By the way, I am a former Marine, disabled from the VN war and I recently had a living will done for me at the Carl T. Hayden VA medical center in Phoenix, AZ and I couldn’t have been treated any nicer. The guys that helped me were all former vets and vets look out for vets. As long as we have these caring people around it’s ok for them to be realistic about our choices. Semper Fi

The issue isn’t whether Mr. Steele or Rev. Klingenschmitt think “Your Life, Your Choices” goads veterans to commit suicide, it is the way these important discussions are to be framed in the first place. This is important because if the approach YLYC advocates is made the norm, it could have a major impact on the lives of all, not just veterans and retired military officers.

First, note that both the original 1997 YLYC and the revised 2007 YLYC direct people seeking an advance directive to only one resource: a pro-assisted suicide non-profit organization (Choice in Dying, formerly the Euthanasia Society, and Compassion and Choices, formerly the Hemlock Society, respectively). The VA can’t and doesn’t deny that fact. To point that fact out is not to suggest that the VA is urging veterans to commit suicide, it is to point out the unshakeable bias of the author, Dr. Pearlman, and the fatally flawed nature of his and his team of authors’ approach to advance care planning.

It is not only what the document says, it is what isn’t said or offered. The quality of life check list starts with the choice of “difficult but acceptable” and then declines to “not worth living.” Where is the positive option? When you frame the discussion in this fashion, you corner people with bad choices. You are not allowing them to say, “I can derive love and joy from life even if I am in a wheelchair or can’t control my bowels. Here’s what you can do to help me live my life to the full.” YLYC does not provide an option for people to say, “I have been taking care of others my whole life and now I am in need of care – I will accept that this is my situation and try to love my caregivers and try to contribute to the lives of my children or grandchildren as best as I can.” People aren’t urged to say, “I am frightened by the fact that I can’t go outside anymore – I want my family and friends to visit me and engage me so that I can live as full of a life as possible.” Many people with disabilities live meaningful and beautiful lives even if they are in a nursing home or need help from others. This was one of the main points made by Jim Towey in his criticism of YLYC.

Second, read the literature of the assisted suicide movement. It treats dependency as a terrible thing and its proponents project their own feelings onto others (“I wouldn’t want to live if I were ever in that condition!” or “I can no longer bear my loved one’s suffering so I wish he/she would die.”). The assisted suicide point of view of Dr. Pearlman measures the value of life in terms of autonomy, control, independence and utilitarianism, as opposed to a belief set that holds life as having inherent dignity and not diminished one bit by incapacity. YLYC casts the debate in “quality of life” metrics of “being a burden” and “depending on others” and “my life won’t return to normal” and does not make any effort to allow people to say: “Here’s what I need to help me live a meaningful life if I have had a stroke or can’t even shake the blues.” This obsession with death is something that no health system should embrace, certainly not one supported by taxpayers and used by our veterans.

Aging with Dignity is an advocate for respect for life at all its stages and for better and dignified care at the end of life. Jim Towey created Five Wishes to allow people to state in their own words what kind of care they want or don’t want in case of serious illness or impending death.

Finally, know that many individual VA facilities have used Five Wishes, which is why he thought to pay them a visit in September 2007. He had not even heard of YLYC until he was given a copy of the June 2007 version. We immediately raised concerns and the VA later pulled both versions. Case closed, or so we thought. It was only when YLYC was revived in July 2009 that he spoke up. This puts to lie the line that he was somehow disgruntled over the VA not choosing to adopt Five Wishes. Why wait two years? The he’s-just-disgruntled story line is a way to avoid speaking to his central point. It’s good that Sen. Specter and Rep. Buyer have called for hearings into YLYC.

I hope you continue this discussion. It is too important to be written off as just more Democrat-Republican politics as usual. I would be happy to send you the June 2007 version in PDF; you can read it and decide for yourself.

Here is the direct link to the update: http://www1.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=2042