Death is certain, as Benjamin Franklin famously said. Still, talking about death, let alone preparing for it, is taboo for a majority of the population. Hence, the concept of “death panels” as part of health care reform legislation and a so-called Veterans Administration “death book” have incited outrage.
It is understandable that end-of-life planning makes people uncomfortable, but a lack of planning — as individuals and a society — leaves these critical decisions to outsiders and the vagaries of grief and despair.
The latest outrage over government’s supposed push toward an early demise centers on the Veterans Administration. Since 1997, it has published a booklet called “Your Life, Your Choices: Planning for Future Medical Decisions: How to Prepare a Personalized Living Will.” It encourages veterans to consider difficult decisions about what types of care and how much care they want — conversations that all Americans should be having with their families.
The 54-page booklet, which is currently under revision, repeatedly stresses that veterans should make their own decisions and communicate their wishes with their family.
Recently, the commonsense publication has been demonized as a “death book” that encourages veterans to go along with a denial of care. The “death book” moniker comes from a column by Jim Towey, director of the Office of Faith Based Initiatives under President Bush, in the Wall Street Journal last month. He argued that the booklet pushed veterans to conclude that their life was not worth living.
He then tied this conclusion to the fear, spread this summer, that a health care overhaul will lead to a denial of care for older Americans.
Sen. Arlen Specter, who recently switched from the Republican to Democratic party, urged the VA to reconsider the publication, although he acknowledged he had not read it. He and other critics should read the booklet.
Yes, the booklet includes questions about whether someone would consider life worth living if she or he were confined to a wheelchair, is in severe pain or is a financial burden to his or her family. These are pointed, difficult questions. They, of course, make some people uncomfortable, but these are issues that need to be discussed before they occur.
In its worksheet sections, the booklet asks readers to consider statements such as: “I believe that it is always wrong to withhold (not start) treatments that could keep me alive.” “I believe it is wrong to withhold (not provide) nutrition and fluids given through tubes, even if I am terminally ill or in a permanent coma.”
Far from a push toward “pulling the plug,” as critics contend, it is a clear-eyed presentation of questions that everyone, not just veterans, should be thinking about.