Death Panels, National Health Care and the VA
By Ralph Smith
Monday, August 31, 2009
Creating a controversy, or a firestorm within a federal agency, can seemingly come from out of the blue. All it takes is good (or bad) timing, an event that relates to a current hot topic in the national media, and a topic that is intriguing or scary that may involve life or death issues. And, if you can throw in emotional issues such as the health care for aging veterans, especially as American military personnel are now engaged in combat operations in Afghanistan and Iraq, the stage is set for a national row.
Here is an example of how a hot topic can suddenly be thrust on an agency that was probably taken by surprise.
A recent column in the Wall Street Journal entitled "The Death Book for Veterans" hit a nerve.
With a dominant political question on news media questioning the role of the government in providing health care, fear of government rationing of health care due to lack of money to provide care for all Americans and a shortage of medical facilities and personnel under a national health care plan, "The Death Book for Veterans" was seen by some Americans as an indication of the future of American health care if a national health care program in some form becomes the law of the land.
The Department of Veterans Affairs (VA) found itself in the middle of this sudden political maelstrom.
After the editorial appeared, the "Death Book for Veterans" controversy took off. A quick search on the internet shows over 1.1 million choices to find out more about the book the VA and the controversy.
No doubt, the agency could not ignore the media swirl. (See, for example VA's Denial-of-Care-Oriented 'Your Life, Your Choices,' Quashed Under Bush, Revived Under Obama). On August 27th, the VA issued a statement that says, in regard to the booklet entitled "Your Life, Your Choices" that "some people have been distorting the purpose of a Veterans Affairs planning tool." "Some people" in this case is an understatement. The bland VA statement is presumably referring to hundreds of thousands of Americans covering the full range of the political spectrum who have weighed in on the debate and designed to quell the controversy.
In its defense of using the booklet, the VA writes that "It is the policy of the Obama Administration to make available to the public scientific and technological information that is developed and used by the Federal Government." The agency also writes that the booklet "was officially retired from use in VA in 2007, and an expert panel was convened to review and comment on an online module version of this document that was under development at that time."
The Journal editorial states: " 'Your Life, Your Choice's' 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 section the author of the editorial is referring begins on page 20 of the "Your Life, Your Choices" document where the veteran is asked to review a list of questions and to select an option ranging from "difficult, but acceptable" to "not worth living".
The instructions to the veteran after answering a series of questions read as follows:
- 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?
- If you checked "not worth living," does this mean that you would rather die than be kept alive?
- If you checked "can't answer now," what information or people do you need to help you decide?
The editorial author charged "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."
The version of "Your Life, Your Choices" now available on the VA website was apparently modified on August 31, 2009--about two weeks after the editorial was written. It was originally created in pdf format on October 2000 according to the document.
The editorial in the Journal stated "I was not surprised to learn that the VA panel of experts that sought to update "Your Life, Your Choices" between 2007-2008 did not include any representatives of faith groups or disability rights advocates."
The current version on the website now reads: "The Your Life, Your Choices online module is currently being revised based on suggestions from the expert panel members and from chaplains representing eight different faith groups. The revised online module is scheduled to be released on the My HealtheVet Web site in the spring of 2010."
It is also worth noting that the author of the editorial, James Towey, founded an organization called Aging with Dignity, and sells "Five Wishes," a booklet that, like "Your Life, Your Choices," is designed to guide people in the creation of a living will.
The person who was probably hit the hardest with the controversy early in her stint at the agency is Tammy Duckworth, The Assistant Secretary for Public and Intergovernmental Affairs. She was formerly the Director of Illinois Department of Veterans' Affairs which was undoubtedly a challenging job but getting hit with a heated nationwide controversy about four months into the job was undoubtedly a trial by fire that no one would envy.
A blog that caters to the employees of the VA castigated the new Assistant Secretary in this way: "But, in the "not so good" category, was the interview with Tammy Duckworth, the VA's Public Affairs Chief. Duckworth is confused about the dates the guide was used and who allowed, or ordered, it to be used. But, the most damning part of this interview is when Wallace put a Veterans' Health Administration (VHA) directive on the screen dated July 2, 2009 urging use of the guide. This was Duckworth's 'deer in the headlights' moment."
Whether the controversy will have an impact on the national health care debate or becomes a minor footnote in a political debate, chances are the controversy will be with us for the next few weeks as Congress returns from its August recess and the American public wrestles with the implications for a national heath care program.
© 2009 FedSmith Inc. All rights reserved. This article may not be reproduced without express written consent of FedSmith Inc.
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