How Conservatives Got The Facts Wrong On Their Latest Obsession: The "Death Book" For Veterans


Assistant Secretary of Veterans Affairs Tammy Duckworth appeared on Fox News Sunday this morning to combat the false allegations that the VA is using a "death book" to encourage veterans to end their lives.


The latest conservative obsession - dutifully spread via Sarah Palin's Facebook page - is marked by the same alarmism and factual inaccuracy as the hysteria over "death panels."

According to this tale, America's veterans are being steered into ending their lives via a "death book" distributed by the government.

It all started with Jim Towey, the former president of the White House Office of Faith-Based Initiatives under George W. Bush, who penned an op-ed in the Wall Street Journal describing how the Department of Veterans Affairs was using an end-of-life planning document that was aimed at steering veterans toward choosing death.

Towey stated that the message of the veterans' health-care system to its patients was "hurry-up-and-die" and he contrasted the "death book" with "Five Wishes," his own advance care planning document.

In dramatic language, he wrote:

"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."

Soon enough, Palin linked to the piece, stating that "the Veterans Administration encourages veterans to forego care as they make end-of-life decisions." And Fox News' Sean Hannity and RNC chair Michael Steele were calling it the equivalent of "death panels" for military veterans.

They failed to mention that the so-called "death book" contains the same advance-care planning required of all health care organizations under federal law, has been in use since 1997 and was developed with the input of interfaith ministers.

In addition, Towey seems to have his own axe to grind. He has repeatedly tried to get the government to spend millions to purchase his "Five Wishes" book, which is published by Aging With Dignity, a non-profit group he founded, to distribute to veterans across the country, according to sources within the VA. Towey used his influence with the White House to get a meeting with VA officials, including then-Secretary of Veterans Affairs Jim Nicholson. At one meeting, Towey was informed that the VA could not act on such an unsolicited proposal without violating federal procurement regulations, according to VA sources.

The VA's policy is in accordance with the 1990 Patient Self Determination Act, which requires all institutions receiving Medicare funds to provide information to patients regarding end of life, living will and other advance directives. During the Bush administration, the VA changed its regulation to extend the act to cover all VA facilities.

In 2007, after Towey complained that the so-called "death book," "Your Life, Your Choices - Planning for Future Medical Decisions," was biased against the right-to-life viewpoint, the VA convened an outside panel of experts to assess and update the booklet.

In his op-ed, Towey stated that this panel did not include any representatives of faith groups or disability rights advocates. In fact, according to the VA, the panel included a priest, a rabbi, a renowned disability rights advocate, and the president of the organization that produces "Five Wishes," the alternative advance care planning document that Towey is promoting and selling.

The panel supported the use of the "Your Life, Your Choices" booklet but included some suggestions for revising its content. The plans to update and release the booklet were developed under the Bush administration and it is due for release in 2010.

Towey, along with Assistant Secretary Of Veterans Affairs Tammy Duckworth are scheduled to discuss the issue on "Fox News Sunday" tomorrow.

Dr. Ellen Fox, the Chief Officer for Ethics in Health Care at the Veterans Health Administration, defended the use of the booklet:

Your Life, Your Choices is an educational workbook that was designed specifically for Veterans. The authors went to great lengths to ensure it would be meaningful and helpful to all Veterans, regardless of their religious and cultural backgrounds. I am impressed by the development process they used, which included extensive input and testing by different Veterans groups, religious leaders from 10 different faiths, elderly and disabled individuals, and experienced doctors and nurses. They even made sure to incorporate everyday language that Veterans commonly use to describe medical conditions, while at the same time providing accurate information from the physician's perspective. Over the past 10 years it has been tested through scientific research, endorsed by many respected professional organizations, and widely used throughout the U.S. health care system. It is one of many educational resources we provide to help Veterans and their families. As a Federal agency we have an obligation to be responsible stewards of taxpayer dollars by maximizing the services we provide our Veterans. Providing an educational resource like Your Life, Your Choices at no cost to Veterans is one of the many ways we fulfill this mission. The whole purpose of this workbook is to encourage more conversations between patients, families, and health care teams. Anyone who is seriously interested in ensuring that Veterans receive the best care possible should recognize this.

Towey did not return calls placed to St. Vincent College, where he is the president.

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