Fear of the government's role in end-of-life care has featured prominently in the ongoing health care debate. Now, there is a new controversy fueling that fear.

As NPR's Joseph Shapiro reports, it's over a Department of Veterans Affairs booklet, one that people can use when they're trying to draw up a living will.

JOSEPH SHAPIRO: The VA document is called, Your Life, Your Choices. There's a worksheet that asks: Under what conditions life is not worth living? And it includes situations such as you now get around in a wheelchair; you can no longer think clearly; you live in a nursing home; you worry you're a severe financial burden on your family; you're depressed; or as the document puts it, you can't seem to shake the blues.

That kind of language is offensive to Jim Towey.

Mr. JIM TOWEY (President, Saint Vincent College, Latrobe, Pennsylvania): 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.

SHAPIRO: Towey called attention to the VA document with an opinion article in The Wall Street Journal last week.

Mr. TOWEY. When you say, you know, I can no longer go outside of the house. I can't seem to shake the blues. I mean, those are serious issues, but they're certainly not issues where you're trying to determine whether you want to keep living or not.

SHAPIRO: Towey worked in the Bush administration. He ran the White House Office of Faith-Based Initiatives. Now, he's president of Saint Vincent College in Latrobe, Pennsylvania. He's also worked in an AIDS hospice and he's the co-author of another 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.

Mr. TOWEY: There was such a furor over the suggestion of death panels because people said, well, that's not in the bill. 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 could help them get better or make life worth living.

SHAPIRO: The original VA document, Your Life, Your Choices, was written in 1997, and there's been some mild controversy about it before. It's gone through several revisions.

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.

Ms. TAMMY DUCKWORTH (Assistant Secretary of Public and Intergovernmental Affairs, Veterans Affairs): We've not used it since 2007, when under the Bush administration, we decided to go ahead and revise it. This checklist is still under revision.

SHAPIRO: But the guide is still on the VA's Web site. And last month, a VA official sent a message to its doctors reminding them to urge patients to fill out a living will and recommending the Your Life, Your Choices guide. So you might expect veterans to be pretty angry.

Mr. DAVE AUTRY (Deputy National Director of Communications, Disabled American Veterans): It's a tempest in a teapot as far as I'm concerned, personally.

(Soundbite of laughter)

SHAPIRO: That's Dave Autry of Disabled American Veterans. More than 1,500 members are meeting in Denver this week for the group's annual convention. And Autry says the VA guide has gotten almost zero attention.

Mr. AUTRY: There are 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, in this case, maybe grandfather who stormed the beaches of Normandy. And I think our members, by and large, understand that there are some political undercurrents that are, you know, certainly out of our purview.

SHAPIRO: The lobbying group for disabled veterans 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.

Joseph Shapiro, NPR News.

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