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<FONT face=Tahoma size=2><B>From:</B> nrlc@nrlc.org [mailto:nrlc@nrlc.org]
<BR><B>Sent:</B> Monday, August 24, 2009 5:25 PM<BR><B>To:</B> Art
Kelly<BR><B>Subject:</B> Concern about Depart. of Veterans Affairs' "Death
Book"<BR></FONT><BR></DIV>
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<TD vAlign=top align=left width=99><B><I><FONT
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<P><I><B><FONT face="Garamond Book" color=#000080
size=7> <FONT face=Georgia
color=#000080 size=7>Today's <BR>News &
Views</B></I></FONT></FONT></P></TD></TR></TBODY></TABLE></DIV></TD></TR></TBODY></TABLE>
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<P align=left><FONT face="Trebuchet MS" size=2><B>Today's News &
Views<BR>August 24, 2009</B></FONT></P><FONT
face="Trebuchet MS" size=2>
<P><FONT size=4><B>Debate Over Department of Veterans Affairs'
"Death Book" <BR>Only Strengthens Reasons for Concern
</B></FONT><FONT size=2><BR><B>Part One of <A
href="http://www.nrlc.org/News_and_Views/Aug09/nv082409part2.html">Two</A></B></FONT></P>
<P><FONT size=2>By Dave Andrusko</FONT></P>
<P><FONT size=2>"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."<BR> From "The Death Book for
Veterans," by Jim Towey, which appeared in the <I>Wall Street
Journal</I> August 19, 2009. </FONT></P>
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<P align=center><I><B><FONT size=2>Jim
Towey</FONT></B></I></P></TD></TR></TBODY></TABLE>
<P><FONT size=2>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.</FONT></P>
<P><FONT size=2>Towey's <I>Wall Street Journal</I> piece (available
at <A
href="http://online.wsj.com/article/SB10001424052970204683204574358590107981718.html">http://online.wsj.com/article/SB10001424052970204683204574358590107981718.html</A>),
charges that a 52-page "hurry up and die" workbook/primer titled
<I>Your Life, Your Choices: Planning for Future Medical
Decisions</I> "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.'"</FONT></P>
<P><FONT size=2>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 '<I>Your Life, Your
Choices</I>.' Not just those of advanced age and debilitated
condition--all patients. America's 24 million veterans deserve
better."</FONT></P>
<P><FONT size=2>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.</FONT></P>
<P><FONT size=2>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 <B>really</B> want to remain alive if
you were in one of these conditions? More about this in a
moment.</FONT></P>
<P><FONT size=2>One can only wonder, as Towey does, how a disabled
young solider coming back from Iraq or Afghanistan would react to
the following:</FONT></P>
<P><I><FONT size=2>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." </FONT></I></P>
<P><I><FONT size=2>When the government can steer vulnerable
individuals to conclude for themselves that life is not worth
living, who needs a death panel?</FONT></I></P>
<P><FONT size=2>When Towey debated Tammy Duckworth, Assistant
Secretary of Veterans Affairs, yesterday on <I>Fox News Sunday</I>,
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.</FONT></P>
<P><FONT size=2>For example, as an increasingly exasperated host
Chris Wallace patiently pointed out, the VA, under the Obama
Administration, <B>did</B> resuscitate <I>Your Life, Your
Choices</I> last July after the VA, under the Bush administration,
had suspended it in 2008. And the directive <B>did</B> "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 <B>not</B> exist until
after Towey's op-ed appeared in the <I>Journal</I>. </FONT></P>
<P><FONT size=2>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.</FONT></P>
<P><FONT size=2>Please take the time to go to <A
href="http://www.ethics.va.gov/YLYC/YLYC_First_edition_20001001.pdf">www.ethics.va.gov/YLYC/YLYC_First_edition_20001001.pdf</A>.
Only if you read this for yourself can you appreciate how dangerous
the document is.</FONT></P>
<P><FONT size=2>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).</FONT></P>
<P><FONT size=2>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?"</FONT></P>
<P><FONT size=2>As Towey pointed out on <I>Fox News Sunday</I>,
</FONT></P>
<P><I><FONT size=2>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.</FONT></I></P>
<P><I><FONT size=2>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."</FONT></I></P>
<P><FONT size=2>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.</FONT></P>
<P><FONT size=2>Please send your much-appreciated comments to <A
href="mailto:daveandrusko@gmail.com">daveandrusko@gmail.com</A>.
</FONT></P>
<P><B><FONT size=2><A
href="http://www.nrlc.org/News_and_Views/Aug09/nv082409part2.html">Part
Two</A></FONT></B></P>
<P><B><A
href="http://www.nrlc.org/News_and_Views/">http://www.nrlc.org/News_and_Views/</A>
</B></FONT></FONT></P></TD></TR></TBODY></TABLE>
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