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If 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?

One can only imagine a soldier surviving the war in Iraq and returning without all of his limbs only to encounter a veteran’s health-care system that seems intent on his surrender.

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. And as you might guess, 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.

Many years ago I created an advance care planning document called “Five Wishes” that is today the most widely used living will in America, with 13 million copies in national circulation. Unlike the VA’s document, this one does not contain the standard bias to withdraw or withhold medical care. It meets the legal requirements of at least 43 states, and it runs exactly 12 pages.

After a decade of observing end-of-life discussions, I can attest to the great fear that many patients have, particularly those with few family members and financial resources. I lived and worked in an AIDS home in the mid-1980s and saw first-hand how the dying wanted more than health care—they wanted someone to care.

If President Obama is sincere in stating that he is not trying to cut costs by pressuring the disabled to forgo critical care, one good way to show that commitment is to walk two blocks from the Oval Office and pull the plug on “Your Life, Your Choices.” He should make sure in the future that VA decisions are guided by values that treat the lives of our veterans as gifts, not burdens.

[Jim Towey, president of Saint Vincent College, was director of the White House Office of Faith-Based Initiatives (2002-2006) and founder of the nonprofit Aging with Dignity.]



People of Good Will Should be Upset by the Veterans Guide that Pushes Euthanasia
by Bradley Mattes
First there were angry senior citizens at town hall meetings, literally fearing for their lives. They’re worried that under the President’s proposed health care plan they’ll be denied critical life-saving services because of their age. There’s good reason for their concern. And what’s come to light since then won’t make them sleep any easier.

The Obama administration now seems to have our nation’s veterans in the crosshairs. Perhaps you’ve heard about the booklet Your Life Your Choices—also known as the Death Book for Veterans. This book is particularly alarming, so I want to share some detail you may not have heard.

I have the book on my desk. Part of it consists of reasonable dialogue on the importance of sharing your wishes regarding potential future medical treatment with trusted family members or friends. I agree that communication before a health crisis arises is key.

But look at one section titled “What makes your life worth living?” It lists 18 potential physical conditions, and the veteran is required to check which column reflects his outlook on life. One of those columns is “not worth living.” I’m all for personal autonomy in choosing appropriate health care, but this booklet clearly crosses the line.

Keep in mind it’s designed for veterans, some who’ve recently returned from the Middle East, missing limbs or sight. Others may be dealing with paralysis or traumatic brain injuries.

Many are looking at months or years of rehabilitation—facing a future that’s dramatically and often permanently altered. The physical wounds are accompanied by the infliction of psychological damage: depression, the fear of being dependent on others or financial concerns.

It is in this context that some of our war heroes will read Your Life Your Choices [ ]. After each of the 18 scenarios on page 21, a veteran is to ask himself or herself if life would be worth living. But a scant few actually reflect life-threatening situations.

Most indicate less critical burdens like being confined to a wheelchair, incontinence or not being able to “shake the blues.” Some don’t reflect the physical condition of the veteran at all, but instead how others will be affected: being a financial burden, not able to contribute to the family well being, or causing stress for other family members. These make me wonder—whose suffering is this booklet designed to alleviate?

The “instructions” that follow sent a chill up my spine. If the veteran more than once checked the column called “worth living, but just barely,” he or she is asked what combination of those would it take to make his or her life “not worth living”? If the veteran checked “can’t answer now” he or she is asked what would it take to “help you decide”? See page 21 in its entirety, .

The obvious purpose of this booklet is to be an advance directive of sorts for medical treatment. Several of the pages even asked for the veteran’s initials and date. But at the back of the booklet where resources are listed, the only group indicated under “advance directives” is Choice in Dying, formerly known as the Euthanasia Society. The purpose of this organization is solely to advocate euthanasia.

The Veterans Administration might as well abandon all subtleties, dig a grave and push our nation’s heroes into it. We owe a debt of gratitude to America’s veterans that we can never repay. The VA has not only brought shame upon its department but also on our whole nation.

After the group Aging with Dignity brought this booklet to light, a disclaimer has been added that a revision is in the works. But no amount of change can take away the stain of the intended purpose—to nudge America’s war heroes toward the grave in an effort to protect limited government resources. If you’d like to see the entire publication, click

Please contact the Veterans Administration: [email protected] Phone: 202.501.0364. Mail: National Center for Ethics in Health Care, Veterans Health Administration (10E), 810 Vermont Ave., NW, Washington, DC 20420.

Tell them America’s veterans deserve better.

[August 28, 2009,; Bradley Mattes is the executive director of Life Issues Institute, a national pro-life educational group. Mattes is a veteran of the pro-life cause, with over 33 years of educational, political and humanitarian experience; ]