End of Life Counseling? Had That in My Twenties

The soles of my feet were blackened. The technician directed me to: "Carefully stand with your feet centered on the papers and don't move." After stepping off the papers, I asked why we had this exercise. The response was: "When a jet crashes, often the boots are all we can find." Such was my not so subtle introduction to the need for end of life planning. Our flight training class was a bit smaller the next day as some folks objected to harsh reality. At the ripe old age of our twenties, we all had wills and arrangements for the folks at home.

Next time mortality hit home hard was when my biopsy returned positive for cancer. My civilian doctor handled the whole unwelcome process very well. This is life threatening if allowed to proceed untreated. He left the alternative of survival open, at least for sometime.

I always envisioned death coming as a surprise, with my last words being something along the immortal lines of "OH! #%€£!" With my active, less than sedate life, the thought of dying slowly from some terminal nastiness like cancer was seldom considered. Well, the good doctor certainly changed those considerations.

Following research and discussion, I selected Walter Reed and their prostate cancer and research program. The outstanding staff, from reception to medical personnel, astonished me with their professionalism; more important, their team approach presented none of the competition I often heard exists between, say, surgery and radiology specialties. All the facts and risks were presented matter of factually and discussed as much as we, the patients, or more often patient, could actually tolerate. My talisman for all things medical, my wife, simply had her eyes watered. With 40 years nursing experience, often on the very leading edge of medicine, that very seldom happens. This is military medicine at its finest, government health care. Now it is being attacked for this very excellence.

Potential, and often actual, death and destruction are part of the military environment. Every military person is briefed during normal deployment on wills, survivor briefings, advanced directives, etc. We know the value of life and the cost of loss. By definition, military, veterans and their families are survivors. Amazingly, the reactionaries of the right are now attempting to use those very traits to not only attack treatment for veterans and the military (with few having served, most conservatives fail to realize they are two different systems) but to mislead civilians.

Last Sunday on Fox News Sunday, Chris Wallace repeatedly cropped quotes from a Veterans Health Administration (VHA) document to falsely suggest that the Obama administration is pressuring veterans to end their lives prematurely and to accuse Assistant Secretary of Veterans Affairs Tammy Duckworth of lying about it. Also, Senator Arlen Specter was ambushed on the same show. Wallace's absurd allegations, presented as facts, goaded the senator into saying he might call for a Senate hearing on the subject. When I spoke with Senator Specter on Thursday, he said he did have a few qualms concerning some wording in the document. The VA is always open to discussing senatorial concerns and addressing the needs of their constituents. I hope the senator reconsiders the absurdity of the allegations and abandons hearings which would draw even further attention to these ridiculous claims.

Why the attacks from the extreme right? The health care debate is the short answer. VA and military health care are held up as government health care systems that work; their very success is being condemned. Now, the merchants of fear march out Mr. Jim Towey whose nonprofit markets the "Five Wishes" document, for a price, and lobbies the Veterans Administration to use its document at great cost. Mr. Towey conveniently labels a competing document as "pro death" while simultaneously implying that the Veterans Administration is urging veterans to make end of life choices based upon expenses. This is unconscionable and the appearance of impropriety reflects exactly why the religious right is now held with such disdain. Media Matters explains it well:

Fox News, NRO, Limbaugh run with "death book" smears. Following false accusations that the Democrats' health care reform legislation would institute "death panels" for the elderly, former Bush official Jim Towey claimed in a Wall Street Journal op-ed that the Obama administration revived a Veterans Health Administration (VHA) booklet on advanced planning directives that would "steer vulnerable individuals to conclude for themselves that life is not worth living," calling the booklet a "death book." As with the death panel smear, conservative media -- particularly Fox News -- promoted Towey's false "death book" claim, ignoring facts that undermine Towey's rhetoric.

Hardly Christian, Towey sought to sow animosity and division, offering neither honest discussion nor helpful disagreement. Towey, former head of Bush's faith-based office, "misspoke." The VA lists just a few "misspoke"s:

"For example, Towey stated "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. In fact, the panel included 5 VA representatives and12 nationally recognized experts from outside of VA, representing diverse perspectives. Members 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 Mr. Towey created and is now actively promoting."

Mr. Towey also stated, "under President Obama, the VA has now resuscitated "Your Life, Your Choices." In fact, VA's current plans to update and release the document were developed under the Bush administration and have not changed. The document is currently under revision. The updated version is due to be released in 2010.

Mr. Towey also seems critical of VA's policy requiring primary care providers to raise the topic of advance care planning with all patients. This is puzzling, because outside of VA, Federal law has required health care organizations to educate all patients about advance care planning since 1991. ..."

Senator Specter tried to give Wallace, FOX and the rest of the reactionaries respect. This is an error. I listened to Wallace's mugging of both Tammy Duckworth and Arlen Specter. Wallace and Towey deserve zero respect. Wallace should be condemned for the absurdity of his "death book" claims. Mr. Towey should be laughed off the national stage.

Republicans, conservatives and FOX are blatantly using and abusing veterans and the military to discredit proposed health care legislation. Veterans are not buying any of it. We faced death before and when we face it again, it will be on our terms. The VA and the military understand this; too bad Towey, Wallace, FOX and the rest of the reactionaries remain ignorant.

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Comments

[Christine Pelosi - Huffpost Blogger]

Thank you, Hal, for your service to our country and for telling the truth and fighting the smears about veterans health care, We must get the facts out there: with tens of millions of dollars devoted to swiftboating reform, we are, as Teddy Kennedy would say, sailing against the wind.

[2008CaliforniaFan]

Mr Donohue,
Thanks for speaking up. I started emailing some of these Veterans organization about a week ago when Fox news and these GOP Politicians started using our proud Veterans as props in their little Political charade.
These men served proudly and "Fox and their Friends" want to drag them through the mud.

AMVETS put out a statement last week on their webpage. ( quote below )

"Over the weekend, cable news pundits bashed the continued use of VA's end-of-life care planning manual, "Your Life, Your Choices," mislabeling the handbook as "Obama's Death Book for Veterans." AMVETS would like to set the record straight on this handbook, which has been in use with the VA for more than a decade."

http://americanveteranmagazine.blogspot.com/2009/08/vas-your-life-your-choices-non-issue.html

Now Military.com has also issued a statement as well.

" Vets' Groups Slam 'Death Book' Claims "
The head of a top veterans' advocacy group is demanding an apology from Republican National Committee chairman Michael Steele for claiming the Veterans Administration is encouraging vets to commit suicide."

"Executive Director of "Veterans for Common Sense" Paul Sullivan is slamming the RNC chairman for comments he made Aug. 25 on Fox News."

http://www.military.com/news/article/August-2009/vets-groups-slam-death-book-claims.html?ESRC=eb.nl
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Through your sources, please ask as many of the Veteran Community to speak up and denounce these actions as well.

[Hal Donahue - Huffpost Blogger]

You just did and it is a great idea. I urge everyone to e-mail or call your state veterans organizations.

[sixyfivepercentwater]

"This is military medicine at its finest, government health care. Now it is being attacked for this very excellence." I grew up under military medicine, and it is not "excellent" by any definition of the word. Throughout my childhood, I saw a different doctor every time I presented to the hospital to be treated. No such thing as continuity of care. Military dependents do not get to question the care they are given, or ask for an alternative. Any such request reflects adversely on the person (my father) whose dependent you are. Waits of many hours for urgent care were not unusual. This all took place at the National Naval Medical Hospital in Bethesda, Maryland. The same hospital the President goes to and the same hospital that treated diplomats and officers' families in some other part of the building. But for us poor enlisted dependents, the care was somewhat less than what I'd want for a neighbor's dog who bit me, and someone more than nothing at all.

[Hal Donahue - Huffpost Blogger]

Well I would think that the water is heavy on the brain. First point is continuity of care can be good but familiarity can indeed breed contempt or in this case blindness. Fresh eyes often see things that familiar eyes miss. A different doctor every time is surprising. Questioning is not at all reflective on the parent if that parent is a stand up person. Make no mistake if an individual is bullied in military medicine, he is dead meat in the private sector. Read my previous blog. If you think the military doctors were happy with our choice of a German doctor you are sadly mistaken. Yes, I was an officer but flying captains like me were a dime a dozen on base. You have to stand up in life. I have been enlisted and an NCO so please spare me the pitiful victim stories. A good officer credo is like the cavalry officer of old: first the horses, then the men, then you. I was on both sides there were benefits on either side but as in life if you think you are a victim; you are often a victim Sorry to burst your bubble

[MauraSatchell]

Whoa! Damned powerful, Hal! Thanks...

[jimpwhite]

Hal as always thank for bringing the picture in focus. As I visit healing veterans at my local VA its a topic that comes up regarding family matters and legal affairs. Ive never seen this booklet, nor have the vets I visit as the subject never comes up. What does transverse in conversations is that they are comfortable , that the staff is on top of of things and any issues needing attention we alert our network that can respond. Much like being in the service, we leave no one behind.It seems to me these last 200 days of the new administration we are seeing compassion take on a new meaning, new veteran laws from the house & senate and a SECVA leading by example. Staff are happier, patients are spirited and hopeful. I guess the opponets can't find any other topic to ambush our healthcare on? It is a role model to consider in the overall health care debate is the consenus. i remain VR+ jim

[Hal Donahue - Huffpost Blogger]

Military healthcare works well and the VA is great once you can get in. This backlog will sadly take a long while to fix. The VA is transforming as I watch. I am keeping my fingers crossed but so far so good. In desperation these reactionaries will not stop at any lie to derail universal healthcare. You said "It is a role model to consider in the overall health care debate is the consenus" which is exactly why they must discredit it.

[Hal Donahue - Huffpost Blogger]

This issue is the topic of our radio show this evening at 5 EST http://www.vmfm917.org. or 91.7 if near Scranton

[John Harvey]

I do not know about Towney but none of the rest appear to be veterans. What gives them the right to criticize what the VA does?

[Hal Donahue - Huffpost Blogger]

Towney is not a veteran. He has shown little interest in veterans except to market his pamphlet to the VA for $5 a copy. What amazes me is that he heads a Catholic College yet he behaves in what I was taught to be a very unchristian way.

[John Harvey]

It is all just profit motive to the right wing. I spent four years in seminary and I do not remember Jesus ever saying, "Blessed are the profit makers."

[TexasDem0]

Do you have to be a child to stand up for childrens issues?
Non-veterans have every right to to demand proper care for veterans.

[Hal Donahue - Huffpost Blogger]

Yes they do and they are more than welcome to do so. My point was Towey never has shown any interest in veterans and is only now voicing "concern" because of his personal and political agenda. Senator Bob Casey is a strong veterans advocate and not a veteran. No one would challenge his interest in veterans. I do challenge Towey's motives.

[HenryDavid]

Yes, it's a curious thing that so many conservatives who speak about the military and veterans have never even served. Cheney's exemption from military service was questionable. Even more so was Rush Limbaugh's "medical" exemption. And don't even get me started on Bush Jr.--trained to fly a plane which was just by happenstance being discontinued for use in Vietnam. (Of course, that's just for starters.)

Towey's "death book" claims are nonsense, and his financial agenda for his own end-of-life book is so transparent. If the populace falls for this, we're in worse trouble than I thought.

[Hal Donahue - Huffpost Blogger]

Couple of points here. Cheney had "five", count them 5, exemptions and was he not the guy who made the comment that he had better things to do? Well I did too and I suspect that most of my fellow veterans did also.

The failed Bush story is better than you say. He "disappeared" when his unit was converting to the F-4 phantom an aircraft in high demand in Southeast Asia.

[TexasDem0]

The GOP, which usually votes as a block, has consistently voted FOR war and AGAINST benefits for veterans and the military. They recently supported the new GI Bill only because it was widely publicized and under consideration just before the election. Sen. John McCain opposed it . . . until he saw which way the political wind was blowing.