Debate Over Department of
Veterans Affairs' "Death Book"
Only Strengthens Reasons for Concern
Part One of Two
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.
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
Towey's Wall Street Journal
piece (available at
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
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
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
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
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
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
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
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