End-of-Life Choice, Palliative Care and Counseling

Aid in Dying

Boomers beware when caring for dying parents

By Gwen Fitzgerald
Compassion & Choices
Aug 20, 2013

A recent legal decision could impact millions of baby boomers nationwide as they care for aging and dying parents.

A recent legal ruling emerging from a courtroom in rural Pottsville, Pa., could impact tens of millions of Baby Boomers nationwide caring for their aging and dying parents. This relatively obscure court’s decision could chill good end-of-life medical care and diminish legal options nationwide.

On Aug. 1, a Schuylkill County magistrate ordered 57-year-old Barbara Mancini to stand trial in the death of her terminally ill 93-year-old father, Joe Yourshaw. Prosecutors from Pennsylvania Attorney General Kathleen Kane’s office charged Barbara with assisted suicide for allegedly handing her father his prescribed morphine, which he consumed. Barbara was there to relieve her mother, Marge, of caregiving duties for Joe, who was in home hospice care as his death approached.

Enduring a long list of serious medical conditions, Joe had made medical decisions to ensure he did not experience a prolonged, painful death. He completed his advance directive and designated his daughter Barbara as his medical surrogate so she could carry out his wishes if he were unable to do so. He had stopped taking all medication and stated he wanted no medical interventions. What he wanted was to die at home in peace. What he and his family got was anything but peaceful.

All parties in this outrageous criminal proceeding seem to agree that Joe consumed a large dose of the morphine prescribed by a hospice physician to relieve his chronic, severe pain. Later that day, a hospice nurse came by the house to check on Joe. When the nurse learned he had taken extra morphine, she called her supervisors, who called 911.

What happened next should disturb every American. Despite Joe’s advance directive and Barbara’s instruction, in her role as his attorney-in-fact for healthcare, to refrain from intrusive medical interventions, EMTs took Joe to the hospital. Then a police captain took Barbara to the courthouse and charged her with assisted suicide, a felony that carries a maximum penalty of 10 years in prison. More

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

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? More

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

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. More

Nurse Charged With Assisting In Her Father’s Death

By Richard Knox
NPR News
July 31, 2013

A Philadelphia nurse has been charged with assisted suicide for allegedly providing her 93-year-old father with a lethal dose of morphine.

Authorities say Barbara Mancini, 57, told a hospice nurse and a police officer on Feb. 7 that she provided a vial of morphine to her father, Joe Yourshaw, to hasten his death.

Mancini and her attorneys acknowledge she handed the medication to her father, but maintain she never said she intended to help him end his life and was only trying to help her father ease his pain — an act they say is legally protected, even if it causes death.

“Barbara did not, would not, would never hand medicine to her father with the sole purpose — or with even a remote purpose — that he was going to intentionally end his life on her watch,” Mancini’s lawyer, Frederic Fanelli, told reporters during a teleconference Wednesday. “It’s ridiculous, it’s abhorrent that they would even say that.” More

One Woman’s future depends on AG Kane’s constitutional consistency: As I See It

By Barbara Coombs Lee and Kathryn Tucker
The Patriot News
August 1, 2013

Pennsylvania Attorney General Kathleen Kane is getting political heat for saying that she will not defend the state’s ban on marriage equality in a federal lawsuit, calling the prohibition “wholly unconstitutional.”

She explained to The Washington Post: “If there is a law that I feel that does not conform with the Pennsylvania state constitution and the U.S. Constitution, then I ethically cannot do that [defend it] as a lawyer.”

As attorneys, we agree it is unethical to defend unconstitutional laws. It follows that Kane’s office should also not pursue a case that impinges on an individual’s constitutional rights. That’s why her office should drop an unsupportable assisted suicide case against a Philadelphia woman. Her preliminary hearing is today. More