End-of-Life Choice, Palliative Care and Counseling

The case of Barbara Mancini, charged with assisting in her 93-year-old father’s suicide, underscores a need to reform end-of-life careby Chris

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By Nick Valada
The Philly Post
August 2, 2013

When it comes to marriage, State Attorney General Kathleen Kane proved herself ahead of the political curve earlier this month with her rejection of Pennsylvania’s anti-gay marriage laws despite a fair amount of political pressure from her bosses. Death, however, appears to be too much, even for a democrat. Kane’s office proved that much yesterday with a Schuylkill County judge giving the go-ahead in the prosecution of Philadelphia nurse Barbara Mancini, 57, who the state alleges assisted her 93-year-old father in an apparent suicide back in February of this year.

The circumstances, however, are hardly that clear. Joe Yourshaw, Mancini’s father, was in home hospice treatment for end-stage diabetes when he asked his daughter for a bottle of drinkable morphine to treat pain associated with his condition after a fall he had recently sustained. Mancini reportedly obliged, leaving her father to treat his ailment.

A hospice nurse stopped by Yourshaw’s home following an unanswered phone call, and found him unresponsive in his bed. Authorities then transported Yourshaw to a hospital for treatment where he was revived and died four days later after a hospital-administered morphine injection, despite a clear do-not-resuscitate order. His official cause of death is listed as a homicide.

Police say Mancini admitted to authorities that she gave her father the drug with the express knowledge that he was using it in an attempt to end his life. Mancini’s lawyers, however, contest that claim, saying that she “would never … hand medicine to her father with even a remote purpose that he was going to intentionally end his life in front of her.” Death with Dignity advocates have since come to Mancini’s aid, with Compassion & Care’s Kathryn Tucker calling the prosecution “crazy” and “the most outrageous attempt to apply this kind of [assisted suicide] statute” she’s seen in her 20-year career.

This, however, is exactly the type of witch hunt that comes from a tepid legislature representing a society profoundly disturbed by the concept of death itself — let alone a death that is self-imposed after rational thought under the right (read: desperate) circumstances. The concept is so alien to the American psyche that every state aside from Oregon, Washington and Vermont have laws expressly forbidding the assistance of a person’s illness regardless of their health situation, beliefs or state of mind. Barbara Mancini, unfortunately, seems to find herself on the losing side — however inadvertently — of a national debate that has been roiling since the early 20th century.

Cowardice, it seems, is the accusation imposed upon anyone who’d rather control their exit and end suffering rather than endure a stilted, painful life wracked with one debilitating disease or another. That aversion goes so deep that politically, we’ve seen just one politician at the state level — who else but Daylin Leach — attempt the passage of a Death with Dignity act. With failed campaigns in 2009 and 2011, Leach promised in January to bring back the bill this year for another shot. But given Mancini’s predicament, it would seem that not much has changed in the public perception concerning death in the last four years.

Joe Yourshaw wanted to die, that much is clear. According to a coroner’s report, the man regularly consumed sugary soda, candy and pastries, worsening his already-advanced diabetes, and hospice documents show at least once instance in which Yourshaw told his family that he wanted to end his life. Worse, there are likely thousands of Joe Yourshaws across the state suffering due to a culture that both cannot confront mortality and humiliates anyone — no matter how sick — who’d rather accept the inevitable than drag out a painful and often humiliating period of life.

Not only that, but we in Pennsylvania have gone ahead and made criminals out of anyone who commiserates with an already-dying person’s wishes to control their fate — or, in the case of Barbara Mancini, is even suspected of commiserating with any end-of-life wishes. It is not as if we’re talking about encouraging suicide in the general populace with pro-assisted suicide legislation, and studies in states where Death with Dignity acts have been passed show that few residents take advantage of the programs — but that doesn’t seem to be making very many legislators comfortable with the concept.

While the state’s aspirations in protecting the extremely mentally ill from being taken advantage of with our anti-assisted suicide laws, as noted by PennLive, are admirable, we’re clearly not applying the law compassionately or correctly in this case. What that law, and our general approach to compassionate end-of-life care, has done — rather than defending the mentally ill, in this case and scores of others nationally — is turned otherwise compassionate people following the wishes of their loved ones into merchants of death prosecutable in a court of law. Luckily, trends show a lean toward lenience on people in Mancini’s situation.

Had Joe Yourshaw been able to pursue a legal course to end his life, which he perceived as having degenerated beyond the point of enjoyment, odds are that he would have. His suffering could have ended, as could have the otherwise-drawn-out suffering of his family in the wake of his deterioration. Instead, though, Yourshaw’s death is listed as a homicide, courtesy of his loving daughter Barbara. In pursuing this case, Kane’s office is only adding to the difficulty that the Yourshaw family was already facing and stood to face in Joe’s coming, and apparently welcomed, death.

And, as suicides go, that is perhaps the greatest tragedy of all.