The Right is desperate—desperate to derail any sort of health care reform. Notably absent from their diatribes is any debate on the merits of one plan or another. They know that the only way to convince Americans to keep the terrible system we have now is to make them think that any reform would be worse. And so they are blowing their dog whistles, talking about “culture of life” and “culture of death”, and along the way encouraging ignorance about one of the most important aspects of medical care.
Any rational person knows that there are no proposed “death panels”—it’s a blatant lie by the far Right designed to frighten the ignorant. And given that the “death panel” wording just isn’t playing as well as they’d hoped, they’re hunting for more “evidence” that government health insurance will kill you. Of course, this requires ignoring the fact that Medicare, the government health system that insures most seniors still hasn’t managed to produce a single gram of Soylent Green.
We’ve discussed in this space many, many times the utility of discussing end-of-life care, and the importance of advanced directives (ADs). To refresh your memory, ADs allow you to in effect make decisions about your health care even when you cannot communicate. This is done using such documents as living wills, which explicitly state your wishes, and by appointing someone to make decisions during your incapacity, for example by appointing a durable power of attorney for health care (DPOA). Ideally, you would discuss your end-of-life wishes in advance with someone you trust and set the whole thing down on paper. Since our current system allows us to keep people’s bodies alive far longer than the actual “person”, this is pretty damned important. But even outside such extreme (but common) circumstances, ADs preserve patient autonomy and are a good thing.
But not if you’re trying to scare the bejeezus out of people. Take Jim Towey (please!)—he quote-mined a VA document on ADs to make it sound like some sort of paper death panel. This was the guy in charge or Bush’s ill-fated “faith-based initiatives”, and apparently he’s not done shoving his own version of religion down our throats.
Well, the message that they want to communicate, I think, is if you have a stroke or if you have a coma situation that somehow your life has lost a little value and it may not be worth living anymore.
My problem with the document, Chris, is that the author of it is a proponent of assisted suicide. He’s way out there on that issue. And the V.A. has been using this. A new directive just came out in July, urging providers to refer patients to it. So in my view, there should be a balanced treatment. And this is a slippery slope that kind of makes people — when you look at the document, it makes people feel like they’re a burden and that they should do the decent thing and die.
Is this what the document in question does? Let’s look at the actual document (gasp!)
Explaining end-of-life medical care should ideally be done in language anybody can understand.
There’s only one person who is truly qualified to
tell health care providers how you feel about
different kinds of health care issues–and that’s you.
But, what if you get sick, or injured so severely that
you can’t communicate with your doctors or family
members? Have you thought about what kinds of
medical care you would want? Do your loved ones
and health care providers know your wishes?
Many people assume that close family members
automatically know what they want. But studies
have shown that spouses guess wrong over half the
time about what kinds of treatment their husbands
or wives would want.
You can help assure that your wishes will direct
future health care decisions through the process of
advance care planning.
The document goes on to offer guidance for how to make sure your wishes are followed: “Think about what you want; communicate it to others; write it down”. Good advice. It then walks you through the process.
So what’s bugging Towey?
Wallace: Let’s put up this page 21. It’s called “What
makes your life worth living?” and it asks the veteran to check off
whether a variety of situations are difficult but acceptable, worth
living but just barely, or not worth living. And here are some of the situations. “I can no
longer walk but get around in a wheelchair.” “I live in a nursing
home.” “I am a severe financial burden on my family.” “I cannot seem to
shake the blues.”
Mr. Towey, what’s wrong with that?
TOWEY: The biggest problem is that when
you go beyond those questions to the boxes you check, the first option
you have, “it’s difficult but acceptable,” a lot of people with
disabilities, a lot of people who have family members with stroke, find
life beautiful. There’s meaning and purpose. Sure, they’re suffering,
but their life hasn’t been diminished by that illness.
think there — if you were trying to be biased and fair, you’d have a
box that starts off that says “My life is beautiful. Yes, I suffer, but
I find meaning in it.”
And I think the
problem with this document, and it permeates the whole thing, is
there’s a bias toward a depression. And so when you see the one that
says, for example, “I can’t shake the blues,” you can actually check
the box that says “My life’s not worth living.”
Another one said if I can’t go outside on my own, so you check a box, life’s not worth living.
This is idiotic. It simply isn’t the tone of the document. The document does contain a questionnaire to help guide advanced planning, and to do this, you can’t ask only the easy questions. There are a lot more questions and examples. It’s actually a thoughtful document.
Towey also complains about the language being biased, with such words as “vegetable”. Tthis is written in a way anyone can understand. “Vegetable” is used in the context a patient would use it in.
Now, Arlen Spector is calling for hearings—hearings—to “look into” this thing. This. Is. Insane.
The VA has a very well-developed tool that explains end-of-life decisions to patients and their families. I don’t know how widely used it is, but it’s thoughtful, complete, and requires detailed patient participation. The Right is, to be generous, paranoid as hell. To be less generous, they are looking for something—anything—to justify their claims that the government wants to kill old people.