End-of-Life Choice, Palliative Care and Counseling

Columnists/Editorials Opposing Prosecution of Barbara Mancini for Death of Dying Dad Joe Yourshawby Chris

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Across the country, columnists and editorial writers that cover their communities are starting to notice the plight of Barbara Mancini, a loving daughter who is being unjustly prosecuted by an overzealous attorney general in Pennsylvania. It’s not enough that Barbara lost her father recently, now she is being prosecuted for “assisting suicide,” when all she allegedly did was hand her father a bottle of morphine to help alleviate his suffering.

Columnists/Editorials Questioning Prosecution of Barbara Mancini for Death of Dying Dad Joe Yourshaw

Philadelphia Daily News, Oped by “Murder, She Wrote” novel series author Donald Bain, “For Barbara Mancini, there is no master detective … or justice,” Feb. 5, 2014

…Ms. Mancini has not only lost her beloved father, she’s been put on unpaid leave from her job as an ER nurse in Philadelphia. Her husband, a paramedic, must work two jobs to keep up with their bills, including more than $100,000 in legal fees that they already have incurred.

Had this case happened in Cabot Cove, Maine, the fictitious town where much of “Murder, She Wrote” takes place – and if I were writing the story – I would have [sleuth Jessica] Fletcher urging the attorney general to drop this case against Mancini.

And do you know what? That’s exactly what would happen. Yes, prosecutors take an oath to uphold the laws of the jurisdiction in which they serve, but they also have broad discretion in choosing which cases to pursue.

[Harrisburg, Pa.] Patriot-News, Editorial, “No. 6 – The Tom Corbett/Kathleen Kane feud: 13 for ’13,” Dec. 26, 2013

Kane made national headlines — and attracted criticism — for her office’s decision to pursue an assisted-suicide prosecution against Barbara Mancini, a nurse, who provided her 93-year-old father who was dying of diabetes, kidney failure, and heart problems, along with painful arthritis, with a dose of the morphine he was legally prescribed.

Los Angeles Times, Columnist Steve Lopez, “Pennsylvania case a chilling one for death-with-dignity advocates,” Nov. 5, 2013

Yourshaw was in hospice care at the time and gravely ill, with renal failure and multiple other life-threatening conditions. While his daughter was caring for him, he asked for some morphine and she handed it to him. Shortly after he took it, a hospice nurse arrived and dialed 911, and Yourshaw was revived even though, according to published reports, he had signed a do-not-resuscitate order.

He died four days later.

“He knew he was dying but he accepted dying, and my mother-in-law had accepted that he wanted to die,” said Joe Mancini, who described how his father-in-law, a World War II veteran, had become so sick “he’d be screaming in pain” just having his shirt buttoned.

Having watched my own father wither away in his last days of hospice care, I can say with certainty that if he’d asked for morphine, I’d have given him as much as he wanted. I’d have given it to him whether he wanted it to ease his pain or whether he’d made it crystal clear that he wanted me to help him die. And the idea that such an act of love and compassion can be considered a crime is beyond my comprehension.

The [Allentown, Pa.] Morning Call, Columnist Paul Carpenter, “Assisted suicide prosecution in Schuylkill County faces compelling challenge,” Sept. 21, 2013

This past week, a “petition for habeas corpus” seeking the dismissal of charges against Mancini was filed in Schuylkill County Court. In addition to citing particulars of the rulings being defied by Kane, the petition makes other compelling points about the propriety of the prosecution.

First, Mancini’s father, Joseph Yourshaw, was given a prescription for morphine, he had access to it in his home, and he was capable of administering it to himself, which is what happened after his daughter handed him the bottle on Feb. 7.

Second, there is no evidence that Mancini knew how much morphine was in the bottle, so there is no way she could have intended it as an avenue to suicide.

Third, and most disturbing, Yourshaw, suffering from terrible and terminal ailments, had a living will and a “do not resuscitate” directive that applied to any event that might lead to his peaceful death, which he stipulated should be allowed at his home and must not be prolonged….

At the hospital, he was forcibly revived in violation of his DNR directive and, when he regained consciousness, he begged the people there to “leave Barbara alone.”

Then came the most bizarre twist in the episode. “Joe was administered additional morphine while he was in the hospital,” the petition says, and he died shortly thereafter, on Feb. 11, four days after Mancini had handed him the morphine bottle.

…. it was the hospital’s morphine, not that in the bottled delivered by Mancini, that contributed to his death.

At a preliminary hearing, the petition noted, “competent testimony revealed that the only thing Ms. Mancini did was hand her father a bottle of morphine at his request.” There was nothing to indicate she opened the bottle, and on previous occasions it was clear he was capable of opening bottles and taking morphine, legally provided under prescription, by himself.

So how could Mancini be charged with a crime?

…. Under the law, if he finally decides he has suffered enough, no one would be able to help him without facing the same threats now faced by Barbara Mancini.

This is barbarism. This is the most malevolent form of sadism.

The [Scranton, Pa.] Times-Tribune, Columnist Chris Kelly (Pa. Atty. Gen. Kathleen Kane’s home town newspaper), “Prosecuting woman in dad’s death is wrong choice,” Aug. 25, 2013

Considering her recent refusal to defend the state’s ugly, unconstitutional ban on gay marriage and tight resources in her office, Ms. Kane is under increasing pressure to drop this case. She should do so not for political expedience, but because putting Barbara Mancini on trial would be cruel and futile.

The jury without a few people who have sat helpless as a loved one suffered a tardy death does not exist. Pain is a universal chord. All but the hardest among us are hard-wired to soothe it. Jurors in this case would also hear from Joe Yourshaw’s widow, who stands by her daughter. And remember that Joe rebounded from his overdose. Can anyone say beyond a reasonable doubt that the morphine caused his death?

A conviction in this case seems next to impossible, and would not serve justice.

Of course, there will always be those who demand blood for blood when they have no skin in the game. The Misery Lobby – fools and liars who exploit suffering for profit and political gain – warns that unless Barbara Mancini is punished, we will toboggan down a slippery slope to state-sanctioned euthanasia of the elderly, sick and disabled. Such self-righteous cynicism is easily spat by those whose selfishness and fear of death affords them the delusion that one can’t be too long for this world.

There are tight corners where the laws, rules, beliefs and sensibilities that govern daily life are overruled by the hard facts of the moment. I believe Barbara Mancini found herself in such a place with the man who paced the hospital halls the day she was born, taught her to ride a bike, cheered at her graduations, screened the boys who came to date her and danced at her wedding.

In a hard moment passed in a tight corner, he asked her for mercy. It was the only hope he had, and all she had left to give.

The York [Pa.] Dispatch, Columnist Larry Hicks, “Leaving a long life on own terms,” Aug. 23, 2013

Legally speaking, I’m not convinced the facts of the case support prosecution. Some years ago, the U.S. Supreme Court ruled that a terminally ill person in pain can take as much pain-killing medication as he/she chooses, even if it results in death.

On that basis alone, I think this case against Mancini is seriously flawed.

This case screams for discretion.

I say that because I think Mancini did a humane thing for her dying father. In fairness, I also say it because, but for the grace of God, I could easily be standing in her shoes.

Mancini did what I could not do.

And I judge her not even a little bit.

The [Washington, Pa.] Observer-Reporter, Editorial, “What ever happened to sense, compassion?” Aug. 23, 2013

The crime here is not that a dying man was administered a pain-killer on his death bed. This happens – thankfully – all the time. It is often the quiet agreement among doctor, nurses, patient and family members that the agony of death should not be prolonged.

 The U.S. Supreme Court even ruled in 1994 that patients who are dying and in pain have the legal right to get prescribed medications “to alleviate that suffering, even to the point of causing unconsciousness and hastening death.”

There is a crime, though, committed by the hospice nurse and emergency medical technicians and hospital staff who ignored Joe Yourshaw’s legal rights and directions and caused him to endure a death that was anything but peaceful. And it is criminal and outrageous that the state should continue to pursue charges against his daughter.

 The case has created controversy and calls for clearer laws regarding end-of-life care. What’s missing here, however, is not clarity in the law but rather a lack of common sense among law enforcement and legal authorities.

 At risk is not just the freedom and reputation of one man’s caregiver but the continued availability of compassionate hospice care and the protection of living wills. Can we be sure that our wishes not to have our own lives extended artificially will be honored when that time comes? Will we be required surrender our dignity to endure pain and in our final hours for fear that our loved ones may be prosecuted for attempting to relieve it?

We urge the attorney general to consider the consequences and drop this case.

The [Chambersburg, Pa.] Public Opinion, Editorial, “Government knows when, how you ought to die,” Aug. 23, 2013

Yourshaw had made arrangements ensure a peaceful death in his home. He legally named his daughter as his medical surrogate. He stopped taking medications, wanted no interventions or resuscitations. Then he reportedly took a large dose of morphine allegedly handed to him by his daughter. A hospice nurse found out and informed her supervisors, who then called 911. Despite his order not to resuscitate, EMTs showed up and rushed Yourshaw to a hospital while police charged his daughter with assisted suicide.

Joe Yourshaw died four days after being revived and learning that 1) he had been taken from his home, and 2) his daughter faced 10 years for attempting to carry out his wishes. That’s almost as unbelievable as it is sad. But it raises some important questions.

Do we really want cops and medical personnel arbitrarily making decisions that overrule our express wishes?

What kind of society institutionalizes our fear of death and loathing for grief in such a way that absurd, bureaucratic extremes are the result?

Why didn’t the state Attorney General Kathleen Kane – who already has a track record of basing prosecutorial decisions upon her personal sense of right and wrong – back slowly away from this one?

Some believe from a religious standpoint that life should be prolonged as long as possible, regardless of misery and suffering. For others, it’s a purely personal – and maybe a bit selfish – matter of wanting as much time with loved ones before they go.

But when officials cast end-of-life issues through a pro-life prism for political gain, we start treading on unholy ground. Anyone remember the sad case of Terry Schiavo?

No one’s life or death should be exploited in the public arena. That’s how we get laws against assisted suicide in the first place.

It boils down to individual autonomy. Everyone should have the freedom to manage their life and death the way they wish.

The [Pottsville, Pa.] Republican Herald (Joe Yourshaw’s home town newspaper), Editorial, “Mancini case should revive death debate,” Aug. 22, 2013

The truth, of course, is that families quietly engage in gut-wrenching decisions about dying loved ones’ care every day in hospitals and homes across the commonwealth and nation – privately.

The [Hazelton, Pa.] Standard Speaker, Editorial, “Solidify State’s Role in Life-or-Death Decisions,” Aug. 22, 2013

At a hearing Aug. 1, Magisterial District Judge James K. Reiley, Pottsville, held the charge for trial and slapped a gag order on all of the parties involved, even though the case should produce vigorous debate about the quality of life, the rights of people to steer their own fate and Pennsylvania law relative to both.

The [Harrisburg, Pa.] Patriot News (state capital newspaper), Editorial, “Why is Kathleen Kane prosecuting Barbara Mancini?” Aug. 21, 2013

More than a hint of politics is in the air here. The coroner who supervised the autopsy, David J. Moylan, is running for Congress in the 17th district as a Right-to-Life candidate. Many have wondered whether Attorney General Kane would have dropped the charges already, had she not kicked up such a stir among conservatives with her decision not to defend Pennsylvania’s ban on gay marriage.

What Mancini stands accused of doing, absent some as-yet-secret and damning evidence, is not assisted suicide that demands the law’s punishment. An idiot “friend” who hands his depressed young friend a gun — that’s illegal assisted suicide ….

Any jury with a heart would probably decide Mancini did nothing wrong. But taking the case to a jury inflicts an unnecessary financial and emotional toll on the accused. Punting to a jury in cases like this is the way less-than-courageous prosecutors dodge responsibility for producing a just outcome.

Unless Attorney General Kane and her prosecutors are privy to facts beyond what have been reported, they should spare Barbara Mancini further prosecution for doing what her dying father asked.

[Wilkes-Barre, Pa.] Citizens Voice, “Assisted suicide case a complicated matter,” Aug. 20, 2013

Regardless of the case’s outcome, the state Legislature should make it a catalyst for a renewed debate on the state’s appropriate role.

Towanda [Pa.] Daily Review, “Open the debate on end-of-life issues,” Aug. 20, 2013

Legally and practically, there are many issues in the case itself. Mr. Yourshaw rebounded and lived four days before he died. And the U.S. Supreme Court has found that a terminally ill person in severe pain may take as much pain-relieving medicine as he chooses, even if it hastens death. Mr. Yourshaw’s widow – Ms. Mancini’s mother – spoke in her daughter’s defense prior to the gag order.

The Goomba Gazette/Huffington Post, Column, “Give us the right to choose,” Aug. 19, 2013

As far as I am concerned I think the lady is a hero for helping he father die with dignity; there should be more people like her ….

What should be illegal is to keep a terminally ill person alive that has absolutely no chance of recovering and that does not want to live anymore. It isn’t how long someone lives; it is how well they live.

It should be absolutely the decision of the sick person or a competent member of their family to make the decision whether to end their life or not ….

I hope the jury in Barbara Mancini’s case has the sense to see her compassion and find her not guilty.

The [Scranton, Pa.] Times-Tribune (Pa. Atty. Gen. Kathleen Kane’s home town newspaper), Editorial, “Mancini case should revive death debate,” Aug. 18, 2013

Ms. Kane, who drew praise and condemnation recently when she decided not to defend the state’s anti-gay-marriage law on grounds that she believes it to be unconstitutional, has not exercised similar discretion in this case. She should think about it ….

The [Carlisle, Pa.] Sentinel, Columnist William Parkinson, “Senior Moment: AG Kane on the wrong side of dying,” Aug. 18, 2013

Why the state attorney general is prosecuting this case is a mystery. Here is Kane, a Democrat who called Pennsylvania’s prohibition on marriage equality “wholly unconstitutional,” pursuing a case in which she defends a clearly unconstitutional law that impinges on an individual’s rights ….

But she feels it’s ethically correct to pursue prosecution in a case in which the deceased had a Do Not Resuscitate order and in which hospital staff administered the same opiate she’s accusing the man’s daughter of giving him?

…. None of us, including Kane, Yourshaw’s daughter or those who whisked him away from his bedside to die in the hospital can know the agony he must have experienced as the result of unwarranted intervention in his death.

Philadelphia Daily News (Barbara Mancini’s home town newspaper), Editorial, “Mercy Act,” Aug. 13, 2013

So a caring daughter who is also a nurse is being treated like she’s a criminal and a threat to society. Her life is in a state of traumatic limbo.

It’s indecent. It’s infuriating.

Never mind the sheer waste of government resources to prosecute this case. Never mind that most people believe that “how a terminally ill person chooses to end his/her life should be an individual decision, not a government decision,” according to a survey by a Republican pollster last year….

The attorney general should end the prosecution of Barbara Mancini.

The [Allentown, Pa.] Morning Call, Columnist Paul Carpenter, “Aiding suicide charge in Pottsville does not seem to square with court ruling,” Aug. 11, 2013

So a 93-year-old man was dying and was in terrible agony from multiple problems, although his mind was sharp enough to feel them all, and the power structure wanted to keep him that way indefinitely.

…. a U.S. Supreme Court ruling — Washington v. Glucksberg — …. said states cannot obstruct “palliative care” to ease pain. “A patient who is suffering from a terminal illness and who is experiencing great pain has no legal barriers to obtaining medication,” one opinion said. “There is no dispute that dying patients…can obtain palliative care, even when doing so would hasten their deaths.”

The New York Times, Columnist Frank Bruni, “Failed Mercies,” Aug. 11, 2013

It would have been easy for prosecutors to walk away; that sort of thing happens all the time. That it didn’t happen here suggests how conflicted, inconsistent and bullheaded we Americans can be when it comes to the very private, very intimate business of dying ….

And the lightness of this alleged assist, coupled with the ambiguity of its connection to his death after he’d rebounded from the overdose, has not only provoked outrage from Compassion and Choices, an organization that supports more options in end-of-life care.

It has also prompted befuddlement on the other side of the issue, with a leading opponent of assisted suicide scratching his head about the way the case is being handled. “It is odd to see one like this prosecuted,” Stephen Drake, the research analyst for the advocacy group Not Dead Yet, told me.

The Philly Post (Barbara Mancini’s home town magazine), Columnist Nick Vadala, “On Death With Dignity, Pennsylvania Proves Most Inhumane,” Aug. 1, 2013

This…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 …. 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.

…. 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.

In pursuing this case, Kane’s office is only adding to the difficulty that the Yourshaw family was already facing…

The Huffington Post Blog, Guest Columnist David Casarett, M.D., “Caring Daughter or Murder Suspect?” Aug. 1, 2013

I’m a hospice doctor in Philadelphia, and already I’m starting to get queries from patients and their families who have read the headlines about Joe Yourshaw’s death. They want to know whether this could happen to them. And they want to know what they can do to avoid it.

I wouldn’t be surprised if, over the next couple of weeks, some of my patients stop taking the opioid drugs like morphine that control their pain. They don’t want to suffer unnecessarily, of course. But neither do they want to be the cause of sending a family member to prison.

…. do we really want a state Attorney General’s office deciding how families should care for their loved ones?

People like Barbara shouldn’t have to stand alone against the entire state of Pennsylvania’s justice system. That’s why Compassion and Choices is here to help, we’re out there every day in places like Montana, New Jersey, Hawaii and Pennsylvania, fighting to make sure good daughters like Barbara, and the fathers they love can have choices at the end of their lives. Pitch in $10 today and help us defend Barbara Mancini, and sign our Moveon.org petition today.