VA “Death Book” shows what we can expect from “progressive” health reform

After weeks of discussion about the Democrats’ proposed health care overhaul, it has become starkly clear that the American people generally have very little faith in what they are hearing. And who can blame them? When President Obama lectures us on the failures of our current health care system, or on the merits of “his plan,” he seems to be about as authoritative as Barney Fife giving a lecture on gun safety (and we all know how that usually turned out). Congressional Democrats have demonstrated repeatedly that they know very little about the content of their draft health care legislation, and that they are deathly afraid of discussing it with angry constituents. And the American people seem to be very concerned about the moral and philosophical worldviews of the policy wonks to whom President Obama has given the task of health care reform.

Perhaps there is no better example of the questionable philosophical underpinnings of progressive health care reform than the 1997 booklet “Your Life, Your Choices,” (Adobe PDF) published by the Veteran’s Administration for use at VA Hospitals and clinics nationwide. Last year, under a directive from the Bush White House, the VA pulled the booklet from its hospitals amid complaints about the way it dealt with complex moral issues. But earlier this year, the booklet’s use was reinstated under President Obama.

Here are a few excerpts from the narrative sections of the booklet:

Chris Larsen never told his family what kind
of medical measures he’d want if he became critically
ill. He is in a nursing home after having suffered a
severe stroke 9 months ago. He is paralyzed and
unable to take care of himself or communicate in any
way. Now he has pneumonia and will probably die
unless he goes to the hospital to receive intravenous
antibiotics. He also may need to be on a breathing
machine for a week or so. The doctor says that his
chances of returning to normal are remote, but that he
has a fair chance of getting over the pneumonia. His
family members disagree about what they should do.

His son Bill says, “Dad was never a quitter. He’d want to fight to the very end, as long as there was the slightest hope.” His daughter Trudy disagrees. “Sure, Dad wasn’t a quitter, but he wanted to die naturally–he would be horrified to be kept alive this way.”

In fact, Trudy’s views were the closest to Mr. Larsen’s true opinion. But the family never had a way to find this out. They treated his pneumonia and he lived another year in the nursing home without recovering his ability to communicate or care for himself.

This story shows why it is so important to discuss your wishes. Talking with your family and health care providers ahead of time can prevent confusion and help ease the burden on them.

Lily Chen, an elderly widow, was diagnosed 4 years
ago with Alzheimer’s disease, a common form of
dementia. Over time she has gradually been losing her
ability to think clearly and make decisions. Now she
doesn’t remember where she is and she can no longer
recognize her daughter who visits her every day. For the
last 8 months, she has been completely dependent on
nurse’s aides to bathe and feed her. Recently, she
stopped eating altogether. Her daughter has power of
attorney for health care and has to decide whether to
have a long-term feeding tube surgically placed into
her mother’s stomach. The surgery is quick and won’t
cause much pain, but the real issue is guessing how
Mrs. Chen would value her current life. If they place the
feeding tube, Mrs. Chen could live for many more years
in the same or worse condition. If they don’t, she will
die in about 2 weeks or less, and probably won’t feel
hungry or thirsty .

Questions to consider:
Do you think Mrs. Chen’s daughter should decide about the feeding tube based on the fact that her mother isn’t eating, or based on her mother’s memory problems and dependence on others for care? Why?

Last week, in the Wall Street Journal, the VA booklet was discussed at length in an op-ed by Jim Towey, president of Saint Vincent College and director of the White House Office of Faith-Based Initiatives (2002-2006), as well as the founder of the nonprofit Aging with Dignity. Towey noted:

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.


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”).

Perhaps it’s a bit hyperbolic to refer to “Your Life, Your Choices” as a “death book,” but throughout the narrative sections of the booklet the reader is undeniably edged toward decisions that favor “natural death” instead of prolonging the life of a loved one who is terminally ill or in a vegetative or unresponsive state.

End of life planning is a serious subject. Everyone should make sure that they have a living will that sufficiently addresses issues such as terminal illness, accidents that result in serious injury or brain death, and issues of medical futility where doctors can only restore basic life functions for an indeterminate amount of time, with little hope of recovery.

But do we need the Federal Government “guiding” us toward “wise decisions” regarding end of life care? Do we trust the progressive elites who are now in charge of shaping health care policies? Without question, they will try to direct a national conversation about end-of-life care toward pragmatic solutions, and urge the acceptance of policies based on a more “enlightened,” progressive, utilitarian, and ultimately secular philosophy of the value of life and the extent of society’s obligation to the welfare of the individual.

The results of such a shift won’t be seen right away. The government will never officially order doctors to “pull the plug” on the terminally ill. But after 15 or 20 years, researchers will look back at the data and discover, perhaps, that a significantly smaller number of patients with end-stage cancer were being treated with aggressive chemotherapy in 2025, compared to the number who were treated in 2010. Our values as a society will have changed slightly, just enough for us to have collectively decided that it is more virtuous to conserve resources for the young and healthy, rather than to consume them in the selfish pursuit of immortality.

The United States is still primarily a Christian nation with a collective worldview that is much closer to the Christian principles of charity, compassion, hope offered to “the least of these,” rather than modernist or post-modern ideas of collectivism and “the greatest good for the greatest number of people.” Until our elites in Washington, DC understand this, they will have a very difficult time convincing the American people to surrender complete control of their medical care to the government. And for that, we should be incredibly grateful.

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