics in Health Care advocated a 52-page end-of-life planning document, "Your Life, Your Choices." It was first published in 1997 and later promoted as the VA's preferred living will throughout its vast network of hospitals and nursing homes. After the Bush White House took a look at how this document was treating complex health and moral issues, the VA suspended its use. Unfortunately, under President Obama, the VA has now resuscitated "Your Life, Your Choices."

Who is the primary author of this workbook? Dr. Robert Pearlman, chief of ethics evaluation for the center, a man who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before the U.S. Supreme Court and is known for his support of health-care rationing.

"Your Life, Your Choices" presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political "push poll." For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be "not worth living."

The circumstances listed include ones common among the elderly and disabled: living in a nursing home, being in a wheelchair and not being able to "shake the blues." There is a section which provocatively asks, "Have you ever heard anyone say, 'If I'm a vegetable, pull the plug'?" There also are guilt-inducing scenarios such as "I can no longer contribute to my family's well being," "I am a severe financial burden on my family" and that the vet's situation "causes severe emotional burden for my family."

When the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel?

One can only imagine a soldier surviving the war in Iraq and returning without all of his limbs only to encounter a veteran's health-care system that seems intent on his surrender.

I was not surprised to learn that the VA panel of experts that sought to update "Your Life, Your Choices" between 2007-2008 did not include any representatives of faith groups or disability rights advocates. And as you might guess, only one organization was listed in the new version as a resource on advance directives: the Hemlock Society (now euphemistically known as "Compassion and Choices").

This hurry-up-and-die message is clear and unconscionable. Worse, a July 2009 VA directive instructs its primary care physicians to raise advance care planning with all VA patients and to refer them to "Your Life, Your Choices." Not just those of advanced age and debilitated condition—all patients. America's 24 million veterans deserve better.

Many years ago I created an advance care planning document called "Five Wishes" that is today the most widely used living will in America, with 13 million copies in national circulation. Unlike the VA's document, this one does not contain the standard bias to withdraw or withhold medical care. It meets the legal requirements of at least 43 states, and it runs exactly 12 pages.

After a decade of observing end-of-life discussions, I can attest to the great fear that many patients have, particularly those with few family members and financial resources. I lived and worked in an AIDS home in the mid-1980s and saw first-hand how the dying wanted more than health care—they wanted someone to care.

If President Obama is sincere in stating that he is not trying to cut costs by pressuring the disabled to forgo critical care, one good way to show that commitment is to walk two blocks from the Oval Office and pull the plug on "Your Life, Your Choices." He should make sure in the future that VA decisions are guided by values that treat the lives of our veterans as gifts, not burdens.

Mr. Towey, president of Saint Vincent College, was director of the White House Office of Faith-Based Initiatives (2002-2006) and founder of the nonprofit Aging with Dignity.

http://online.wsj.com/article/SB10001424052970204683204574358590107981718.html

 

katy_kay
by on Aug. 22, 2009 at 9:10 AM

Again I feel compelled to point out the one very obvious fact you want to continue to overlook Blonde (and others). 

It was a Republican that added the 'end of life discussion' provision to the Health care Bill - (Senator Johnny Isakson, Republican.)

Such was also the case with your post yesterday about Texas' Futile Care Law.  That signed into law under George W. Bush.  

For all the bluster and blunder over this issue I would think you would want to get it right so you know where to file your complaints. 

katy_kay
by on Aug. 22, 2009 at 10:31 AM

 

stormcris
by Christy on Aug. 22, 2009 at 2:38 PM


So, you believe that the OP should stay in place?


Quoting katy_kay:

 


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