Monthly Archives: October 2013

Innocuous-Appearing “Advance Medical Directive” Pamphlet Actually Prompts Elders to Consent to Termination

"Grandma loved us so much that she wanted to have something to leave us, and she didn’t want to burden us by trying to cling to life after she had lived her time."

The Implication: “Grandma loved us so much that she wanted to have something to leave us, and she didn’t want to burden us by trying to cling to life after she had lived her time.”

acrobitty Krames Communications #1771 Advance Medical Directives, Low Literacy

Cover : 6” × 4” color photographic composition. A well dressed, well coiffed elderly woman looking on wistfully with a smile on her face, sits at a desk, her hand resting on a sheet of paper holding a pen, a picture resting on the desk. The desk pans into purplish surf at sunset, a man in his ‘30s walking on the beach explaining something to a young teenage boy.

Given the content of the booklet, the implication seems to be that the woman’s son is explaining to the boy, “Grandma loved us so much that she didn’t want to burden us by trying to cling to life after she had lived her time.” The booklet later betrays the hidden subject of economic interest – an intrinsic conflict of interest despite the publication’ s dispassionate posture – on page 4, “Your Values,” question 11: How important is it for you to
[Leave money to my family or a cause I believe in].

UC Davis Health System booklet
Advance Medical Directives:
Your Wishes for Future Medical Care

Description:16 pages (including covers) soft-cover booklet (5” × 14”).
© 1996 Krames [Patient]Communications
1100 Grundy Lane, San Bruno, CA 94066-3030
(800) 333-3032
“#1771 Advance Medical Directives (Low Lit)”

Page 2
1” × 2” b&w photo of a less-self-assured elderlty woman, her face expressing mild grief. Caption: “My husband didn’t make an advance directive. Now, he can’t tell us what he wants.…We don’t know what to do.”

The booklet offers Do Not Resuscitate (DNR) orders as a reasonable alternative, and pre- conditions elderly and chronically ill patients toward the acceptance of life-ending, rather than life-sustaining, medical choices.

The American Medical Association (AMA) is working directly with the Obama Administration to implement [Advance Care Planning advice] reimbursement by administrative action, bypassing Congress.…An AMA panel approved a new [ICD-9 medical] code for “advance planning conversations” [Death Panels].

Page 4:
4” × 3” color photo: A smiling, vigorous-looking elderly man kneels on one leg, tousling the hair of a golden retriever dog, a cane poised beneath his arm.
Your Quality of Life
• What things give meaning to your life? If you lost some of them, how would you feel?
• Answering the questions below can help you decide. You may want to talk with family, close friends, or a counselor, too.
1. What do you fear most about being seriously ill or injured?
2. How would you feel if you couldn’t do the things you enjoy most?
3. How would you feel if you couldn’t get around by yourself or think for yourself?
4. Would you want to be moved from your present home?
5. Would you want to be in a nursing home or hospital at the end of your life?

(This booklet reveals its stake in the domain of the culture of death, by the scant, token respect that is paid to the normal healthcare concern for well-being and life. The overwhelmingly fear oriented list, above, would be more appropriate in an advertisement for burial plots and caskets, or in a lawyer’s exhortation for clients to make out their wills. Pope John-Paul II’s encyclical Evangelium Vitae (§19) comments on “an extreme concept of subjectivity” in an individual’s self-valuation of life: “The mentality which tends to equate personal dignity with the capacity for verbal and explicit, or at least perceptible, communication [presupposes that] there is no place in the world for anyone who…is a weak element in the social structure, or …appears completely at the mercy of others and radically dependent on them….In this case it is force which becomes the criterion for choice and action in interpersonal relations and in social life.” The booklet’s regime of fear sets up elders and the disabled for a predetermined “choice” to die that is inevitable and unavoidable – far from “choice in dying.”)

Your Values
Read each statement below. How important is it for you to do each of these things? Very important? Somewhat important? Not very important? Check the box that best describes your feelings.

Importance Very Somewhat Not Very
1. Care for myself
2. Get out of bed every day.
3. Go out on my own.
4. Recognize family and friends.
5. Talk to and understand others.
6. Decide things for myself.
7. Stay in my home as long as I live.
8. Live without a lot of pain.
9. Live without needing medical treatment or machines to keep me alive.
10. Pay my own expenses.
11. Leave money to my family or a cause I believe in.
12. Be faithful to my beliefs.
13. Live as long as I can.
14. Try all medical treatment possible.
15. Not linger before I die.

A rating of these questions by 4 subjectively selected categories, yields a finding that a majority of the 15 questions above are moderately or profoundly negative in cast, and only a small minority are positive in character. The rating categories are:

I – Idealism S – Self Image & Autonomy
M – Minimal Functioning E – Extreme Measures

The 15 questions were casually rated with the following results:

1 M 5 M 9 E 13 E
2 M 6 M 10 S 14 E
3 M 7 E 11 I 15 E
4 M 8 E 12 I

A count of the ratings yielded these results:

Idealism – 2 Self Image & Autonomy – 1
Minimal Functioning – 6 Extreme Measures – 6

A casual assignment of the ratings (along with their counts) in a 2-dimensional “truth-window” by criteria of necessity and desirability, yields the following:

“Truth Window” Necessary Unnecessary
Desirable Self Image & Autonomy – 1 Idealism – 2
Undesirable Extreme Measures – 6 Minimal Functioning – 6

Irrespective that the criteria and ratings are subjective, a clear majority of the 15 questions (12 out of the 15, or 80%) are of a moderately to profoundly negative cast. In view of the euthanasia-oriented context of the booklet, this check-list is therefore highly weighted toward a pre-determined outcome, that normal end-of-life debility and distress are intolerable and must be avoided by means of extreme measures.

§12 This culture [of death] is actively fostered by powerful cultural, economic and political currents which encourage an idea of society excessively concerned with efficiency. Looking at the situation from this point of view, it is possible to speak in a certain sense of a war of the powerful against the weak: a life which would require greater acceptance, love and care is considered useless, or held to be an intolerable burden, and is therefore rejected in one way or another. A person who, because of illness, handicap or, more simply, just by existing, compromises the well-being or life-style of those who are more favoured tends to be looked upon as an enemy to be resisted or eliminated. In this way a kind of “conspiracy against life” is unleashed.

§15. Threats which are no less serious [than those against the unborn] hang over the incurably ill and the dying. In a social and cultural context which makes it more difficult to face and accept suffering, the temptation becomes all the greater to resolve the problem of suffering by eliminating it at the root, by hastening death so that it occurs at the moment considered most suitable.

Various considerations usually contribute to such a decision, all of which converge in the same terrible outcome. In the sick person the sense of anguish, of severe discomfort, and even of desperation brought on by intense and prolonged suffering can be a decisive factor. Such a situation can threaten the already fragile equilibrium of an individual’s personal and family life, with the result that, on the one hand, the sick person, despite the help of increasingly effective medical and social assistance, risks feeling overwhelmed by his or her own frailty; and on the other hand, those close to the sick person can be moved by an understandable even if misplaced compassion. All this is aggravated by a cultural climate which fails to perceive any meaning or value in suffering, but rather considers suffering the epitome of evil, to be eliminated at all costs. This is especially the case in the absence of a religious outlook which could help to provide a positive understanding of the mystery of suffering.

On a more general level, there exists in contemporary culture a certain Promethean attitude which leads people to think that they can control life and death by taking the decisions about them into their own hands. What really happens in this case is that the individual is overcome and crushed by a death deprived of any prospect of meaning or hope. We see a tragic expression of all this in the spread of euthanasia-disguised and surreptitious, or practised openly and even legally. As well as for reasons of a misguided pity at the sight of the patient’s suffering, euthanasia is sometimes justified by the utilitarian motive of avoiding costs which bring no return and which weigh heavily on society. Thus it is proposed to eliminate malformed babies, the severely handicapped, the disabled, the elderly, especially when they are not self-sufficient, and the terminally ill. Nor can we remain silent in the face of other more furtive, but no less serious and real, forms of euthanasia. These could occur for example when, in order to increase the availability of organs for transplants, organs are removed without respecting objective and adequate criteria which verify the death of the donor.

— Pope St. John-Paul II, Evangelium Vitae