Wednesday, August 19, 2009

Someone who will care

The recent attention given to end of life issues has been related to the controversy about the President's health care reforms. My own concern long predates that argument. Back in the seventies when euthanasia was being debated in Britain [it could never happen here], I read arguments that convinced me, first, that healthy people are in no condition to know how they will feel about death when very ill or very old, and, second, that vulnerable people can easily be made to feel guilty about being alive. At about the same time I became aware of hospice as a humane, non-coercive, and caring alternative to both euthanasia and pointless, prolonged medical treatment.

Today Jim Towey, founder of Aging with Dignity and creator of a model advance care planning document that has been widely accepted, describes how things can go very badly wrong — and this in the VA, an institution often touted by those who favor a government run health system.
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." ....

"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." ....

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"). ....

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. .... [more]

Jim Towey: The Death Book for Veterans - WSJ.com
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