Barack Obama with Iraqi war veteran Tammy Duckworth after the two placed a wreath at The Bronze Soldiers Memorial in Chicago on Veterans Day last year. Duckworth, now assistant secretary at the Department of Veterans Affairs, says a controversial VA guide on end-of-life decisions continues to undergo revisions.
It is another 'alarmist' attempt as defaming the Obama Administration. This is a Right Wing initiative and there really isn't anything to say, but, the document in question is 52 pages or so long, so I thought I'd read through it.
Living-Will Guide For Vets Stirs Health Overhaul Fears (click here for audio presentation)
by Joseph Shapiro
...That kind of language is offensive to Jim Towey, a former official in the Bush administration. "It's framing these quality of life issues in a way that guilt trips veterans. That makes them feel their life is a burden not a gift," he says....
It is only correct to note the Department of Veteran's Affairs has made a disclaimer stating the document is being reviewed by professionals and clergy and will ungo changes as needed.
I have a feeling this is standard issue, "Living Will" stuff. I haven't read it before, so let's see exactly what is so offensives. I'll say this up front as an initial assessment, as this Bush Official, what's his name? Jim Towey. Mr. Twoey was grasping at straws in 2007 when he couldn't explain the heightened suicide rate and the negligence of those Veterans that were in 'waiting lines' for treatment. Mr. Towey, took the 'easy route' out of a difficult situation and decided to 'blame' a document he found offensive. Perhaps there are some words that are offensive and perhaps if a Veteran was suicidal and decided to read a book on "Living Wills" it might push him over the edge, but, the point is WHY were Veterans feeling suicidal? The book didn't cause the suicidal feelings or ideation. It questionably could have entertained throughts AFTER the fact, but, it didn't CAUSE those overwhelming feelings. A lot of these Veterans were attempting to receive treatment, but, were put on waiting lists. The waiting lists are the issue, NOT, the book.
That said.
The PDF opens up to 55 pages. The first page is the VA disclaimer I already stated. Page Two is the title page; "Your Life, Your Choices, Planning for Future Medical Decisions: How to Prepare a Personalized Living Will." The picture on the cover is of a COUPLE sitting together in COUNCIL with a man that seems to be interested in their outcome in the decision making. There is one cup of coffee on the round table they are all sitting at with an undetermined person as to whom is drinking the coffee.
Page 3 is another title page with the authors listed. Yep. The 'creators' are:
Authored by
Robert Pearlman, MD MPH
Helene Starks, MPH
Kevin Cain, PhD
William Cole, PhD
David Rosengren, PhD
Donald Patrick, PhD MSPH
Design & Layout by
Brems Eastman & Partners
Information Design Seattle
There is one MD MPH, one MPH, three PhDs and one PhD MSPH. Now, if there is anything offensive in this official document by the USA Veterans Affairs I would think the highly qualified authors should be held responsible. What do they call it when a person kills themselves because of actions of someone else? Manslaughter? There ya go.
The book opens with an example. It is a good example. It is fictious, but, does place the reader in a set of circumstances that would dictate a 'moral/ethical' dilemma. Profoundly. The Example states:
Dad had been in declining health for months. Then he fell asleep at the wheel and was in a bad car accident. Three weeks later he was still in a coma. A breathing machine pumped air into his lungs because he could not breathe on his own. The doctors thought his chances of coming out of the coma were slim. They talked with Mom and me about turning off the breathing machine and allowing Dad to die naturally. I felt terrible. I didn't think Dad would want to be kept alive like this. But I knew Mom would feel guilty for the rest of her life if we told the doctors to "pull the plug" while there was still even the slightest hope. We weren’t sure what we should do because Dad never told us what he would have wanted. I really wish we'd talked about this before."
I want to take a look at the example. The 'content' is a person of unknown gender with a father. There is absolutely no reference to a 'military' anything in that example. It is a bland example, void of any 'invitation' to military demise. No names, no titles, no rank, no nothing.
The same page has an introduction to the 'concept' of taking responsibility for 'advanced directives/decision making.' It is standard issue regardless of it being a hospital brochure or otherwise:
...But studies have shown that spouses guess wrong over half the time about what kinds of treatment their husbands or wives would want. You can help assure that your wishes will direct
future health care decisions through the process of advance care planning.
Page 5 gets right down to business. Think about it, decide, write down your wishes, tell your significant other(s), etc. Most terminally ill cancer patients welcome this discussion.
Page 6 offers the reader two options. Either read through 'The Basics' and fill out the form at the back of the booklet OR there is a further 'insight' in a section called "Resources." This is the description of the "Resources."
Part II: Resources. Turn to these sections for additional help and further explanation of ideas and topics introduced in “The Basics.”
Page 7 and 8 are the Table of Contents and the title to each section gives the reader a good preview to any of the topics. Certainly, someone not prepared to discuss the issue could be well warned off by any of the titles. Nowhere so far have I witnessed this booklet recommending to make this decision on one's own. There is 'collaboration' written all through this up to now. Ultimately, taking 'responsibility' is still up to the person making the Living Will.
The brochure goes on with examples. The topic is unpleasant and so are the examples. It discusses how family members are left to 'guess' about someone's final decision regarding life support. By page 11, the brochure is giving examples of the 'differences' in definition of words casually used in conversations regarding life support and the continuation of life. The concept is difficult to discuss and the words are difficult to read:
People have very different notions of what it means to be a “vegetable.” Here are some more examples:
• “You sit in a chair and don’t do anything all day.”
• “You can’t read anymore.”
• “You’re just a body with some life in it.”
In the margins of the brochure there is mentioned a 'exercises' to help one decide beginning on 21. On page 20 there is help in guiding decision making to Health Care Power of Attorney (my words, not theirs). The brochure is worded very 'simply' at this point.
Page 13 is frequently asked questions.
Page 14 are definitions to advanced directive, proxy directive, instructional directives and personalized statement. The brochure goes on to ask, "Which directive is best?"
I am up to Page 22 and I am finding NOTHING offensive about this brochure. It has a goal and that is to have the client write a Living Will. In the side margins there are little illustrations stating there is an blank document to fill out in the back and on Page 45 and 46 there are statements to help open up the discussion between yourself and the person you choose to be your spokesperson should you not be able to speak for yourself in a health care setting. All through these pages I have read nothing but collaboration between the person writing the Living Will and the person they are entrusting their life to. There is nothing, absolutely nothing offensive or inappropriate in these 22 pages. It is s difficult subject and the brochure acknowledges it all through its content.
The bottom of Page 22 it refers to Resource section. HOWEVER, it 'previews' the kinds of topics covered in the Resource section. In previewing the topics the reader is fully aware as to whether it is necessary to proceed. There are no statement of 'must read' the Resource section or no absolutes in any of the content.
Here’s a sample of the kinds of questions that are answered in the Resources section:
• What makes life worth living?
• What’s likely to happen if you have a serious stroke? What do you need to think about in
advance?
• What if someone you love needs a feeding tube? What are the pros and cons?
• What can you do to keep the courts out of these advance care planning decisions?
There is not a darn thing wrong with this brochure. NOTHING. It approaches a delicate subject with openness and as if the reader has no basis of understanding of the topic. The brochure states to seek spiritual advise. Now, a book that is THE DEATH BOOK wouldn't bother doing that, would it?
The pages of the PDF do not coincide with the pages of the brochure as it would appear in print.
Thought-provoking exercises.
Which exercises should I complete?
You can complete any or all of them. Each of the exercises addresses different issues, including:
1. What to consider when choosing a spokesperson (page 20),
2. Your wishes regarding what makes life worth living (page 21),
3. Your personal and spiritual beliefs that affect medical decision making, and your feelings about hope and risk taking (pages 22-23),
4. Your wishes regarding the way you might spend your last weeks or days if you were dying, and other related matters (pages 24-26).
We recommend that you complete at least the exercises on pages 21-24. These will be the most useful to others if they have to make decisions for you. You may want to ask your religious advisor to help you think through the questions about quality of life, medical interventions, and death and dying. Religions have different philosophies about what to do under the situations described in these exercises.
Everyone that has a Living Will, I hope has put some thought into it. We know as a society what is tolerable as a 'condition' of the body to one person, might be intolerable to others. I witnessed a runner who stated, "If I were ever in an accident and couldn't walk or run, I wouldn't want to live." That is somewhat questionably extreme to my way of thinking, but, none the less they are legitimate points of view. Hopefully, it is a point of view that was well thought out and 'decided' with the discussion of those that love them and perhaps with a 'spiritual' advisor.
So, on Page 24 of the PDF begins CHECK LISTS. Page 24 hosts the 'checklist' "Who should speak for me? "
Page 25 of the PDF begins the CHECK LIST for "Your Beliefs and Values - What makes your life worth living?" Within this Check List are four selections for one to check off. They are: "difficult, but acceptable," "worth living, but just barely," "not worth living," and "can't answer now." The LIST to the Check List has some very tough statements. I believe these are some of the frequently mentioned as 'offensive.':
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....
...j. I can no longer control my bladder.
k. I can no longer control my bowels....
....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.
p. My situation causes severe emotional burden for my family (such as feeling worried or stressed all the time)....
...r. I cannot seem to “shake the blues.”
They are definitively 'sensitive' statements. HOWEVER. Nowhere in this brochure is it advised to make these decisions alone. Nowhere in this brochure does it state there should not be a conversation with those that are significant to your life. On the contrary this brochure goes out of the way in the early pages of its content to be sure the one filling out these pages have engaged others in discussion and is supported through their participation, even with a suggestion to consult a 'spiritual' advisor.
The brochure continues in 'facing' tough questions regarding 'end of life' issues. The brochure discusses organ donation, autopsy, funeral services, burial arrangements and it has many pages dedicated to discussing specific medical conditions such as coma, dementia, stroke, etc. I believe if there needs to be any 'update' to the brochure it might be in the area of medical conditions and what is being done in the year 2009, which is very different than nearly 40 years ago.
There is a discussion of feeding tubes, CPR, ventilators, palliative care and hospice. Beginning with page 42 of the PDF, there are more checklists that CUSTOMIZE the care one would receive if any, for all the specific medical conditions previously discussed. See, the person working through this brochure is allowed to receive different 'care' or 'lack of it' for a stroke or coma or whatever the case may be. I've need seen that approach before. I think it is a good one. There isn't necessarily a 'blanket' Living Will for all incidence of health insults one might encounter. As a matter of fact, in the year 2009, the outcome to many strokes these days is very hopeful with better understanding, yet, a vegetative coma is another subject entirely.
There are mentioned words such as ethical standards, legal considerations. All sorts of complicated concepts such as that. The brochure does an incredibly good job of 'breaking it all down' into understandable and definitively challenging terms.
On page 55 of the brochure even goes on to REFER anyone reading it and working through its Check Lists to contact other Resources.
Other Resources
Contact any of the following organizations for more information about topics covered in this workbook. Many of the national organizations have local chapters. Call the numbers listed for a referral to the chapter nearest you. Each organization also has a wealth of information on the World Wide Web, with links to other sites and organizations. Visit them at the internet addresses
listed below.
Resources on the List (and this section should be checked for accuracy of addresses and websites)
Disease-related groups
Alzheimer's Association
(800) 272-3900
Internet: www.alz.org
American Cancer Society
(800) 227-2345 (800-ACS-2345)
Internet: www.cancer.org
American Diabetes Association
(800) 342-2383 (800-DIABETES)
Internet: www.diabetes.org
American Heart Association
(800) 227-8721 (800-AHA-USA1)
Internet: www.americanheart.org
American Lung Association
(800) 586-4872 (800-LUNGUSA)
Internet: www.lungusa.org
National Kidney Foundation
(800) 622-9010
Internet: www.kidney.org
National Stroke Association
(303) 649-9299
Internet: www.stroke.org
Advance directives
Choice in Dying
(800) 989-9155 (800-989-WILL)
Internet: http://www.choices.org/
Hospice
National Hospice Organization
(703) 243-5900
Internet: http://www.nho.org/
Organ & Tissue Donation
Coalition on Organ & Tissue
Donation
(800) 355-7427 (800-355-SHARE)
Internet: http://www.infi.net/~donation
Funerals & Cremation
National Funeral Directors Association
(800) 228-6332
Internet: http://www.nfda.org/
Neptune Society (cremation)
(800) 201-3315
http://www.neptunesociety.com/
There is dearly nothing wrong with this brochure. It is to the point and it is an excellant tool for those that want to confront this subject. I will say this, any Veteran that is suicidal belongs in treatment, surrounded by loving families and should not be handed a brochure on Advanced Directives UNLESS that Veteran is feeling despondant due to 'end of life issues.' Then a Living Will might actually seem like a mechanism of control. But, if the Veteran is suffering from PTSD, depression or other psychological issues; there is no way they should be confronting this issue. It could be that they never should confront this issue. Now, is having this brochure on a website wrong? No. There are plenty of other places a suicidal individual could go to decide about a Living Will if they wanted to, so having it on a Veterans' website is no different than having one anywhere else on the web.
What has occurred with this brochure is the same thing that is occurring with the House's Health Care Bill. It is taken out of context and exploited to raise fear in the American populous to turn the tide of 'popular opinion' away from President Obama and his administration. Lying and decieving the public is the only way the Right Wing can achieve their goals. Chris Wallace is guilty of removing the meaning of the 'content' of the words in this brochure. He is one of Murdock's. (I don't care if I do spell his name "W"rong. Actually, I kinda like it that way.) What do you expect from Murdock's 'tribe' ?
I am sure any 'updates' that can be brought to the brochure will be welcome. I also believe President Obama and his Press Secretary are handling this mess exactly right. They talk to the issue in logical terms without ignoring the topic. They have to confront the lies and deceptions. That is the best part about being decent people in an honorable administration; the lies can be directly dispelled and once they are, then dismiss them as lies and get on with the business of the country.I'll start back with the House Health Care Bill this evening.
