In my last article, “Our Veterans deserve better than Obama's VA 'Death Book' directive”, I reported on the ‘Your Life, Your Choices’ book that the Veteran’s Health Administration directed practitioners to starting using again and making available for all Veteran Health Administration patients as of July 2, 2009. Jim Towey’s article from the Wall Street Journal, ‘Death Book for Veterans’, was my first glimpse into the story which made me look further into what he refers to as a ‘Death Book’. The exact questions that I had serious issues with are detailed in my last article. This afternoon on Chris Wallace’s show ‘Fox News Sunday’, he interviewed both Mr. Towey and the Assistant Secretary for Public and Intergovernmental Affairs L. Tammy Duckworth, herself a wounded Veteran (the video has yet to be released - transcripts here).
Wallace asked Ms. Duckworth about the questions themselves, the directive and the VHA Handbook that contains specific references to the ‘Your Life, Your Choices’ handbook created by the VHA. Unfortunately for them, everything they have is published online and available for anyone to research for themselves. The Advance directive does indeed state that ALL Veterans are to receive ‘Advance directive notification and screening’:
“Advance directive notification and screening is required at:
(1) Check-in for a patient’s first primary care appointment, unless there is documentation of
advance directive notification and screening within the last year;
(2) Each admission to a VHA inpatient facility (including hospital, nursing home, or
domiciliary facility);..”
Since we have many returning Veterans from Iraq and Afghanistan who would indeed be using the VHA, this means that even the 20 year old wounded soldier who ends up in a wheelchair would be given the ‘Your Life, Your Choices’ document. As I stated previously, I have no issues with the true end-of-life questions, but the other questions such as ‘unable to shake the blues’ and ‘living in a wheelchair’ are troubling to me because a 20 year old Veteran has many, many years of a wonderful life left (as do many older Veterans who may be in wheelchairs or nursing homes). Ms Duckworth refused to respond to some of the more specific questions asked by Chris Wallace about the worksheet (wheelchair, nursing home and not shaking the blues) and what they have to do with end-of-life planning.
Ms. Duckworth maintains that the VHA also tells Veterans that they can use any Healthcare Directive documents they choose, yet they specifically point them to the ‘Your Life, Your Choices’ document:
“Primary care practitioners are responsible for:
a. Raising the issue of advance care planning with all patients who have decision-making
capacity, explaining that they do this with all their patients. These conversations may be brief, or
more extensive, depending on the patient’s circumstances. …
b. Giving patients pertinent educational materials (e.g., Refer patients to the “Your Life,
Your Choices” module…)”
The following is from Appendix C in the VHA Handbook that directs Veterans to the ‘Your Life, Your Choices’ document:
“Other resources for advance directives:
Your Life, Your Choices has exercises to help you think about important questions.”
When Chris Wallace asked Ms. Duckworth why this document is now being used as of July 2, 2009(at first she said it was not a directive), she claims that there is a note on the top of the document that alerts Veterans that the ‘Your Life, Your Choices’ planning directive is being revised. Ms. Duckworth maintains that the following statement has been on the ‘Your Life, Your Choices’ document all along:
“Note – The following is a 1997 publication that was produced under VA IIR Grant No. 94-050, “Development of an Advance Care Planning Workbook,” 4/01/95 – 3/31/97. The document is currently undergoing revision for release in VA. The revised version will be available soon.”
Since I too researched this story, I have a copy of the original document and this note was absolutely NON-EXISTENT in the ‘Your Life, Your Choices’ document. Ms. Duckworth lied. I have added a photo of the before and after as I now have both copies of the document itself.
Why is the administration backpedaling? Why are they obviously lying to Veterans and Americans? No one disagrees that many of the questions in the worksheet are valuable and truly end-of-life questions that all people should indeed have prepared. What is questionable is the ethical and moral reasoning behind questions that have nothing to do with end-of-life planning. I thank Ms. Duckworth for her invaluable service to this country; there is no doubt about that. But I have issues with a Veteran who works for the VHA lying to fellow Veterans and Americans about the facts behind ‘Your Life, Your Choices’. I have issues with an administration that lies to Veterans and Americans. I have issues with an administration that doesn't find some of the questions in the worksheet morally reprehensible as reasons for 'wanting to die'. The facts that Ms. Duckworth and the VHA dismissed as untruths are, as Chris Wallace stated on his program, ‘in black and white’.
UPDATE: Jonah Goldberg made a good point today on his National Review blog: The administration is throwing her under the bus, which enrages me and why I updated. Have they no shame?
Photo from the title page of the 'Your Life, Your Choices' document by the VHA.
Comments
Kimberly,
Do you want to control your own health care? If so, you should have a living will to make your wishes clear if you are ever injured or disabled and unable to communicate them yourself.
"Your Life, Your Choices" is an outstanding brochure that will help you. I encourage you and all your readers to read the brochure, which for the moment is available here: www.rihlp.org/pubs/Your_life_your_choices.pdf.
Yet another ridiculously slanted article from a website owned by a Republican BILLIONAIRE Philip Anschutz. Scroll down and look at the d/b/a, folks (that's "doing business as"): Clarity Digital Group LLC d/b/a Examiner.com. Through it, Anschutz just bought The Weekly Standard (ol' Billy Kristol's mouthpiece) from Fox News' guru Rupert Murdoch.
Now don't THAT 'splain a lot!!
Steve thank you but I do have a copy and I have read through it. As I stated in both articles I completely agree with this. What I have a problem with are the specific questions that I refer to in both articles.
Philip - WOW.. I didn't even know that!! We have Examiners from all walks of life working here - Liberal, Democrat, Republican, Conservative, Progressive etc etc. Please do check out all of the othe Examiners - I will bet you 100% that you will find many that you agree with.
Republican extremists have always depended on the ignorant and the weak-minded to repeat their misinformation as if it were the truth to anyone that will listen to them. It has worked pretty well so far as I have heard the same lines of bogus claims from several of the kids I work with. They are barely educated, mostly racist and live by the gospel according to 'hate radio'. The bad news for you, Ms. Morin, is that through experience (mostly bad thanks to you and your ilk) they will eventually grow up and begin to think like adults. Well, maybe not the girl in love with Bill O'Reilly, but I do have hope for the rest.
I'm sick of all this disinformation being thrown around. It makes me angrier when the media treats this crap as though it were legitimate. But what makes me even angrier still is the idea that I'm told I have to tolerate all these stupid people who fall for this nonsense.
I served my country for 25 years and was abroad from 1995 to 2008. I've been back now for 17 months and the depth of ignorance is incredible. I served all this time to preserve Americans' freedoms, and this is what I got for my trouble - a populace that is absolutely clueless. My God.
I'm a vet and recently completed a visit to VA. The first thing they asked me is would you like to have VA unplug you should your health deteriorate. I thought it strange they should ask me this. I felt a little uncomfortable with them asking me if I would be happier to not live on support. So I believe the VA is being sinister for the Obama administration. Why would any Veteran trust this government, now knowing their plan is to take our lives. Saving money for the government.
Now having watched the report on FOX News which did this story with Duckworth and Specter. I now know Obama wants to kill those that are costing the government money for service connected problems.
Obama saying he cares about the welfare of Veterans is a lie. This government with CZARS is out of control.
I will vote against him and his people in the next election in 2010. Maybe they should have unplugged Kennedy when they knew be had brain cancer but did not. We could have save money.
Michael - first THANK YOU. Second - please point out where I am giving any misinformation. I appreciate your opinion and I do not want to misreport FACTS.
Norm and THANK YOU as well. I do not think this is a sinister plan but I had issues with the specific questions that I mentioned. I believe in healthcare proxies.. I have my own. This document would better serve to be rid of the questions that are not life or death questions.
This so-called "death book" business is stupid, and people who propagate such nonsense are equally stupid.
The whole issue is helping GIs make choices on how they wish to be dealt with in the event of an injury so serious they cannot sustain themselves. They have that right, and the VA is very simply pointing that out to them. Civilians have the ability to do this - why not the members of the Armed Forces?
Do you know what a durable power of attorney for health care does? A living will? VHA Handbook 1004.02, Advance Planning and Management of Advance Directives (your so-called "death book"), speaks to how those two things, otherwise known as Advance Directives, work into the scheme of treating catastrophically wounded warriors.
Please stop wasting people's time with all this nonsense you and those like you are spreading around. We have serious work to do in this country and have no time to waste with this foolishness.
Norm - which VA hospital did you visit, and what are the extent of your injuries that would lead them to ask you such a question?
Thank You Micheal - as I state in the article the 'Death Book' name was given via Towey however... it IS a book about death isn't it??
You agree w/ all of the NON-death questions in the book?
a. I can no longer walk but get around in a wheelchair.
b. I can no longer get outside—I spend all day at home.
c. I can no longer contribute to my family's well being.
d. I am in severe pain most of the time.
e. I have severe discomfort most of the time (such as nausea, diarrhea, or shortness of breath).
i. I need someone to help take care of me all of time.
j. I can no longer control my bladder.
k. I can no longer control my bowels.
l. I live in a nursing home.
m. I can no longer think clearly-I am confused all the time.
n. I can no longer recognize family/friends
o. I can no longer talk and be understood by others.
And others...
VETS have earned this “My existence, while grotesque and incomprehensible to you, saved lives. You don't want to admit that because deep down in places you don't talk about at parties you want me on that wall, you need me on that wall. We used words like honor, code, loyalty. We use then as the backbone of a life trying to defend something. You use them as a punchline.
I have neither the time nor the inclination to explain myself to a Administration who rises and sleeps under the blanket of the very freedom I provided and then questions the my need for healthcare in a manner ROI. I would rather you just said "thank you, Veteran" and went on your way. Otherwise, I suggest that you pick up a weapon and stand a post. Either way, I don't give a damn what you think you are entitled to or what you've "worked hard for." AND I ADD We are Americans who have given the ultimate sacrifice to God Country and Community and our investment is not just expected it is demanded.
Norm - which VA hospital did you visit, and what are the extent of your injuries that would lead them to ask you such a question?
"Thank You Micheal - as I state in the article the 'Death Book' name was given via Towey however... it IS a book about death isn't it??
You agree w/ all of the NON-death questions in the book?..."
Yes, I do.
Ever keep a loved one alive so that you don't have to deal with the grief that would come with their loss? I've seen it, and I think it stinks. It's a terribly selfish thing to make another person suffer needlessly.
How many quadriplegic GIs do you know? How many GIs existing on life support in a vegetative state with half their head gone have you seen? When was the last time you saw a 22 year-old with only arms and a torso moving about in a wheelchair?
Have you had the nerve to tell any of those people that they live a wonderful life? For whom, exactly, are they living - and why do you think they should not be given alternatives?
Would you like to spend the next 50 years of your life that way? If not, why do you think they should?
Thank You Micheal - as I state in the article the 'Death Book' name was given via Towey however... it IS a book about death isn't it??
You agree w/ all of the NON-death questions in the book?
a. I can no longer walk but get around in a wheelchair.
b. I can no longer get outside—I spend all day at home.
c. I can no longer contribute to my family's well being.
d. I am in severe pain most of the time.
e. I have severe discomfort most of the time (such as nausea, diarrhea, or shortness of breath).
i. I need someone to help take care of me all of time.
j. I can no longer control my bladder.
k. I can no longer control my bowels.
l. I live in a nursing home.
m. I can no longer think clearly-I am confused all the time.
n. I can no longer recognize family/friends
o. I can no longer talk and be understood by others.
And others...
So Micheal... tell me.. What does the VA do if a quadraplegic does not want to live that way?
What does the VA do if a Veteran who can't 'shake the blues' doesnt' want to live that way?
This is a book about 'end-of-life' scenarios that equate to life and death situations. Are you telling me it is also a book about 'ending-your-life' solutions?
"So Micheal... tell me.. What does the VA do if a quadraplegic does not want to live that way?
There isn't much that the VA can do at that point. I guess you think that they encourage them to consider euthanasia. They aren't.
"What does the VA do if a Veteran who can't 'shake the blues' doesnt' want to live that way?"
They provide counseling.
"This is a book about 'end-of-life' scenarios that equate to life and death situations. Are you telling me it is also a book about 'ending-your-life' solutions?"
No, I am not. You seem to think that it is, however.
The exact title of the pamphlet is "Your Life, Your Choices: Planning for Future Medical Decisions: How to Prepare a Personalized Living Will". Again, the 53-page document deals with advance care planning. I don't think you've read it. You're merely parroting what others are saying.
You are disinformed, and are propagating disinformation. You need to stop, because those people you're getting your information f
Can we please stop calling this pamphlet a "Death Book." Have the Conservatives no shame whatsoever?
The people you rely on for information are lying to you. And you don't have a cogent argument. You can't even sustain it with tangible evidence. This "title" piece you placed in your article isn't even correct. The questions you posted here were taken totally out of context - they're part of a worksheet that gives multiple choices, and are used as a tool to help in your decision-making as you prepare your living will.
What are you doing? Do you even know?
Michael I am relying on the VHA's own guides for information. No one is 'telling' me anything. I heard the responses from the VHA today on Chris Wallace's program. I linke to the written transcripts. Not sure what you mean by 'title piece' being incorrect.
The questions were not taken out of context - they are part of an 'end-of-life' living will document.
You did not answer my question - Are you suggesting that this document is also an 'ending-your-life' solutions document?
Many of the questions, the ones I specifically have issues w/ are absolutely NOT end-of-life questions. Which is why I have a problem with them in this document. If they were in a consultation document to give Veterans specific help in one area, that would be different.
Peter - It IS a book about death. What is YOUR issue with that? Liberals are flipping about about calling it a 'Death Book' when that is indeed what it is!
Michael,
You must be completely ignorant. 'Complete' ignorance even in today's world is hard to come by. Did you have access to the book they are showing veterans? Have you looked at page 21? Do you agree with all the items(?) on page 21? If so, then you need help
I'm a vet AND a VA health care provider "on duty" right now...after reading the brochure (NOT a directive) and VHA HANDBOOK 1004.02 (also NOT a directive), I immediately went to our reception area to get TWO copies, one for myself & one for my wife, so that we can begin the process of planning & making our own "Advance DIRECTIVES" following these excellent guidelines.
You, on the other hand, either have a severe reading &/or comprehension disability.
Michael,
You must be completely ignorant. 'Complete' ignorance even in today's world is hard to come by. Did you have access to the book they are showing veterans? Have you looked at page 21? Do you agree with all the items(?) on page 21? If so, then you need help
To help get control of such costs, Democratic plans call for saving money by creating new oversight committees. Medicare and insurers would be expected to follow "advice from a new federal panel of medical experts on 'what treatments work best.'”
The paper added: "The zeal for cutting health costs, combined with proposals to compare the effectiveness of various treatments and to counsel seniors on end-of-life care, may explain why some people think the legislation is about rationing, which could affect access to the most expensive services in the final months of life."
Critics of the Democratic plan believe the government system will face an overload when 50 million currently uninsured are added to the government health care system. Something will have to "give," and that something may just be critical, but often expensive medical procedures for the elderly.
The Times quoted Mark D. Eaton, a 59-year-old AARP member in Lancaster, Mass., who said: “Medicare might stay t
The Times quoted Mark D. Eaton, a 59-year-old AARP member in Lancaster, Mass., who said: “Medicare might stay the same. But by the time you provide insurance to millions and millions and millions of people, we will be out of money, and we’ll be out of doctors.”
"Michael,
You must be completely ignorant. 'Complete' ignorance even in today's world is hard to come by. Did you have access to the book they are showing veterans? Have you looked at page 21? Do you agree with all the items(?) on page 21? If so, then you need help"
LOL I read the whole thing - and I agree with the intent behind publishing it, which is giving GIs the information they need should they decide to prepare advance care directives.
Tell me about your personal experience with catastrophically wounded GIs.
Kimberly-
Call it what you want, but it's the same "directive" that was issued in 2007 during the Bush Administration, with very minor editing. Go read the original and compare. Then report. going off half cocked on what you hear on Fox news is not reporting.
Using Kimberly's definition of what a "deathbook" is the Five Wishes is also a deathbook. And what Mr Towey want the VA to do is get rid of the deathbook they are using now and replace it with his deathbook. For those who feell that they are Taxed Enough Already, why would you advocate spending millions of taxpayer dollars to replace one deathbook with another?
I did my own piece this morning for the Wichita site on this same topic. You bring up some very, valid points and though I'm sure Ms. Duckworth will deny she actually "lied" yesterday, she certainly was not short on "mis-truths".
The distracting comments here are most likely from those that actually believe a single payor system would be good for this country.
Hand in there and keep up the good fight.
Geoff Caldwell
Wichita Independent Examiner
So Mark Eaton's opinion has some special weight because he's an AARP member, or because he's 59?
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