August 20, 2009

VA’s Denial-of-Care-Oriented ‘Your Life, Your Choices,’ Quashed Under Bush, Revived Under Obama


If you were a reporter trying to gauge the credibility of Obama administration’s protests that it is really serious when it says that it will honor patient, doctor, and family treatment wishes in serious illness situations if the government takes an exponentially greater role in health care, you might look into how areas of health care already controlled by the government are dealing with these sensitive matters.

Apparently either no journalist has cared to look, or if anyone has looked, they haven’t found anything they believe is worth reporting.

In today’s Wall Street Journal, Jim Towey, a former director of the Bush White House’s Office of Faith-Based Initiatives and founder of the nonprofit Aging with Dignity, found a troubling, newsworthy, death-encouraging decision that has already been made during Barack Obama’s short term in office.

As Towey chronicles and explains, it’s in the Veterans Administration, and it really is appalling. Here are key excerpts from his column (bolds are mine):

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?

….. 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.

Towey wraps by challenging the president “to walk two blocks from the Oval Office and pull the plug on ‘Your Life, Your Choices.’”

Don’t hold your breath, Jim — waiting for the president to make that walk, or waiting for anyone else in the press to note a federally-controlled health care system that is realizing the worst fears of those who believe in the dignity of life.

Cross-posted at



  1. And what, exactly, is your point? My late father, without the VA’s help, explicitly considered these and many other, similar questions before drawing up his own end-of-life instructions. And I am grateful that he did, because when he did fall ill and became, among many other problems, incapable of communicating, it made family members’ health care decisions for him about as easy as such decisions can be under such tragic circumstances.

    Comment by Lex — August 21, 2009 @ 9:54 am

  2. #1, the point, as described in the post, is that the VA publication encourages people to tilt their end of life instructions towards surrendering instead of fighting, that it has been revived during the Obama administration after being mothballed by Bush, and that the publication’s bring-back is evidence that the “death panel” fears of ObamaCare opponents aren’t imaginary.

    But I think you already knew that.

    Comment by TBlumer — August 21, 2009 @ 10:35 am

  3. I don’t see that, but let’s say for the sake of discussion that it’s true. Why, when the overwhelming majority of a person’s lifetime health-care expenses will be generated in the last few weeks or months of a typical person’s life, should we continue to pour vast amounts of health-care resources into pointlessly extending a person’s life? It’s hard to read a news-media account of a cancer patient without encountering many permutations and combinations of the word “fight,” and that mindset has no doubt been particularly inculcated into our service members and veterans. That’s a good thing; don’t misunderstand me: You don’t win wars without that mindset. But in terms of one’s own health, sometimes the best thing to do is just make yourself as comfortable as you can, enjoy yourself as much as you can, and when the time comes, let it come. With the rise of the hospice movement, that mindset is more common than it used to be, but the idea that as many patients have DNR orders as need them is badly mistaken.

    (Now, that said, older people can suffer from depression from a wide variety of *physical* causes, including as-yet-undiagnosed tumors. So it’s important to both 1) consider the depression as a possible marker of a physical problem and 2) consider it as something to be treated, not a sign that a person should commit suicide.)

    Comment by Lex — August 22, 2009 @ 6:27 pm

  4. Lex ::
    “Why, when the overwhelming majority of a person’s lifetime health-care expenses will be generated in the last few weeks or months of a typical person’s life, should we continue to pour vast amounts of health-care resources into pointlessly extending a person’s life?”

    That is a remarkably fatuous question. “Why…should we [we?]… extend a person’s life…?” who are you to decide the opposite? who are you to decide that some one else should have the power and authority to make that decision for anyone at all aside from themselves? if it is your dime on your life I would only argue with you; but if not, you’d better stay away from me and mine unless you are bullet-proof.
    You might like to call it Very-Late-Term Abortion or just ‘sending them to the showers’ but it stinks all the same.

    Comment by Dexter — August 24, 2009 @ 6:21 pm

  5. I spent some of the best days with my grandfather in the last months of his life, so take yourself and your cold psychobabble elsewhere.

    Comment by zf — August 24, 2009 @ 10:51 pm

  6. Just because it seems “pointless” to you, does not mean it will seem that way to a person and.or his family.

    Comment by zf — August 24, 2009 @ 10:55 pm

  7. Dexter, you’re the one who’s being disingenuous. As you very well know, I did not say, suggest or imply that the government should MAKE the end-of-life decisions. The person who should make that decision should be the patient, if he is able, or his legally designated proxy. The government can play a helpful role by making it financially possible to ensure that whoever is making the decision has all available relevant information, including likely costs of continued treatment, palliative care only and other options.

    The Nazi imagery doesn’t help you.

    Comment by Lex — August 26, 2009 @ 1:15 pm

  8. #7, no Lex, you’re just okey-dokey with the government heavily influencing the decision. In the real world, that’s all too often a distinction without a difference.

    Comment by TBlumer — August 26, 2009 @ 2:08 pm

  9. Tell it to the Vietnam Veterans of America, TBlumer:

    Comment by Lex — August 27, 2009 @ 2:07 pm

  10. Also, tell it to the Bush 43 administration, which used the same damn guide:

    Comment by Lex — August 27, 2009 @ 2:21 pm

  11. #9 and #10 — Uh, no.

    The original source is the WSJ op-ed linked in this post, not Fox News. So first, get your sources right.

    Second, the WSJ’s op-ed writer, who worked in the Bush Admin, specifically says the book was pulled from active use, i.e., “suspended.” He didn’t say they burned what was in print or nuked the related PDF.

    Unless you can prove him wrong, or unless the Kossack can, whether or not the guide can be found in a web archive search proves NOTHING about whether it was actually used.

    Even if its use was revived in 2007 as claimed (which I don’t concede until a vet actually says he or she had the guide foisted on them, that would mean they took it out of circulation for roughly six years before that, surely saving some lives of those who might otherwise have given up as a result of the Guide’s influence. Its revival, if true, would only suggest that faith-based officials let their guard down while VA bureaucrats flouted the admin’s clear intent and prior action.

    So …. even if that’s true, now that its use is known, will Obama do the right thing the author suggested, “walk two blocks,” and pull the guide, or not? If not, given the publicity, I’ll assume he’s OK with it. Bush himself and his faith-based people clearly never were.

    Comment by TBlumer — August 27, 2009 @ 3:05 pm

  12. And your point is … ?

    The bottom line is that a careful reading of the document shows that it isn’t the malevolent “pro-death” publication you claim it to be, and the government isn’t forcing anyone to do anything he/she doesn’t want to do.

    We’re done here.

    Comment by Lex — August 27, 2009 @ 3:54 pm

  13. a careful reading of the document shows that it isn’t the malevolent “pro-death” publication you claim it to be.

    Oh. Yes. It. Is.

    And of course it’s not about “force,” it’s about “friendly persuasion.”

    I’ve made plenty of points. I fail to see where you’ve made any.

    Obviously you haven’t read or have failed to understand the Wall Street Journal article and the guide’s actual contents.

    Comment by TBlumer — August 27, 2009 @ 4:49 pm

  14. Lex::
    You cannot revise your own words:
    “Why…should we [we?]… extend a person’s life…?”

    add to that “The government can play a helpful role by making it financially possible ….”
    The government IS our money and not much else right now.
    The word ‘disingenuous’ doesn’t apply to you yourself?
    You think you can blow smoke like the rest of them, but they are lining their pockets and assuming greater power from the likes of you.
    Go to Cuba if you want to live that way — I’m not buying ‘what the Obama government can “afford”‘.
    I guess Very-Late-Term Abortion does strike a rather Nazi cord, thanks.

    And al fin, I suppose you would say, for that mouse in your pocket: ‘We’re done here.’ Too bad our fight (the real one) is not over as well.

    Comment by Dexter — September 3, 2009 @ 11:51 am

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