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  • So, Fox reports – but Not Nearly as Well as Iowahawk.

    Posted by Ginny on August 23rd, 2009 (All posts by )

    Iowahawk allusion (if you don’t want to entangle yourself in the rest).

    Today Fox News discussed “Your Life, Your Choices” , an “end of life” booklet developed by the VA and recommended for use in counseling. The segment appears to have been prompted by Jim Towey’s piece in WSJ, “The Death Book for Veterans.” To counter Towey, the VA’s spokesperson was Tammi Duckworth, VA Assistant Secretary. The exchange was lively, if frustrating.

    [Paragraph Added after first comment] Towey’s complaint is that the booklet has a bias – and a strong one – toward death. Towey argues, for example, questions about whether life is worth living include such questions as

    being in a nursing home, being in a wheelchair and not being able to “shake the blues.” There is a section which provocatively asks, “Have you ever heard anyone say, ‘If I’m a vegetable, pull the plug’?” There also are guilt-inducing scenarios such as “I can no longer contribute to my family’s well being,” “I am a severe financial burden on my family” and that the vet’s situation “causes severe emotional burden for my family.”

    The use of the word “vegetable” more than once was another criticism. Towey’s argument – and certainly Wallace’s implicit one – was not that a gag order should be imposed. Rather that this single document has a clear message,

    This hurry-up-and-die message is clear and unconscionable. Worse, a July 2009 VA directive instructs its primary care physicians to raise advance care planning with all VA patients and to refer them to “Your Life, Your Choices.” Not just those of advanced age and debilitated condition—all patients. America’s 24 million veterans deserve better.

    [end of addition]

    Of course, these are the big issues. The tensions are not merely the great one intersection between life and death, but, here, it is also between religion and government, the physical and the spiritual. The booklet tries to bring clarity to the discussion. We aren’t always honest with ourselves, such a booklet defines what we often think of in amorphous ways. I suspect that is useful.

    Some commentors argue it might help detect depression – that, too, might be useful. Facing questions early may relieve our relatives. I’m not sure if we really “know” what we want. What we define as a life worth living at 20 might be different than at 90. At an earlier age we might have thought life wasn’t worth living if we couldn’t support ourselves or perhaps if we couldn’t climb stairs; indeed, at some points we probably thought life wasn’t worth living if we couldn’t have sex at least once a day. Our standards change. This booklet would be used by the greatest generation (my parents) and also by someone at 20, the age of my youngest daughter; though she’s barely out of the nest, some her age are returning from battle, facing restraints only a much older person might expect. For both groups, the government should tread lightly. Towey argues this is heavy – it “presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political ‘push poll.’ For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be ‘not worth living.’”

    Coming upstairs to finish my freshman English syllabus, I realized yet again that what we do is important – and seldom do I succeed. What used to be a semester’s class in argumentation after a full one on writing, has been sandwiched into one course, adding the “research” paper. Our republic rests on enabling students to develop these somewhat separate skills – ones surely worth more than four weeks. I fail, I am sure – but how quickly do any of us master these skills? Over forty years later, I have much to learn. And those years of education in explicating novels only tangentially prepared me for a class like this one.

    The interview challenges us to apply that analysis – my students would find it interesting, I’m sure. My job is to give them the vocabulary and force them to examine their own – and others’ – assumptions. We often blink – certainly, I do. We forget what we feel, what we “know”. Education is sometimes helping us understand what we already know.

    WSJ gives Towey’s biography: “president of Saint Vincent College, was director of the White House Office of Faith-Based Initiatives (2002-2006) and founder of the nonprofit Aging with Dignity.” We know where his sympathies lie. This background gives him gravitas but also a clear agenda.

    Wallace does a similar framing of Tammi Duckworth’s background; she is a double amputee who returned from Iraq with major war wounds; young, attractive, vibrant she is a hero. She serves the bureaucracy that – tragically – could not put her back on her feet, but repaired her in such a way we see her its strong advocate. She began with an authority few could match.

    On the other hand, we note a critical tone in Wallace’s introduction; Duckworth refused to appear with Towey. Such restrictions oten dismiss the opponent’s gravitas. We began to suspect another reason: face to face, ad hominem attacks affect the tone. They damage the smearer rather than the smearee. But speaking of another, not present – ah, the critical remark lingers in the viewer’s memory. So, she attacked motivation: repeatedly bringing up the cost of his, similar, book – one that the audience could buy if they wanted to spend $5.00. Not that “Your Life, Your Choices” was exactly free – grant money went to Pearlman, whose biographical note on the VA site emphasizes his authorship. (Her rather exasperating assumption seems to be that works paid for by the government are “free” and those paid for in the open marketplace cost us – an irritation compounded when she argued the law mandated its availability because it was paid for by the government.) This is, of course, an argument that reminds us of other government policies.

    Wallace helped Towey counter this argumemt – explicitly by describing this argument of his opponents and allowing rebuttal; implicitly this reminded us that Towey hadn’t seemed to be pushing a book. Whether we find his argument compelling or not, we do have the sense that he has thought long and hard about this issue. We might have felt the playing field was being tipped by Wallace (who clearly seemed shocked by the thrust of the booklet); on the other hand, if we began with certain assumptions, we might have felt it was a fair response to ad hominem attack. Her argument also came from an interpretation of motivation and value we might not find persuasive. If your assumptions differ from your audience’s – if they see the material and financial as less important than the spiritual and principle – your argument is less convincing.

    A representative also needs to know what is on the web, what is – and what can be – known. Fox is not so incompetent that it will assume what is up to day might not be different than what was up a week ago, before Towey’s piece. It seemed clear that Wallace wanted to give this remarkable woman credit; it also became clear that he wasn’t going to let her make assertions that appeared to counter the facts as he found them on the net. In exasperation, he remarked that the “he said, she said” balance just didn’t work when sites – on the VA site – were available that supported one position and didn’t the other. [This is in reference to Towey's description of the July 2009 directive - one that she denied but which Wallace gave a screen shot.]

    The “gotcha” journalism at which his father was so good seems to have been passed down, though Chris Wallace has a readier good humor. Arlen Specter followed; he grabbed an opportunity with his usual flamboyance, to assert his authority & promise congressional investigations. To give him his due, he appears to be ready to fight for his life – both real and political – and may not be so ready for suggestions of the burden he might pose to others. But he was inaccurate in describing her as standing up well to Wallace’s grilling. No, she didn’t fold – politicians have seen so many weepy confessionals of late they may have developed that criteria instead of one of a lost argument. In her case, It was the lack of definition, assertions that did not seem to be supported by the documents (at least as Wallace demonstrated), and attacks on the man that didn’t stand up well. Her voice remained strong. Withstanding combat as a helicopter pilot is likely to have been a powerful experience that reset any of her senses of proportion – and I doubt this grilling is all that important in her life.

    Charming, vital – her statements became longer and more discursive, became repeated sophistries, appeals to our emotions (the VA, she told us repeatedly, helps hundreds of thousands of Americans, the VA recognizes its duty to America’s fallen, the VA. . . is a good thing; veterans need to be respected). She was not unlike our local rep in his telephone conference,spinning a sugary, airy argument from, well, nothing. I’m easily distracted – but these weapons are not so useful when they have become familiar and are done with such a heavy hand – we hear them, stop, rewind, then fast forward through boilerplate we’ve heard before. I assume that Duckworth wants to help veterans and Chet Edwards wants to help his constituents – if they were worse people than they are (and I suspect they are good people) there would be no advantage to making our lives miserable. But that isn’t the point. That is when people like Wallace are welcome – with a bracing approach to that cotton candy sugary mist.

    Our junior rhetoricians can also learn of the difference between a man who believes firmly in certain values – values he sees as inherent in the nature of a human being – and a woman making an argument for a bureaucratic system and who does not appear to have examined her own assumptions. One spoke with a moral clarity; one did not.

    I assume it is possible to mount an argument for the culture of the VA booklet. The primary author is Dr. Robert Pearlman, who is Chief, Ethics Evaluation for the VA. Surely the criteria for that position is one of making intelligible assumptions and choices. It can’t be his judgment but his reasoning that he has to offer – it hasn’t been my impression that the position of “God” is one many of us are looking for a mortal to fulfill – Obama aside.

    Debt, Obama’s grandious vision, “Death Book” or “Death Panels” – no, none of these are likely to give us much comfort. We might expect, for instance, a bit more consistency from our president (say on one-payer plans) before he asks us to trust him on end-of-life counseling.

     

    11 Responses to “So, Fox reports – but Not Nearly as Well as Iowahawk.”

    1. tdaxp Says:

      I’ve read this post twice, and I’m not sure I understand. Why put a gag over the VA, preventing them from discussing what forms of care would make a patient worse off?

    2. Ginny Says:

      Sorry, Tdaxp,
      I realize this was not clear – I plunged in as if my readers had read or heard what I had.
      On the other hand, I don’t really see where in this post (even as I originally posted it) anything is said of a gag order. The argument on the one side is that a book with a clear bias toward making a choice of death should not be directed to be used by all doctors for all patients at all VA hospitals. Complaining of forced approaches and forced speech is not an argument for a gag. Some are likely to be at a vulnerable place in their lives (whether they have become wheelchair-bound at 20 or 80); some of the worksheets are more guilt-inducing (speaking of financial burdens on relatives) than they need to be. The argument on the other side was that there was no directive (when it was) and to cast doubt on Towey’s motives.

    3. tdaxp Says:

      Ginny,

      Thanks for the reply. I guess what I don’t see is this:

      . The argument on the one side is that a book with a clear bias toward making a choice of death should not be directed to be used by all doctors for all patients at all VA hospitals.

      While certainly one can argue about framing (the book presupposes that continuing to live in rather hellish conditions is an option, the book presupposes that dying is an option, etc.), given that both options are available, the book asks individuals to think about the qualities that make their life worth living.

      It may be that life is worth living for a reason apart from the quality of life. For individuals who believe such, their answers are obvious.

      It may be that life is worth living as a function of the quality it has. For individuals who believe such, their answers require more thought.

      Clearly, individuals are vulnerable when they receive care. One can make an argument that insurance companies should be having individuals consider these options regularly throughout their lives. However, as some individuals have not done so until they begin care, it is important that they begin considering their options.

      some of the worksheets are more guilt-inducing (speaking of financial burdens on relatives) than they need to be

      I don’t think so. We live in a country where relatives are expected to care for their ill. Certainly, if the VA would be willing to take up the entire cost of care of the sick this would not be an option. I’m not aware of anyone suggesting this, however, so to keep this consideration away from the ill is to exhibit a clear bias.

    4. Ginny Says:

      But the argument is about the framing and it is about the required use of one booklet. Again, I seem not to have made myself clear.

    5. sol vason Says:

      Because of the miracles of medical advances made after 1940, for the first time in human history, everyone is healthy and living longer. Unfortunately this means there are a lot of old people who don’t do nothing because they are retired.

      Liberals have a 2 point plan. Give free health care to everyone and kill them when they retire (but keep them in perfect health if they are on welfare). Don’t make sense.

    6. tdaxp Says:

      Ginny,

      Because of the asynchronous, indirect manner of blog comments, I apologize for not understanding.

      The bias of the book is to present options, which is a good thing. I remember being shocked when reading the NHS (at least in the 1990s) was refusing to provide patients’ medical files to patients, because it might worry them.

      Here, it seems you are talking about the same thing, not presenting options to patients, because it might worry them, or they may make wrong decisions.

      It seems the conservative thing to do is to protect patient rights, while the paternalistic thing to do is to shield patients from knowledge.

    7. Marty Says:

      Sol Vason,

      it makes sense if you view people as existing in order to support the State–keep them healthy and productive while they can earn and pay taxes, but if they are not nearly that age at the young end, or almost past it at the old end, they aren’t worth the effort and are just more mouths to feed, as it were—strictly benefit-cost, nothing personal, y’know. That’s what E. Emanuel’s paper said, anyway.

    8. Ginny Says:

      Tdaxp,
      I’m beginning to wonder if your reading “in” isn’t willful.

      At no point does anyone say anything about denying choice, options, “muzzling.” Towey doesn’t argue we should protect people from “worrying”.

      Since I’m pretty discursive and unorganized, I’m generally off topic. However, I’m too busy today to deal with your speculative approach that has little to do with anyone’s point; indeed, the narrowing of options is the very point of the complaints.

      Sol Vason,
      Another point, however, is that few of us are doing back-breaking work and most of us can do what we are doing much later in life. As with women & child raising, the most productive society is surely the most flexible one. The back-breaking laborer should have available an earlier retirement, but these people are still productive and, while not wanting to continue at the jobs at which a younger person could excel, are likely to feel happier with “second life” positions. We can use their wisdom and they can use the purpose.

      Raising the retirement age is logical – given the circumstances when it was set up, it is also essentially living up to its promise – at least as I saw it almost 50 years ago when I started paying in.

    9. tdaxp Says:

      Ginny,

      Thanks for the comment!

      I’m beginning to wonder if your reading “in” isn’t willful.

      It’s not. I have no patience for that sort of activity. I want to understand positions that don’t make sense to me, not bait opponents.

      At no point does anyone say anything about denying choice, options, “muzzling.” Towey doesn’t argue we should protect people from “worrying”.

      Perhaps I am confused here? I thought your position was that the VA handbook should not include the checklist? (Maybe I missed the point!)

    10. mishu Says:

      Looks like they pulled the book from the VA website. Score one for Towey.

    11. Susan Lee Says:

      That the VA “death book” presents questions that are to be answered by choosing from a multiple choice list is a Big Problem. All possible alternatives are not represented in the list of answers from which to choose. That is what is meant above by “biased toward death”.

      I heard a few questions and the range of possible answers on radio a few days ago, and I would find it very difficult to choose any of the offered answers. All answer choices are based on Doing Something.

      As a good Roman Catholic, I would answer some questions saying, “It’s not my choice to make” or “In God’s time”, etc….

      Pre-prepared answer choices are like a cattle chute forcing the answerer to go somewhere predetermined.

      Couple with the instability/uncertainty of ill health described in some previous comments, and you get a recipe for Death

      (sounds like the title of a Nero Wolfe book….)

      Susan Lee