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Death Panels? We Don't Need No Stinking Death Panels!

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Posted on August 25 2009 8:39 am
David Forsmark is the owner and president of Winning Strategies, a full service political consulting firm in Michigan. David has been a regular columnist for Frontpage Magazine since 2006. For 20 years before that, he wrote book, movie and concert reviews as a stringer for the Flint Journal, a midsize daily newspaper.

One of the common counters by liberals to conservative arguments against government health care goes something like this: “I’ve never talked to a veteran who wants to give up his VA health care.”

Ignore, for a moment, the idea that for many liberals only the first half of that sentence applies. Let’s take them at their word that VA health care would be the model for the “public option.”

As Jim Towey, former Director of Faith Based Initiatives,  wrote in the Wall Street Journal Friday, and told Chris Wallace on Fox News Sunday, the VA already uses a manual that  encourages veterans to consider if “Life is not worth living,” for things like living in a nursing home, needing a wheelchair, or being a financial burden to one’s family.

As Towey wrote: “When the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel?”

This is euphemistically called “end of life counseling.” But for at least two of the above conditions, in the 52-page manual, called “Your Life, Your Choices,” that could be a self-fulfilling prophecy.

Sarah Palin, sign in to your Facebook.

Sunday, Chris Wallace interviewed Towey, followed by a spokesperson for the Obama Administration. ( The following are in chronological order, but are excerpts, not the complete interview.)

WALLACE: Let’s start with an overview. What’s wrong with this material, “Your Life, Your Choices,” that the V.A. is using for end-of-life counseling right now? In the article that you wrote in the Wall Street Journal in which you disclosed this, you say the message is clear, hurry up and die.

TOWEY: Well, the message that they want to communicate, I think, is if you have a stroke or if you have a coma situation, that somehow your life has lost a little value and it may not be worth living anymore.

My problem with the document, Chris, is that the author of it is a proponent of assisted suicide. He’s way out there on that issue. And the V.A. has been using this. A new directive just came out in July, urging providers to refer patients to it. So in my view, there should be a balanced treatment. And this is a slippery slope that kind of makes people — when you look at the document, it makes people feel like they’re a burden and that they should do the decent thing and die.

WALLACE: All right. We’re going to get to the specifics in this book in a second, but I want to ask you another general question.

President Obama calls talk of a government-run “death panel” a, quote, “extraordinary lie,” but I want to put up what you said in your Wall Street Journal article this week.

You said the following: “When the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel?” Explain.

TOWEY: Well, I think the fear that Americans have is that somehow when they are fragile and they’re vulnerable, and they’re facing serious illness, that a discussion they’re going to have with the doctor is going to be biased or tilted in some fashion.

Here you have the government that has a financial stake in the answers that they give, and I think a lot of people are afraid that somehow they’re going to be steered toward a denial of care.
And I think that whole right to die movement, which Dr. Perlman has written about — I think that whole right to die movement means that the right to die is a right the poor will get. And I think a lot of people are afraid about it.

So whether there’s “death panel” written in a law or not, the real issue is, why would the V.A. be promoting a document written by an assisted suicide advocate that has such a — kind of an obsession with death and with pushing people, I think, in a direction to deny care.

WALLACE: All right. You are especially critical of this worksheet on page 21 of the book… Let’s put up this page 21. It’s called “What makes your life worth living?” and it asks the veteran to check off whether a variety of situations are difficult but acceptable, worth living but just barely, or not worth living.

And here are some of the situations. “I can no longer walk but get around in a wheelchair.” “I live in a nursing home.” “I am a severe financial burden on my family.” “I cannot seem to shake the blues.”

Mr. Towey, what’s wrong with that?

TOWEY: 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.

I think there — if you were trying to be biased 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.”

And I think the problem with this document, and it permeates the whole thing, is there’s a bias toward a depression. And so when you see the one that says, for example, “I can’t shake the blues,” you can actually check the box that says “My life’s not worth living.”   Another one said if I can’t go outside on my own, so you check a box, life’s not worth living…

WALLACE: You’re also upset about another question in the booklet, and I want to put that up. “Have you ever heard anyone say, ‘If I’m a vegetable, pull the plug?’”

TOWEY: Yeah. I think the word vegetable’s demeaning. It’s used three times in the document. And it kind of communicates somebody that’s not human…

For the Obama administration’s version, Wallace interviewed Tammy Duckworth, an assistant secretary at the V.A. who lost both legs during a mission as a helicopter pilot in Iraq. Duckworth had refused to be on the air with Tohey, and Fox acceded to back-to-back interviews.

WALLACE: I want to ask you about the worksheet, page 21 in the V.A. booklet. You’re a hero who, despite severe injuries, lives a full life, but you have to get around some of the time in a wheelchair yourself.

Do you have any problem with the V.A. asking elderly veterans whether life is worth living if they have a disability, if they live in a nursing home, if they’re unable to shake the blues?

DUCKWORTH: Well, I have to say, Chris, that this is a really important discussion because when I was in Iraq and I was injured, thank goodness I had an advanced directive, that I had both a living will and a medical power of attorney that my husband was able to use to really execute my wishes…

And V.A. is very happy for veterans to use any booklet that they would like. This booklet was used throughout the Bush administration under two secretaries. But if veterans want to go out and — and we provide it free of charge. There are many other free-of-charge booklets that are out there.

If they want to go and spend $5 apiece and buy Mr. Towey’s book, they are welcome to do that. And that all falls under V.A.’s advanced directive policy which was…

And so it went, Wallace asking why the document was still on the VA website, Duckworth claiming it was “just a tool,” that it’s being revised and trying to make Towey’s argument all about the 5 dollars for his book. She even tried to say that a disclaimer said the worksheet was not to be used.

WALLACE: … that’s just not true. The VHA put out a directive on July 2nd, 2009, and I want to put up two pages from that directive. The first one, page 8, “Primary care practitioners are responsible for giving patients pertinent educational materials, e.g. refer patients to the ‘Your Life, Your Choices’ module.”

And on page 9 it says, “If they request more information, patients may be directed to the exercises in ‘Your Life, Your Choices.’”

So as of July 2nd, 2009, last month, more than a month ago, V.A. health practitioners were told to refer all veterans, not just end-of-life veterans but all 24 million veterans, to this document, “Your Life, Your Choices.”

DUCKWORTH: Let me make a correction there, Chris. What our practitioners were told is to refer patients to any type of a tool. They can use Mr. Towey’s if they want to spend the $5 apiece.
V.A. simply was not willing to buy his booklet at $5 per veteran at the time. This is a decision that was made…

After a round of back and forth in which Duckworth tried to argue that the controversial workbook was not being used, and Wallace pointed out what Fox found on the website only the week before.

WALLACE: I want to ask you one last question. If you feel so strongly about the value of life, although the disclaimer is on there, this document, “Your Life, Your Choices,” is still on the V.A. Web site. Secretary Duckworth, while it’s supposedly being revised, it’s still up there. Can you promise us that this will be taken down today?

DUCKWORTH: It is still up there with the disclaimer that it’s under revision and do not use it. It cannot…

WALLACE: It doesn’t say don’t use it.

DUCKWORTH: Let me, Chris…

WALLACE: But why have it up there at all? Why not just say we’re going to take it down?

DUCKWORTH: Because we are bound by federal law. It was developed with federal research grant monies, and most of our — all of our programs that were results of federal research grants are online for people to use for research purposes.

But we very clearly tell all of our veterans, “Please use any type of a tool that is most suitable for you and your loved ones,” and you can certainly — there are many great ones out there, including Mr. Towey’s, if they want to go spend the $5 for it apiece.

V.A. makes ours available for free. The checklist that we’re actually using is a completely different checklist from this one, because this one has been taken off for revision.

WALLACE: Well, it hasn’t been taken off. It’s being revised, but it’s still on the Web site.

One would have more sympathy for Duckworth, if she had not tried to slime Towey with the “buy his book for 5 dollars” line every chance she got.  Her mission — and she chose to accept it — was to cast doubt on Tomey’s motives and to confuse the issue about who is responsible for the work sheet being available currently, and whether it is being used.

Then, of course, it might be easier for the Administration and its various flacks to reassure people that they care about the old and the sick, if it weren’t for this:

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