EDITORIAL: The government ‘Death Book’

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The Obama administration claims that a health care takeover by government won’t restrict access to care. Everybody will get more care for less money, the president has said. Of course, something has to give. One likely target for rationing will be care in the later stages of life. Bureaucratic disregard for the value of all life is insinuated in a government manual known as “the Death Book.”

The Death Book is a nickname given to an advice manual published by the Department of Veterans Affairs that instructs veterans “how to prepare a personalized living will.” Officially titled, “Your Life, Your Choices,” the book fosters dark thoughts about a difficult life somehow being less of a life.

On Page 21, the Death Book poses questions to veterans to which they are to answer whether life would be “difficult, but acceptable,” “worth living, but just barely” or “not worth living.” The scenarios include: “I can no longer walk but get around in a wheelchair,” “I can no longer contribute to my family’s well-being,” “I live in a nursing home,” “I can no longer control my bladder,” “I am a severe financial burden on my family,” “I cannot seem to ‘shake the blues’ ” and “I rely on a kidney dialysis machine to keep me alive.”

The most positive answer allowable is “difficult, but acceptable.” Every situation is phrased in the most negative terms. If veterans check any of the “not worth living” boxes, they are asked if this means they “would rather die than be kept alive.” Further along, the book asks, “If you checked ‘worth living, but just barely’ for more than one factor, would a combination of these factors make your life ‘not worth living?’ If so, which factors?”

There is no attempt to ask people, “What would it take for you to want to live?” Instead, the booklet focuses on wanting to die. “Your Life, Your Choices” originally was put together by the Clinton administration and then shelved during the George W. Bush presidency. Jim Towey, director of the White House Office of Faith-Based and Community Initiatives during the Bush administration, said the booklet was problematic because it made injured veterans feel like a burden and encouraged severely injured soldiers to want to die.

After a ruckus over the booklet this past week, the Obama administration added a new note saying the work was being revised. Either way, the Death Book is instructive as a reflection on Obamacare priorities and perspectives and what the administration might view as a “waste.” This is important because Mr. Obama and other administration officials regularly talk about a need to cut back on what they term as massive waste in health care.

What government considers a waste, many patients and doctors consider a necessity. Denying this care based on vague notions of efficiency is rationing. Even the New York Times admitted last week that “the concerns [about rationing] are not entirely irrational.” Concern about rationing has been particularly acute among the elderly for good reason. The Death Book shows government’s perverse interest in the end of life rather than its extension.

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