The "Your Life, Your Choices" booklet didn't cause trouble at the Department of Veterans Affairs until late in President George W. Bush's second term. That's when critics spotted an odd detail in this guide for end-of-life medical decisions. It urged aging veterans to seek expert advice from one group -- Compassion & Choices. It helps to know that this organization was created in 2005 through the merger of two groups, Compassion in Dying and End-of-Life Choices and that, until 2003, End-of-Life Choices was known as the Hemlock Society.
The Bush White House pulled that edition of "Your Life, Your Choices," but a revised version -- minus the plug for Compassion & Choices -- has been restored to the VA.gov website. Conservative critics remain worried.
"Obviously, the Catholic church and our bishops have been strong advocates of health-care reform, especially when it comes to making the system more accessible for the poor and needy. That's a no-brainer," said John Haas, president of the National Catholic Bioethics Center and a member of U.S. Conference of Catholic Bishops task force on health care.
"But this VA issue shows why we just don't trust the government when it comes to helping people make all the moral and religious decisions that come at the end of life. ... The Hemlock Society? Catholics would rather do our own counseling, thank you very much."
It's easy for outsiders to get lost in the details of the sprawling packages of legislation now being debated on Capitol Hill. However, Haas stressed that critical questions remain unanswered about how efforts to reform America's health-care system will affect hot-button issues such as abortion, stem-cell research and health-care rationing for the elderly and chronically ill.
Thus, a letter from the U.S. bishops to Congress and the White House pledged support for accessible, affordable, universal health-care reform that truly "protects and respects the life and dignity of all people from conception until natural death."
In the headlines, it is easy for these concerns to be crunched into shouted questions in health-care forums about taxpayer-funded abortions and fears that government "death panels" will micromanage critical decisions in nursing homes.
But calmer, quieter voices inside the Washington Beltway still want to know more about the proposed Center for Health Outcomes Research and Evaluation, which legislation sponsored by the late Sen. Edward Kennedy claims would "collect, conduct, support and synthesize research comparing health outcomes, effectiveness and appropriateness of health care services and procedures."
While striving to avoid risky specifics, President Barack Obama has said it will be impossible to expand health-care services without tough-minded reforms that cut costs. This is especially true when discussing care for the elderly.
"That's where I think you just get into some very difficult moral issues. But that's also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here," said Obama, in a much-quoted New York Times interview.
"I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. ... That's part of why you have to have some independent group that can give you guidance."
The president recently went further, according to Twitter postings from a conference call with 1,000 rabbis. Obama reached out to these religious leaders, stressing, "We are God's partners in matters of life and death."
No one doubts that millions of Americans want help while making decisions about end-of-life medical issues, stressed Haas. The question is whether most would prefer to face these ultimate issues with help from government experts or from their own pastors, rabbis, priests, hospice workers and other religious counselors.
"The Catholic Church has a highly developed body of teachings and traditions to help guide people through these kinds of decisions," said Haas. "We believe that hospice care is normal and good. We believe that it's right to die a good death, with an emphasis on the relief of pain and suffering. ...
"But let's be clear. We think the government has an agenda on these kinds of issues and it's not the church's agenda. When it comes to dying, controlling costs is not our primary goal."