End-of-Life Care Guide for Veterans

End-of-Life Care Guide for Veterans

This is a discussion on End-of-Life Care Guide for Veterans within the Law Enforcement, Military & Homeland Security Discussion forums, part of the Related Topics category; Our current President, or someone in his administration seems to have revised a booklet that makes injured Veterans feel like a burden and may encourage ...

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Thread: End-of-Life Care Guide for Veterans

  1. #1
    VIP Member Array TN_Mike's Avatar
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    End-of-Life Care Guide for Veterans

    Our current President, or someone in his administration seems to have revised a booklet that makes injured Veterans feel like a burden and may encourage them to die to keep from being an emotional strain on their families.

    This is disgusting.

    Read the article HERE


    This administration never stops surprising me.
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  2. #2
    VIP Member Array rodc13's Avatar
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    What's really disgusting is lying to veterans -- a really sleazy tactic. A little actual research would be a really good idea.

    VA policy derives from the 1990 (George H.W. Bush administration) Patient Self Determination Act. It requires all institutions receiving Medicare funds to provide information to patients regarding end of life, living will and other advance directives. The VA updated its regulation to extend the act to cover all VA facilities.

    The booklet has been in use since 1997, was reviewed and updated in 2007, during the George W. Bush administration, and is scheduled for re-issue in 2010.
    Dr. Ellen Fox, the Chief Officer for Ethics in Health Care at the Veterans Health Administration:
    "Your Life, Your Choices is an educational workbook that was designed specifically for Veterans. The authors went to great lengths to ensure it would be meaningful and helpful to all Veterans, regardless of their religious and cultural backgrounds. I am impressed by the development process they used, which included extensive input and testing by different Veterans groups, religious leaders from 10 different faiths, elderly and disabled individuals, and experienced doctors and nurses. They even made sure to incorporate everyday language that Veterans commonly use to describe medical conditions, while at the same time providing accurate information from the physician's perspective. Over the past 10 years it has been tested through scientific research, endorsed by many respected professional organizations, and widely used throughout the U.S. health care system. It is one of many educational resources we provide to help Veterans and their families. As a Federal agency we have an obligation to be responsible stewards of taxpayer dollars by maximizing the services we provide our Veterans. Providing an educational resource like Your Life, Your Choices at no cost to Veterans is one of the many ways we fulfill this mission. The whole purpose of this workbook is to encourage more conversations between patients, families, and health care teams. Anyone who is seriously interested in ensuring that Veterans receive the best care possible should recognize this."
    Last edited by rodc13; August 23rd, 2009 at 06:51 PM.
    Cheers,
    Rod
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  3. #3
    Senior Member Array tbrenke's Avatar
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    Quote Originally Posted by rodc13 View Post
    More "deather" disinformation and outright lies. Just like the "birthers", they can't argue the actual issues, so they make things up to create a scare. Why not come up with a real issue instead of big-lie claptrap.
    Quote Originally Posted by rodc13 View Post
    And some people wonder why "deathers" get lumped in with the "birthers".
    I found your response to this thoughtful except for the first paragraph and the last sentance. Why not cut that part out and have your argument stand on its own merits?
    "I cannot undertake to lay my finger on that article of the Constitution, which granted a right to Congress of expending, on objects of benevolence, the money of their constituents." -1792, James Madison
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    VIP Member Array rodc13's Avatar
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    Quote Originally Posted by tbrenke View Post
    I found your response to this thoughtful except for the first paragraph and the last sentance. Why not cut that part out and have your argument stand on its own merits?
    Good idea. Done.
    Cheers,
    Rod
    "We're paratroopers. We're supposed to be surrounded!" Dick Winters

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    Member Array SCbuckeye12's Avatar
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    This booklet was not published and was stopped by the Bush Administration from being released. It made it through the VA administration without the VA Secretary even knowing about it. Once discovered it was shelved. The same thing is happening again probably without President Obama's knowledge. We'll see how he handles it now that it's out in the open.

    My confidence is low that it will be handled appropriately, given the bungling of every issue recently. Whoever is pushing this within the VA needs canned ASAP.

  6. #6
    VIP Member Array rodc13's Avatar
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    Quote Originally Posted by SCbuckeye12 View Post
    This booklet was not published and was stopped by the Bush Administration from being released. It made it through the VA administration without the VA Secretary even knowing about it. Once discovered it was shelved. The same thing is happening again probably without President Obama's knowledge. We'll see how he handles it now that it's out in the open.

    My confidence is low that it will be handled appropriately, given the bungling of every issue recently. Whoever is pushing this within the VA needs canned ASAP.
    Again, a little research can go a long way. The booklet was published and released in 1997. After continued complaints from Jim Towey, late of the Bush Administration's Office of Faith-based Initiatives, an independent review board was set up. The board determined that the booklet was useful, but agreed to make a few revisions, to be incorporated in the 2010 release. There's nothing "secret" about it. It's never been hidden.

    By the way, here's the link to the actual booklet on the VA site.
    Your Life, Your Choices: Planning for Future Medical Decisions
    Cheers,
    Rod
    "We're paratroopers. We're supposed to be surrounded!" Dick Winters

  7. #7
    VIP Member Array TN_Mike's Avatar
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    Quote Originally Posted by SCbuckeye12 View Post
    This booklet was not published and was stopped by the Bush Administration from being released. It made it through the VA administration without the VA Secretary even knowing about it. Once discovered it was shelved. The same thing is happening again probably without President Obama's knowledge. We'll see how he handles it now that it's out in the open.

    My confidence is low that it will be handled appropriately, given the bungling of every issue recently. Whoever is pushing this within the VA needs canned ASAP.
    Agreed. 100%, they need to be fired right now.


    Quote Originally Posted by rodc13 View Post
    Again, a little research can go a long way. The booklet was published and released in 1997. After continued complaints from Jim Towey, late of the Bush Administration's Office of Faith-based Initiatives, an independent review board was set up. The board determined that the booklet was useful, but agreed to make a few revisions, to be incorporated in the 2010 release. There's nothing "secret" about it. It's never been hidden.
    I didn't think there was anything secret about it. I posted it because it is despicable to publish and then give to injured Veterans, Heroes really, anything that might make them feel that they are a burden to their families and country.

    I hope the current administration takes the appropriate action but I do not have a lot of faith that will happen.
    ,=====o00o _
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    l_--- \___l---[]lllllll[]
    (o)_)-o- (o)_)--o-)_)

  8. #8
    VIP Member Array rodc13's Avatar
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    Quote Originally Posted by TN_Mike View Post
    I didn't think there was anything secret about it. I posted it because it is despicable to publish and then give to injured Veterans, Heroes really, anything that might make them feel that they are a burden to their families and country.
    I would strongly suggest you take the time to actually read the booklet, before issuing a judgement like that. It raises questions that do need to be considered, before it's too late to make such decisions yourself. Anyone who hasn't taken into consideration the inevitability of their own death is being, at best, shall we say, unrealistic.

    I would further suggest that you revise your initial statement excoriating President Obama, since he, obviously had nothing to do with the creation or revision of the booklet. Remember, it was published in 1997. An independent panel is reviewing it.

    Distorting veterans issues for use as a political football is despicable.
    Cheers,
    Rod
    "We're paratroopers. We're supposed to be surrounded!" Dick Winters

  9. #9
    VIP Member Array AZ Husker's Avatar
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    Many Vets from my generation have no families, are homeless, or are mentally ill. Advanced Directives gives them some control and dignity when the time does come.
    Treat me good, I'll treat you better. Treat me bad, I'll treat you worse.

  10. #10
    VIP Member Array nedrgr21's Avatar
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    I just finished reading the pamphlet. For Christ's sake! There is not one thing that encourages anyone to refuse life saving treatment or addresses being a burden on someone's family. It is all about giving people the tools to ensure they live or die on their terms while maintaining their belief in what constitutes personal dignity while, hopefully, they are in the best position to make those decisions. Most people don't give a thought about this until they are elderly even though accidents can happen at any time; which is when it may very well be too late. This is what any responsible adult should do. It allows one to maintain control over one's life/death even in the event of not being able to communicate and relieves a person's family of the responsibility/grief/feelings of guilt associated with trying to guess what someone else wants and forcing them to possibly make the most agonizing decision of their lives w/o your input when they need it the most.

    Actually, the pamphlet is short and doesn't go into as much detail as other forms. It does ask hard questions. They should be hard - it is a life and death matter. It starts off slowly (wheelchair question) to get going instead of getting right to more serious situations like being in a vegetative state. This makes perfect sense. It asks about a person's current state of health as there is no way for the authors to know at what point in a person's life they were exposed to these questions. - it might be that someone is currently in such bad shape they are only temporarily lucid. In that case, those periods of lucidity should be taken advantage of to make sure a person's wishes are respected. - or it might be the person is in perfect health. These choices are as private as they can get and are better made in solitude with no interruptions and no inputs (intentional or unintentional) from anyone else - family or professional - unless specifically asked for and with no time restrictions (like in a doctor's office).

    I know someone who just went through this. His mother had a stroke previously, was 86 yrs old, and just had another stroke. She was left paralyzed on one side of her body. She had led an active life and was satisfied with the life she lived. I don't know all the details, but basically she had an opportunity to have surgery to regain some control over her body. As with any surgery, especially at her age and in her condition, there was a chance of death. She decided she wanted the surgery to improve her quality of life. She (supposedly) had a DNR order, but I'm not sure if it was in her file or not. She never woke up after surgery. Some of her children, except for the guy I know, decided to keep her on life support b/c one family member wasn't able to arrive in town for a couple of days to say his final good-byes (she was in a coma - how selfish is that on the siblings' part). The guy I know was furious and lit into his siblings for not obeying their mother's wishes. When he arrived at the funeral everyone did their best to avoid him and a very potential fight. Their mother (apparently) didn't have her affairs in order to make sure her wishes were followed, the siblings ignored wishes she made public, but not legal, the siblings were (in their minds) left to make very hard/disturbing decisions, a family was torn apart at a time when everyone needed all the support possible.

    If you truly are opposed to this, you are just showing an ultimate level of immaturity, denial, selfishness, ignorance, and inconsideration for your loved ones.

  11. #11
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    Two questions:

    Is Euthanasia legal under federal law?
    Has anybody done a bit of research on the people who wrote the pamphlet?
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    VIP Member Array Thanis's Avatar
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    44 percent of the military vote went to Obama. I don't get the feeling that Obama is that disliked by vets as say other former POTUS of the same political party. Considering he ran against a war hero, and historical trends in voting, that is a very good percent. I'm not sure there is much animosity between Obama's policies and the military.

    At the same time...

    I'm not an expert on what advise should be given to injured vets. I imagine the two basic school of thoughts are pull no punches or love and support. I honestly don't know the answer. I would think it needs to be handled on an individual basis (so the same booklet for all does not sound like the right answer).

    Quote Originally Posted by nedrgr21 View Post
    ...There is not one thing that encourages anyone to refuse life saving treatment or addresses being a burden on someone's family...
    I've read it as well. I don't agree with you. There are a few questionable remarks, and if you take into account the possible state of mind of the reader, I can see the concern. This thread makes me uncomfortable, as it is ripe with potential emotion. I leave it to others to argue the details, but I would not make such a definate remark as I've quoted. It really depends on when the vet were to be handed such a thing. I think (but I'm no expert) someone suffering fom post-traumatic stress syndrome or depression should not be handed this to read. If it were my wife or child, I would not want them to read this until well down the road, if after an injury.
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    I read the Wall Street Journal article that "uncovered" this issue. The article referenced another book that also discusses end of life concerns/plans, Five Wishes. Having read both books, I feel more comfortable with the Five Wishes book as its questions tend toward a more positive tone.

    Further details about the book are available at Aging With Dignity The .pdf is too large to attach. The .pdf is available for download at http://www.stjosephhospicefoundation...fs/5wishes.pdf

    Both books stimulate a realistic evaluation of an individual's personal desires with regard to end of life health care.
    Last edited by PackerBackerToo; August 24th, 2009 at 07:21 AM. Reason: At link to download Five Wishes.

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    Member Array SCbuckeye12's Avatar
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    I thought the main issue with the pamphlet was it's tone and the original versions reference to euthanasia organizations. The tone was not positive and more slanted to not being a burden on the family. But again, the main reason it was pulled by President Bush was the negative tone and reference to euthanasia organizations, one being the Hemlock Society.

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    VIP Member Array nedrgr21's Avatar
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    Quote Originally Posted by Thanis View Post
    I've read it as well. I don't agree with you. There are a few questionable remarks, and if you take into account the possible state of mind of the reader, I can see the concern.
    Please quote the remarks you find questionable and why you find them questionable in the context of making such serious decisions.

    If this pamphlet is given to a vet who is already wounded, they are already under a doctor's care and if wounds are life threatening, that doctor will address the same questions as it is their obligation to explain the patient's options in a realistic manner.

    All I read was hard questions that should be asked, no encouragement one way or another; just getting people to think about real world problems/issues. It also goes on to explain common perceptions and misconceptions about how one's wishes may be misunderstood. It also addresses both schools of thought - prolong life at any and all costs or let nature take its course by itself. I found the "tone" to be nothing but factual. That's one of the big problems with this country today - no one wants to face reality. Most people would rather remain in a world of denial and political correctness. Life gets messy, deal with it.

    Putting one's wishes in writing like this also gives people a chance to communicate how they feel w/o getting into a major confrontation with others who feel differently about these issues. Believe it or not there are people/family who will berate others to conform to their own wishes with no respect for the other person.

    The couple of articles I've read that are against it seem to be strictly the "put every tube in me you have" crowd and come across as wanting to take away everyone else's choice about how to handle their medical care.

    Backpacker: I read the Five Wishes pamphlet as well (it's not a book). It is more touchy-feely, but Your Life, Your Choices gives more information about the details of different treatments, states of infirmary, and is more direct (that's a good thing in a legal document).

    Both pamphlets mention being a financial burden on one's family - that is a fact of life and dying and is a rational and important consideration for many.

    God forbid people should be exposed to information about their medical care and given resources to do their own research.

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