The Death Book for Veterans is Nothing New

The Death Book for Veterans Ex-soldiers don't need to be told they're
a burden to society.

  By JIM TOWEY

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 der of the nonprofit Aging with Dignity.

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