By Dave Andrusko

"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."
     From "The Death Book for Veterans," by Jim Towey, which appeared in the Wall Street Journal August 19, 2009.

Jim Towey

Although Jim Towey's column has stirred the proverbial hornet's nest, my hunch is that not enough people are aware of the growing controversy over what is afoot at the Department of Veterans Affairs (VA). According to Towey (the one-time director of President George W. Bush's Faith-Based Initiatives, among other things), the VA has brought back to life a death initiative into which Bush tried to drive a stake back in 2007. All this, needless to say, is being pooh-poohed by the Obama Administration.

Towey's Wall Street Journal piece (available at http://online.wsj.com/article/SB10001424052970204683204574358590107981718.html) charges that a 52-page "hurry up and die" workbook/primer titled Your Life, Your Choices: Planning for Future Medical Decisions "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.'"

This "hurry-up-and-die message is clear and unconscionable," Towey writes. "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."

Since the document is available online (complete with a quickly added disclaimer once Towey's op-ed appeared), I read it for myself to see if Towey's allegations held water. And, unfortunately, they most assuredly do.

The workbook is permeated from the first grim example onward with a bias in favor of death--of presenting one scenario after another followed by the question (begging for a negative response) would you really want to remain alive if you were in one of these conditions? More about this in a moment.

One can only wonder, as Towey does, how a disabled young solider coming back from Iraq or Afghanistan would react to the following:

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?

When Towey debated Tammy Duckworth, Assistant Secretary of Veterans Affairs, yesterday on Fox News Sunday, it is instructive, to say the least, that Duckworth refused to be on the air at the same time. Forced to defend an unconscionable document, Duckworth--herself a decorated veteran--was reduced to denying the undeniable.

For example, as an increasingly exasperated host Chris Wallace patiently pointed out, the VA, under the Obama Administration, did resuscitate Your Life, Your Choices last July after the VA, under the Bush administration, had suspended it in 2008. And the directive did "urg[e] providers to refer patients to it." And the "Note" now on the VA website [which states that the document is "currently undergoing revision" and "will be available soon"] did not exist until after Towey's op-ed appeared in the Journal.

To make matters worse, Duckworth also not-too-subtly suggested Towey's motives included promoting a small book he authored on end of life decision-making.

Please take the time to go to www.ethics.va.gov/YLYC/YLYC_First_edition_20001001.pdf. Only if you read this for yourself can you appreciate how dangerous the document is.

The scariest section is titled, "What make your life worth living?" It lists a series of circumstances and asks "if this factor by itself described you" would you find it "difficult, but acceptable"; "worth living, but just barely"; "not worthy living"; or "can't answer now" (but how-we-can-help-you-decide hints at the bottom of the page).

Those circumstances include, "I live in a nursing home," "I am a severe financial burden on my family," and "I cannot seem to 'shake the blues.'" Just in case the reader isn't quite ready to go the direction the workbook clearly prefers, it helpfully asks, "If you checked 'worth living, but just barely' for more than one factor, would a combination of these factors make your life 'not worth living?' If so, which factors?"

As Towey pointed out on Fox News Sunday,

The biggest problem is that when you go beyond those questions to the boxes you check, the first option you have, "it's difficult but acceptable," a lot of people with disabilities, a lot of people who have family members with stroke, find life beautiful. There's meaning and purpose. Sure, they're suffering, but their life hasn't been diminished by that illness.

I think there -- if you were trying to be unbiased and fair, you'd have a box that starts off that says "My life is beautiful. Yes, I suffer, but I find meaning in it."

Yes, that would be proper...if the goal were to be "unbiased and fair." But in an Administration whose first instinct is to decrease the level of care to the elderly and the most vulnerable (ostensibly to make it available to all), it is only prudent to suspect the worst.

Please send your much-appreciated comments to daveandrusko@gmail.com.

Part Two