The truth about the VA “death book”

Last week I wrote that opponents to health care reform had gotten their panties in a twist over the VA’s end-of-life information/help/advanced vetsguidedirective booklet, “Our Life, Our Choices.”

Jim Towey, the former president of the White House Office of Faith-Based Initiatives under George W. Bush, wrote in an op-ed in the Wall Street Journal that “‘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.’”

Towey’s argument against the booklet inferred that it somehow (subliminally?) tried to push veterans to choose to state, in legal advanced directive form, that their families and the medical staff caring for them should just “pull the plug” if they were to become terminally injured or ill. His op-ed infers that the Veteran’s Administration views caring for our military veterans as not worth the trouble or money; that “Our Life, Our Choices” is a “hurry up and die” message to the veterans that served our country.

Within a day of the editorial’s appearance in the WSJ, health care reform opponents and the always helpful main-stream media were referring to “Our Life, Our Choices” as the VA’s “death book.” Chris Wallace, the “journalist” on the Aug. 23 edition of Fox News Sunday repeatedly suggested that the Obama Administration is pressuring veterans to end their lives prematurely. If that wasn’t enough, he also inferred that Assistant Secretary of Veterans Affairs Tammy Duckworth is lying when she countered his assertions.

It all seemed sorta fishy to me, being a veteran who’s received (and continues to receive) affordable, excellent, timely health care through the VA. So I promised in my post here on Blue Wren that, since I was going to an appointment at the VA Medical Center near my home later in the week, I’d get a copy of “Our Life, Our Choices,” read it, and tell you what I thought.

Alas, after more than an hour spent trekking to various offices all over the medical campus before and after my appointment, I discovered that this particular VA medical center didn’t have it. Instead, it had a 10-page, photocopied handout that includes a copy of the California Advanced Directive, along with instructions on how to use it and where to get more information. Nice to have, sure – I took it – but it wasn’t the evil “death book” being discussed by breathless talking heads on the cable news channels.

So after I got home I did some more searching online. When I googled “Our Life, Our Choices,” I found a number of websites that offered the complete booklet as a PDF. One of them was I downloaded it and sat down to read, curious.

Does “Our Life, Our Choices” list various scenarios and then ask users to decide whether their own lives would not be “worth living?” Only if you twist the intention of the questions. Only if you’re trying to scare people away from making thoughtful, informed decisions about how they wish to be treated by medical professionals and their families if they become deathterminally ill or catastrophically injured.

Only if you’d tried to sell your own, 12-page booklet regarding advanced directives and end-of-life planning to the VA while you worked for the White House, and had the VA turn you down because federal procurement regulations forbade action on such unsolicited proposals.

Because that’s what happened to Towey. Apparently the VA also felt that “Our Life, Our Choices” was the better deal anyway, since it was offered free to all veterans and included advanced directive paperwork that was accepted as legal in every state in the country. Towey’s short, simplistic “Five Wishes” was not legally sound as a living will in 10 states.

Here’s the other part of this story. “Our Life, Our Choices” was used as an educational tool to assist veterans in how to fill out an Advanced Directive for ten years. In 2007 the VA decided to revise some of the content – which most government agencies do, now and then, to keep them current. Towey claimed in his op-ed that no outside faith groups or disability rights advocates were asked for their input for the revision.

Well, that was a lie. In fact, “‘according to the VA, the panel included a priest, a rabbi, a renowned disability rights advocate, and the president of the organization that produces "Five Wishes," the alternative advance care planning document that Towey is promoting and selling. [my emphasis] “… The plans to update and release the booklet were developed under the Bush administration and it is due for release in 2010.”

Ah. That must be why I couldn’t find a copy of “My Life, My Choices” at my local VA medical center – the revised version hasn’t been released yet!

The fact is, the booklet does offer users a series of examples, in workbook form, which present several end-of-life situations and scenarios. It does ask, basically, “if this were you, what would you want done?” The booklet doesn’t try to persuade the user to “pull the plug.” In fact, it reiterates more than once that everyone has different beliefs about what should be done at the end of life, not least because of their religion, and that these decisions can and should only be made by the user. What’s more, your Advanced Directive is only consulted if you are unable to speak for yourself because of terminal injury or illness.

Because that’s what an Advanced Directive – a living will – is all about. It doesn’t matter who you are – a U.S. veteran, the manager of a grocery store, an executive or a parent raising children – it gives you a great deal of control regarding your own end-of-life care. An Advanced Directive states your wishes as to how you want to be treated, and by which methods. It ensures that your wishes will be carried out. If you want to be kept alive for as long as humanly possible in the hope for a miracle cure, that’s your right. Maybe there will be one. But if you’d rather not be kept alive, that’s your right too.

Finally, “Your Life, Your Choices” reminds the user several times that an Advanced Directive can be changed anytime – and as many times – as you want. If you change your mind (regardless of the reason) five years from now about how you want to be treated, then all you have to do is make the change on the legal document. It doesn’t cost anything but a little bit of time and effort.

Thinking about death – as inevitable as it is for all of us – is pretty uncomfortable. No one really wants to. No one really wants to have to discuss it with their families or put it all down on paper for the same reason. But the point of having an Advanced Directive is that we don’t know when or how we’ll die. It could be tomorrow; it could be in 40 years. We have no control over it.

What we can control is how we’ll be treated, medically, if we are dying and are unable to tell our families and the medical professionals helping us what we want.

That’s all “Our Life, Our Choices” does: It educates. It explains. It gives veterans the tools they need to have legal copies of their advanced directive available at their homes, with their family members, and on file at their doctors’ offices – just in case it’s needed.

And then it leaves the whole thing up to the veteran. Make an Advanced Directive, or don’t. It’s your choice.

It really couldn’t be more benign. And frankly, it makes this old pagan hot under the collar that someone like Towey, who calls himself a Christian, would try to scare veterans and other Americans away from something so morally right and inarguably good for them. And why? The reason appears to be personal gain. Mr.. Towey, is that what Jesus would do?


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