"Death Book for Vets" under increasing scrutiny

Veterans Affairs officials are reviewing the use of a controversial booklet on end of life care after lawmakers and bureaucrats raised concerns over the tone of the publication, dubbing it a "death book" that suggests older vets take steps to make sure they don't become a burden on their families.

But the VA still insists the publication is a valuable tool,designed to help vets make decisions about the medical care they want in advance of an incapacitating injury or illness.

In a statement to the Washington Post yesterday, VA spokeswoman Katie Roberts said the message behind the booklet was being distorted by critics, and the information can still help veterans "deal with excruciating questions about what kind of health care they would like to receive if they are unable to make decisions for themselves."

Last week in a Wall Street Journal editorial former Bush Administration official Jim Towey called the booklet a "push poll" which could guilt older veterans into denying themselves care for the perceived benefit of their family finances.

Yesterday Pennsylvania Sen. Arlen Specter asked the VA to suspend use of the book, and House Armed Services Committee Ranking Member Steve Buyer blasted the publication as "unsuitable" for use with wounded warriors.

Of course, the veteran's care issues don't appear to be the real crux of the controversy. Towey's article framed the booklet in terms of the larger debate on health care, and referenced President Obama's decision to include end-of-life care discussions in those proposals as "slippery slopes" which could lead to denial of medical treatment for many Americans as part of bureaucratic cost cutting. Buyer has openly questioned how Obama's health care proposals will affect veterans, despite White House assurances that they will not.

But the booklet does contain frank language about what aging veterans might expect with their health, and offers a number of hypothetical scenarios where family and friends suffered mental anguish because their loved one did not outline their health wishes. The excerpt below offers a quick self-assessment for veterans dealing with incurable medical conditions:

During a terminal illness people often lose strength and become confined to bed either in their own home, or if they need more help, in a hospital, nursing home, or hospice ... If you had a terminal illness, what would be the most important thing for you: relieving suffering or prolonging life? What would be your goals for treatment of any other problems if you had a terminal illness? Treatment for secondary problems (such as an infection) would not cure theprimary terminal illness (such as cancer or heart disease).

Veterans groups so far have held their criticism, saying the booklet is just one of many tools made available for individuals facing tough health decisions.

UPDATE: AmVets has a much stronger statement of support for the booklet and the VA, over at their blog. They're calling it "a manufactured issue designed to stir public dissent and sell books." But the American Legion isn't sold on the booklet.


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