Living-Will Guide For Vets Stirs Health Overhaul Fears

Then President-elect Barack Obama walks with veteran Tammy Duckworth  on Veterans Day, 2008.

Barack Obama walks with Iraqi war veteran Tammy Duckworth after the two placed a wreath at The Bronze Soldiers Memorial in Chicago on Veterans Day last year. Duckworth, now assistant secretary at the Department of Veterans Affairs, says a controversial VA guide on end-of-life decisions continues to undergo revisions. Stan Honda/AFP/Getty Images hide caption

itoggle caption Stan Honda/AFP/Getty Images

A Department of Veterans Affairs booklet is stirring up new controversy over the federal government's role in end-of-life care.

The document, called Your Life, Your Choices, has a worksheet that includes a tough question: When is life "not worth living?"

Options include:

— "I can no longer walk but get around in a wheelchair."

— "I live in a nursing home."

— "I can no longer think clearly — I am confused all the time."

— "I am a severe financial burden on my family."

— "I cannot seem to 'shake the blues.'"

That kind of language is offensive to Jim Towey, a former official in the Bush administration. "It's framing these quality of life issues in a way that guilt trips veterans. That makes them feel their life is a burden not a gift," he says.

Towey called attention to the VA document with an opinion article in The Wall Street Journal last week. "Those are serious issues, but they're certainly not issues where you try to determine whether you want to keep living or not," says Towey, who ran the White House Office of Faith-Based Initiatives from 2002 to 2006 and who is now president of Saint Vincent College in Latrobe, Pa.

He has also worked in an AIDS hospice and is the co-author of Five Wishes, a popular guide to writing a living will.

Towey says the VA pamphlet shows there's reason to worry whether government agencies can stay neutral when it comes to costly end of life care. "There was such a furor over the suggestion of death panels because people said 'Well, that's not in the bill,'" he says. "But here I think this does play to the fear of people that somehow government's going to bias this discussion and get to their doctor and they're not going to be given care that will help them get better or make life worth living."

The original VA document, Your Life, Your Choices was written in 1997 and has gone through several revisions; this isn't its first brush with controversy.

Over the weekend, on Fox News Sunday, Tammy Duckworth — a disabled Iraq veteran who is now an assistant secretary of the VA — said the guide was under review. "We've not used it since 2007 when we decided to go ahead and revise it. This check list is still under revision."

But the guide is still on the VA's Web site. Last month, a VA official sent a message to its doctors, reminding them to urge patients to fill out a living will and recommended the guide.

In Denver, more than 1,500 members of the Disabled Veterans of America are meeting for the group's annual convention,

"It's a tempest in a teapot as far as I'm concerned, personally," says Dave Autry, a spokesman for DAV.

He says although health care is on the minds of veterans at the convention, the VA guide has gotten almost no attention. And then, mainly from veterans who worry that it's being used to undermine attempts to change health care. "There's some people who have expressed concern to us that it's being used by some people as ammunition for the argument that government intervention in health care will result in pulling the plug on granny or maybe in this case on grandfather who stormed the beaches of Normandy. And I think our members, by and large, understand that there are some political undercurrents that are certainly out of our purview."

The lobbying group for disabled veterans has no official position on attempts now in Washington to overhaul health care — except that any change protect veterans. And the group is often critical of the VA. But Autry says veterans trust the VA on this issue — because it's been a leader in promoting good geriatric and end-of-life care.

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