09/30/2009 05:12 am ET Updated Dec 06, 2017

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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