Death Book vs. Death Book: A Disagreement Over End-of-Life Philosophy

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Nine days ago, Jim Towey, the former director of President Bush’s Office of Faith Based Initiatives, and founder of the non-profit group Aging with Dignity, entered the health care debate by throwing gasoline on the dying death panel embers with a Wall Street Journal op-ed called “The Death Book for Veterans.”

What is “The Death Book for Veterans”? Towey reports that, under President Obama, the Department of Veterans Affairs is reviving a 52-page end-of-life planning document called “Your Life, Your Choices“, which Bush had scrapped because, allegedly, it “presents end-of-life choices in a way aimed at steering users toward predetermined conclusions.” Namely, it urges ailing veterans to choose death over life.

Facts are tricky things, though. For instance, the document Towey cites was created over 10 years ago. And though the VA did indeed stop distributing it, the department has been in the process of updating the document for months now, following plans developed during the Bush administration. Curiously, among the panelists involved in updating “Your Life, Your Choices” was the president of Aging with Dignity.

The new version should be completed next year.

But though Towey’s clear aim is to inflame the death-panel scorched health care wars, his real suggestion could have been offered in a somewhat more constructive way. For instance, he could have just said, “My death book is better than your death book!”

Towey is the author of a separate, 12-page end-of-life planning document called “Five Wishes”–available in full for the low, low price of $5.00 on the Aging with Dignity website. You can see a preview here (PDF).

The two documents are significantly different. “Your Life, Your Choices” guides people to their end-of-life decisions in a storybook way, presenting Veterans with the conclusions other patients and families had reached, and asking them if they agree or disagree with those decisions.

“5 Wishes” is more blunt, presenting recipients with hypothetical scenarios–including coma and brain damage–and asking them to check a box: “I want to have life-support treatment,” or “I do not want life-support treatment. If it has been started, I want it stopped,” or “I want to have life-support treatment if my doctor believes it could help. But I want my doctor to stop giving me life-support treatment if it is not helping my health conditions or symptoms.”

Towey, of course, prefers his own document, which, he says, “does not contain the standard bias to withdraw or withhold medical care.” And perhaps he’s right. Perhaps his pamphlet is superior to the one the VA used several years ago. But that’s a much smaller, and more arguable claim than the one he made–trumpeted by the right–that Obama is reviving a death book for veterans.

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