This past Friday a great man, and a great patriot brought this travesty to the forefront.
His name is Jim Towey, who is president of Saint Vincent College. He also was director of the White House Office of Faith-Based Initiatives (2002-2006) and founder of the nonprofit Aging with Dignity.
His OpEd in the Wall Street Journal is available from the WSJ.com here: http://online.wsj.com/article/SB10001424052970204683204574358590107981718.html
I'm also including the full text, which I'll make reference to in future posts.
PLEASE REFERENCE THE ARCHIVE FOR FURTHER INFORMATION
Monday, August 31, 2009
Saturday, August 29, 2009
Thursday, August 27, 2009
Great Follow Up Editorial
The Washington Times published a great follow up to the original Towey piece yesterday.
They took the time to delve a little deeper than the original Death Book Op ED -- highlighting some of the points I had previously, and discussing a few more. It also ties the Death Book with the ongoing Obamacare debate, illustrating how instructive an example it could prove to be in the future.
The article can be found here: http://washingtontimes.com/news/2009/aug/26/the-government-death-book/
I will include the full text here, adding my own emphasis.
The Death Book is a nickname given to an advice manual published by the Department of Veterans Affairs that instructs veterans "how to prepare a personalized living will." Officially titled, "Your Life, Your Choices," the book fosters dark thoughts about a difficult life somehow being less of a life.
On Page 21, the Death Book poses questions to veterans to which they are to answer whether life would be "difficult, but acceptable," "worth living, but just barely" or "not worth living." The scenarios include: "I can no longer walk but get around in a wheelchair," "I can no longer contribute to my family's well-being," "I live in a nursing home," "I can no longer control my bladder," "I am a severe financial burden on my family," "I cannot seem to 'shake the blues' " and "I rely on a kidney dialysis machine to keep me alive."
The most positive answer allowable is "difficult, but acceptable." Every situation is phrased in the most negative terms. If veterans check any of the "not worth living" boxes, they are asked if this means they "would rather die than be kept alive." Further along, the book 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?"
There is no attempt to ask people, "What would it take for you to want to live?" Instead, the booklet focuses on wanting to die. "Your Life, Your Choices" originally was put together by the Clinton administration and then shelved during the George W. Bush presidency. Jim Towey, director of the White House Office of Faith-Based and Community Initiatives during the Bush administration, said the booklet was problematic because it made injured veterans feel like a burden and encouraged severely injured soldiers to want to die.
After a ruckus over the booklet this past week, the Obama administration added a new note saying the work was being revised. Either way, the Death Book is instructive as a reflection on Obamacare priorities and perspectives and what the administration might view as a "waste." This is important because Mr. Obama and other administration officials regularly talk about a need to cut back on what they term as massive waste in health care.
What government considers a waste, many patients and doctors consider a necessity. Denying this care based on vague notions of efficiency is rationing. Even the New York Times admitted last week that "the concerns [about rationing] are not entirely irrational." Concern about rationing has been particularly acute among the elderly for good reason. The Death Book shows government's perverse interest in the end of life rather than its extension.
They took the time to delve a little deeper than the original Death Book Op ED -- highlighting some of the points I had previously, and discussing a few more. It also ties the Death Book with the ongoing Obamacare debate, illustrating how instructive an example it could prove to be in the future.
The article can be found here: http://washingtontimes.com/news/2009/aug/26/the-government-death-book/
I will include the full text here, adding my own emphasis.
The government 'Death Book'
Bureaucrats investigate what life is 'not worth living'
The Obama administration claims that a health care takeover by government won't restrict access to care. Everybody will get more care for less money, the president has said. Of course, something has to give. One likely target for rationing will be care in the later stages of life. Bureaucratic disregard for the value of all life is insinuated in a government manual known as "the Death Book."The Death Book is a nickname given to an advice manual published by the Department of Veterans Affairs that instructs veterans "how to prepare a personalized living will." Officially titled, "Your Life, Your Choices," the book fosters dark thoughts about a difficult life somehow being less of a life.
On Page 21, the Death Book poses questions to veterans to which they are to answer whether life would be "difficult, but acceptable," "worth living, but just barely" or "not worth living." The scenarios include: "I can no longer walk but get around in a wheelchair," "I can no longer contribute to my family's well-being," "I live in a nursing home," "I can no longer control my bladder," "I am a severe financial burden on my family," "I cannot seem to 'shake the blues' " and "I rely on a kidney dialysis machine to keep me alive."
The most positive answer allowable is "difficult, but acceptable." Every situation is phrased in the most negative terms. If veterans check any of the "not worth living" boxes, they are asked if this means they "would rather die than be kept alive." Further along, the book 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?"
There is no attempt to ask people, "What would it take for you to want to live?" Instead, the booklet focuses on wanting to die. "Your Life, Your Choices" originally was put together by the Clinton administration and then shelved during the George W. Bush presidency. Jim Towey, director of the White House Office of Faith-Based and Community Initiatives during the Bush administration, said the booklet was problematic because it made injured veterans feel like a burden and encouraged severely injured soldiers to want to die.
After a ruckus over the booklet this past week, the Obama administration added a new note saying the work was being revised. Either way, the Death Book is instructive as a reflection on Obamacare priorities and perspectives and what the administration might view as a "waste." This is important because Mr. Obama and other administration officials regularly talk about a need to cut back on what they term as massive waste in health care.
What government considers a waste, many patients and doctors consider a necessity. Denying this care based on vague notions of efficiency is rationing. Even the New York Times admitted last week that "the concerns [about rationing] are not entirely irrational." Concern about rationing has been particularly acute among the elderly for good reason. The Death Book shows government's perverse interest in the end of life rather than its extension.
Tuesday, August 25, 2009
The Death Book for Veterans
The full text from the Wall Street Journal.
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 founder of the nonprofit Aging with Dignity.
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 founder of the nonprofit Aging with Dignity.
Hurry-Up-and-Die
"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."
This directive is available from the Veteran's Administration, here: http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=2042
On page 8, in plain language, directing the VA to use "Your Life, Your Choices."
This directive is available from the Veteran's Administration, here: http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=2042
On page 8, in plain language, directing the VA to use "Your Life, Your Choices."
Updating the Death Book
"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")"
For more background on the Hemlock Society (Hemlock is a poisonous drug derived from an Eurasian plant of the genus Conium) read this great expose -- http://www.normemma.com/advocacy/arhemloc.htm
A brief quote from said expose -- "What can those of us who sympathize with a justified suicide by a handicapped person do to help? When we have statutes on the books permitting lawful physician aid-in-dying for the terminally ill, I believe that along with this reform there will come a more tolerant attitude to the other exceptional cases."
For more background on the Hemlock Society (Hemlock is a poisonous drug derived from an Eurasian plant of the genus Conium) read this great expose -- http://www.normemma.com/advocacy/arhemloc.htm
A brief quote from said expose -- "What can those of us who sympathize with a justified suicide by a handicapped person do to help? When we have statutes on the books permitting lawful physician aid-in-dying for the terminally ill, I believe that along with this reform there will come a more tolerant attitude to the other exceptional cases."
Life 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?"
Obviously graphically condensed, but you can see all quoted items from the story appear on page 21 of the original document.
When the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel?"
Obviously graphically condensed, but you can see all quoted items from the story appear on page 21 of the original document.
Your Life, Your Choices
"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."
This pamphlet is available to download on the internet, here: http://www.rihlp.org/pubs/Your_life_your_choices.pdf
This pamphlet is available to download on the internet, here: http://www.rihlp.org/pubs/Your_life_your_choices.pdf
Who is Dr. Robert Pearlman?
"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."
Dr. Pearlman is currently working for the US Department of Veteran's Affairs -- his page is available here: http://www.ethics.va.gov/about/staff/pearlman.asp
From said page: "His interests and expertise pertain to empirical research in clinical ethics (especially end-of-life care) and organizational ethics. His research has explored euthanasia, the role of quality of life in decision-making, the validity of life-sustaining treatment preferences, medical futility, advance care planning, physician-assisted suicide, and relief of patient suffering."
Dr. Pearlman is currently working for the US Department of Veteran's Affairs -- his page is available here: http://www.ethics.va.gov/about/staff/pearlman.asp
From said page: "His interests and expertise pertain to empirical research in clinical ethics (especially end-of-life care) and organizational ethics. His research has explored euthanasia, the role of quality of life in decision-making, the validity of life-sustaining treatment preferences, medical futility, advance care planning, physician-assisted suicide, and relief of patient suffering."
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