"Death book" distortions abound on Fox News Sunday

Wallace, Towey promote "death book" smear

August 18: WSJ published Towey op-ed headlined, "The Death Book for Veterans." On August 18, The Wall Street Journal published an op-ed by Towey headlined, "The Death Book for Veterans." In it, Towey criticized the booklet "Your Life, Your Choices," which is one of several end-of-life educational materials used by the VHA. Towey asserted that "government bureaucrats are greasing the slippery slope that can start with cost containment but quickly become a systematic denial of care." Towey continued: "Last year, bureaucrats at the VA's National Center for Ethics in Health Care advocated a 52-page end-of-life planning document, 'Your Life, Your Choices.' It was first published in 1997 and later promoted as the VA's preferred living will throughout its vast network of hospitals and nursing homes. After the Bush White House took a look at how this document was treating complex health and moral issues, the VA suspended its use. Unfortunately, under President Obama, the VA has now resuscitated 'Your Life, Your Choices.' " [The Wall Street Journal, 8/18/09]

August 23: Wallace interviews Towey on Fox News Sunday, promotes "death book" distortions. Days later, on August 23, Wallace interviewed Towey on Fox News Sunday to discuss his inflammatory Wall Street Journal op-ed. Wallace introduced the interview by saying, "Usually we discuss the news, but today we're going to tell you about something you may never have heard about -- what critics are calling the 'death book.' " During the show, Wallace and Towey distorted "Your Life, Your Choices" in several ways: Wallace promoted Towey's distortion that the booklet encouraged veterans to "pull the plug"; Wallace and Towey both claimed that the Bush administration suspended use of the booklet; and Wallace claimed that a Veterans Health Administration document requires doctors to direct veterans to the booklet. [Fox Broadcasting Co.'s Fox News Sunday, 8/23/09]

"Your Life, Your Choices" is not a "death book"

"Your Life, Your Choices" emphasizes "your wishes will direct future health care decisions." From "Your Life, Your Choices: Planning for Future Medical Decisions: How to Prepare a Personalized Living Will":

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. ["Your Life, Your Choices," Page 1]

"Your Life, Your Choices" presents preserving one's life "using any means possible" as an option to consider. From "Your Life, Your Choices":

Think about the following statements. Do you agree with any of them? Discussing your answers with others can help them understand what is important to you and where you stand with respect to health care decisions.

My life should be prolonged as long as it can, no matter what its quality, and using any means possible.

I believe there are some situations in which I would not want treatments to keep me alive.

I'd want my religious advisors to be consulted about all medical decisions made on my behalf to make sure they are in keeping with my religious teachings.

My personal wishes would not be as important as what my family thinks is best for me.

I'd want to have my pain controlled, even if the medications make me sleepy or make it difficult to have conversations with my family. ["Your Life, Your Choices," Page 7]

"Your Life, Your Choices" asks individuals to consider the statement: "I believe that it is always wrong to withhold (not start) treatments that could keep me alive." In a section that addresses "personal and spiritual beliefs," "Your Life, Your Choices" asks individuals to consider whether they agree with the following statements and to explain and clarify their beliefs regarding the statements:

I believe that it is always wrong to withhold (not start) treatments that could keep me alive.

I believe that it is always wrong to withdraw (stop) treatments that could keep me alive after they've been started.

I believe it is wrong to withhold (not provide) nutrition and fluids given through tubes, even if I am terminally ill or in a permanent coma. ["Your Life, Your Choices," Page 22]

VoteVets.org blog post: "Really, if the document was really trying to get veterans to pull the plug on themselves, then first suggesting to them that their life should be prolonged at all costs is a pretty stupid way to do it." An August 23 blog post on VoteVets.org criticized Towey's assertion that "Your Life, Your Choices" presents "end-of-life choices in a way aimed at steering users toward predetermined conclusions," pointing to the passage in the document that presents preserving one's life "using any means possible" as an option to consider. Richard Smith, the VoteVets.org blogger, then added: "I feel like I've been brainwashed into pulling the plug already. Really, if the document was really trying to get veterans to pull the plug on themselves, then first suggesting to them that their life should be prolonged at all costs is a pretty stupid way to do it." [VoteVets.org, 8/23/09]

Wallace, Towey distorted passage that says: "If I'm a vegetable, pull the plug"

"Your Life, Your Choices" passage addresses the importance of being more specific regarding end-of-life care. In a passage explaining the importance of being very specific regarding your end-of-life preferences, "Your Life, Your Choices" says that statements like, "If I'm a vegetable, pull the plug," can mean different things to different people. From "Your Life, Your Choices":

Have you ever heard anyone say, "If I'm a vegetable, pull the plug"? What does this mean to you? What's a vegetable? What's a plug? Even people who live together can have very different ideas about what the same words mean without knowing it. The story of May and John Williams shows how important it is to be specific about what you mean.

"I'd never want to live like a vegetable." Both May & John Williams have always shared this belief during their fifty years of marriage. But when they were talking about their advance care plans, they learned that they had very different views about what that meant. For May, it's when she can't take care of herself. John was surprised. For him, being a "vegetable" is much worse. "It's when my brain's not working but my body is being kept alive by machines." ["Your Life, Your Choices," Pages 6-7]

Towey misrepresented the passage in his WSJ op-ed. In his Wall Street Journal op-ed, Towey said of "Your Life, Your Choices," "There is a section which provocatively asks, 'Have you ever heard anyone say, 'If I'm a vegetable, pull the plug'?' " Towey never explained the context of the quote and suggested that the statement was "aimed at steering users toward predetermined conclusions, much like a political 'push poll.' " From Towey's op-ed:

"Your Life, Your Choices" 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."

The circumstances listed include ones common among the elderly and disabled: living 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 Wall Street Journal, 8/18/09]

Wallace, Towey misrepresented the passage on Fox News Sunday. On Fox News Sunday, Wallace similarly presented the statement from "Your Life, Your Choices" without context:

WALLACE: You're also upset about another question in the booklet, and I want to put that up: "Have you ever heard anyone say, 'if I'm a vegetable, pull the plug'?"

TOWEY: Yeah. I think the word vegetable's demeaning. It's used three times in the document, and it kind of communicates somebody that's not human. This is why I think the document is so fundamentally flawed that the VA ought to throw it out. [Fox News Sunday, 8/23/09]

Wallace, Towey claimed Bush suspended purported "death book" use

Towey claimed Bush VA "suspended" use of "Your Life, Your Choices" and Obama VA "resuscitated" it. In his Wall Street Journal op-ed, Towey claimed, "After the Bush White House took a look at how this document was treating complex health and moral issues, the VA suspended its use. Unfortunately, under President Obama, the VA has now resuscitated 'Your Life, Your Choices.' " [The Wall Street Journal, 8/18/09]

Wallace claimed "Bush suspended the use of this document" and Obama administration "reinstate[d] it." From Fox News Sunday:

WALLACE: All right. You were instrumental, as you point out, back in 2007 -- you had left the Bush White House by then. You'd been the head of faith-based initiative for four years.

But in 2007, the V.A. tried to put this out and make this a tool that was widely distributed to veterans. You were instrumental in getting it stopped and put up on a shelf. What happened?

TOWEY: Well, I think that President Bush was - and his administration were very surprised to hear that this document has moved so far through the V.A. chain of command and was about to be approved. The secretary there didn't even know about it. [...] So when I raised it with the Bush White House, they said, "This isn't a vision of life. People have their dignity. They're endowed with that. It's not lost when they get dementia or stroke," and so they pulled it.

WALLACE: So after President Bush suspended the use of this document, why did the Obama administration last month reinstate it?

TOWEY: Good question. I don't fault President Obama on this yet, because I suspect he was like President Bush and knew nothing about it. The question is why hasn't it been pulled from their Web site now. [Fox News Sunday, 8/23/09]

In fact, Bush VA was still promoting "Your Life, Your Choices" at the end of his term. Contrary to Towey and Wallace's claims that the Bush administration stopped using the purported "death book" and that the Obama administration "resuscitated" it, Bush's VA actually promoted the document throughout his presidency, as documented by Daily Kos blogger Jed Lewison. Indeed, an online document on the VA's website labeled "Reviewed/Updated Date: December 29, 2008" states, "To learn about a Living Will, read 'Your Life, Your Choices."

Wallace falsely claimed VA doctors required to refer vets to "Your Life, Your Choices"

Wallace falsely claimed VHA document directs VA doctors "to refer all veterans" to "Your Life, Your Choices." During his interview with Assistant Secretary of Veterans Affairs Tammy Duckworth on Fox News Sunday, Wallace claimed that "more than a month ago -- VA health practitioners were told to refer all veterans -- not just end-of-life veterans, but all 24 million veterans -- to this document, 'Your Life, Your Choices.' " In fact, as Media Matters for America documented, the VHA document to which Wallace was referring actually directs patients to " 'Your Life, Your Choices' ... or other published resources." [Fox News Sunday, 8/23/09]

Towey's organization selling its own booklet on end-of-life issues

Towey's organization is selling "Five Wishes" booklet on end-of-life issues. The organization Towey founded, Aging with Dignity, sells "Five Wishes," a booklet that, like "Your Life, Your Choices," is designed to guide people in the creation of a living will. On Fox News Sunday, Wallace stated to Towey, "In the course of this controversy in the last couple of days, VA officials are suggesting that you want the government to buy and use your book." Towey began his response by saying, "They can if they want. Millions of Americans do. But that's not what this is about." Aging with Dignity also sells several companion materials to its "Five Wishes" booklet, including a "Five Wishes Video" for $24.95 per individual copy.

Towey received more than $90,000 from Aging with Dignity in 2007. Towey is a member of Aging with Dignity's board of directors and received more than $92,000 for "consulting" services from the organization in 2007, the latest year for which Aging with Dignity's tax disclosure form is available. According to Aging with Dignity's disclosure form, "Ed Towey & Associates" received $51,106 for "video production" services. The disclosure form also states that "Jim Towey and Ed Towey are brothers."

From the August 23 edition of Fox Broadcasting Co.'s Fox News Sunday:

WALLACE: We're going to do something different here today. Usually we discuss the news, but today we're going to tell you about something you may never have heard about -- what critics are calling the "death book."

It's a 52-page pamphlet the Department of Veterans Affairs is using right now in end-of-life counseling for the nation's 24 million veterans.

We're going to talk with Jim Towey, former director of faith-based initiatives in the Bush administration, who broke this story. And then we'll turn to Tammy Duckworth, assistant secretary of Veterans Affairs. Miss Duckworth insisted on being interviewed separately.

Mr. Towey, welcome to Fox News Sunday.

TOWEY: Great to be with you.

WALLACE: Let's start with an overview. What's wrong with this material, "Your Life, Your Choices," that the VA is using for end-of-life counseling right now?

In the article that you wrote in The Wall Street Journal, in which you disclosed this, you say that the message is clear: hurry up and die.

TOWEY: Well, the message that they want to communicate, I think, is that 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 VA 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.

WALLACE: All right. We're going to get to the specifics in this book in a second, but I want to ask you another general question.

President Obama calls talk of a government-run death panel a, quote, "extraordinary lie." But I want to put up what you said in your Wall Street Journal article this week. You said the following: "When the government can steer vulnerable individuals to conclude for themselves that life is not worth living, who needs a death panel?"

Explain.

TOWEY: Well, I think the fear that Americans have is that somehow, when they are fragile and they're vulnerable and they're facing serious illness, that a discussion they're going to have with a doctor is going to be biased or tilted in some fashion.

Here you have the government that has financial stake in the answers that they give, and I think a lot of people are afraid that somehow they're going to be steered toward a denial of care.

And I think that whole right-to-die movement, which Dr. Pearlman has written about -- I think that whole right-to-die movement means that the right to die is a right the poor will get. And I think a lot of people are afraid about it. So whether there's death panel written in a law or not, the real issue is why would the VA be promoting a document written by an assisted suicide advocate that has such a kind of an obsession with death and with pushing people, I think, in a direction to deny care?

WALLACE: All right. You are especially critical of this worksheet on Page 21 of the book.

TOWEY: Right.

WALLACE: And I'm going to first tell the audience what's in it, and then I'll talk to you about it.

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.

I think they're -- 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 -- 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 a 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.

WALLACE: I guess one of the questions I have about it is why would those even be in a document about end of life? Usually people don't even contemplate end of life until they're in an irreversible coma.

Why would being in a nursing home or having to live in a wheelchair be a not-worth-living option?

TOWEY: Good question. I think advance care planning's important, and there are a lot of great VA doctors and nurses out there providing superior care. So families need to talk about these issues well in advance of a deep decline in health.

My problem is when you treat individuals like their life has less worth because they have dementia, for example, I think that that's a dangerous, slippery slope. And when government has a financial stake in it, they shouldn't be talking about quality of life and kind of pushing people toward a predetermined conclusion.

WALLACE: You're also upset about another question in the booklet, and I want to put that up: "Have you ever heard anyone say, 'if I'm a vegetable, pull the plug'?"

TOWEY: Yeah. I think the word vegetable's demeaning. It's used three times in the document, and it kind of communicates somebody that's not human. This is why I think the document is so fundamentally flawed that the VA ought to throw it out. They've had it out there kind of as a research tool, and then a few years ago they tried to push it and promote it -- two years ago tried to push it and promote it.

And now they're at it again -- a July directive telling health care providers to refer patients to it.

WALLACE: All right. You mentioned earlier one of the primary authors of the workbook, and this a fellow named Dr. Robert Pearlman. He's a member of the VA's Center for Ethics in Health Care, and he is listed as the prime author in the document.

Who is Dr. Pearlman?

TOWEY: Well, that's a good question. A lot of Americans have never heard of him, and yet he's influenced the course of VA health care. He's written this document.

And he's an adviser. I think he got the initial research grant with tax dollars to write this document, and he's been an advocate for assisted suicide, both in a U.S. Supreme Court case where he filed an amicus brief, but in other writings where he was a contributor to a book about physician-aided killing.

So I think -- I think the problem is in America there's a lot of people that wrestle with care-giving issues and with serious illness. We should be encouraging people to have a hopeful vision.

When a veteran comes back from Iraq, they shouldn't be given a book like this. They should be encouraged to talk about their preferences on how they can maintain their dignity. Because that's what, I think, America owes them.

WALLACE: Now, in fairness, the book also offers other ideas and statements for veterans to consider. And let's put those on the screen: "My life should be prolonged as long as it can, no matter what its quality and using any means possible."

And then there's this: "I believe that it is always wrong to withhold -- not start -- treatments that could keep me alive."

Mr. Towey, aren't both sides presented?

TOWEY: There's -- there are lines like that in the book. But if -- a fair reading of the book, just looking at the cases they give as examples, where the woman that has the stroke says I don't want to live if I can't take care of myself.