Fatal Mercies - Assisted Suicide? Yes or No

New York Times August 10, 2013 Fatal Mercies By FRANK BRUNI FEW of us get anything approaching the degree of control we’d like over our lives. Must we also be denied a reasonable measure over our deaths? That’s all that Joseph Yourshaw, 93, seemingly wanted: to exit on his own terms, at home, without growing any weaker, without suffering any more. And that’s all that one of his daughters, Barbara Mancini, 57, was trying to help him do, according to the police report that set her criminal prosecution in motion. She’s charged, under Pennsylvania law, with aiding a suicide, a felony punishable by up to 10 years in prison. Such a sentence would be ludicrous, but so, by all appearances, is the case against her: a waste of public resources, a needless infliction of pain on a family already grieving, and a senseless prioritization of a frequently ignored (and easily ignorable) law over logic, compassion, decency. 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. These are the facts of the case, according to public records and news reports: Yourshaw was receiving hospice care at his home in the small central Pennsylvania city of Pottsville. A decorated World War II veteran who had gone on to run his own contracting business, he was terminally ill, with severe diabetes, heart disease and kidney disease, among other ailments. He was frail and in pain, and had indicated a yearning for an end to it all. On Feb. 7, he sought one, swallowing an unusually large measure of his morphine in the presence of Mancini, who did nothing about it. A hospice nurse who stopped by the house afterward found him unresponsive and later said that Mancini, herself a nurse, confessed to having provided him, at his request, a vial or bottle of his painkiller that contained a potentially lethal dose. The hospice nurse called 911. The police and paramedics arrived. Although Mancini insisted that her father did not want to be revived, he was given medical attention and brought to a local hospital, where his condition stabilized. He nonetheless died there on Feb. 11. He did not get to spend his final days in his own home or his final hours in his own bed. The statement of the police officer who interacted with Mancini on the day of the overdose says, “She told me that her father had asked her for all his morphine so he could commit suicide, and she provided it.” Mancini, through her lawyers, later denied that she was deliberately enabling him to end his life. Trying to reconcile these conflicting claims is, for now, impossible: a judge has issued a gag order for the main players in the case, which is headed to trial, barring a plea agreement or a prosecutorial change of heart. But nowhere can I find any dispute that Mancini’s 93-year-old father was fading and hurting. Nowhere can I find any insinuation that Mancini coaxed him toward suicide. Or poured the morphine down his throat. Or did anything more than hand it to him. That’s it. 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. He added that the case worries him, because if it gets significant publicity and informs what many people believe assisted suicide is, they’ll see it as a more benign act than he believes they should. “It’s going to make it even harder to prosecute ones that really call out to be prosecuted,” he said. Such prosecutions are rare all in all, even though assisted suicide — under medical supervision and specific circumstances — is legal in only four states: Oregon, Washington, Montana and, as of a few months ago, Vermont. Alan Meisel, the founder and director of the Center for Bioethics and Health Law at the University of Pittsburgh, said that that’s partly because “these kinds of things usually happen in secret.” But that’s also because when they do come to light, the police and prosecutors exercise enormous discretion, knowing that there are all kinds of gray areas in which the law is a clumsy, crude instrument; that a jury may be loath to punish a gesture of apparent mercy; and that it’s not uncommon for death to be hastened by painkillers, even in hospitals. Did Mancini break the law? If the accounts of both the hospice nurse and the police officer are accurate, probably so, but the Pennsylvania statute that forbids assisted suicide, like similar statutes in other states, is worded broadly and says nothing about what rises to the level of assistance. That vagueness can be a blessing, allowing the police and prosecutors to filter the law through their own good judgment and sensitivity. No such filter has been applied here, at least based on the evidence presented at a preliminary court hearing early this month. A SPOKESMAN for the Pennsylvania attorney general’s office, which is in charge of the prosecution, declined to comment for this column, citing the gag order. So I couldn’t ask anyone there how, in an era of severely limited government resources, the dedication of time and money to this case made any sense. I couldn’t ask anyone how, precisely, Mancini had done her father wrong. I couldn’t point out that his widow — her mother — had spoken out in defense of her before everyone involved stopped talking. I couldn’t note the different exit made recently by a terminally ill journalist in Seattle, thanks to Washington’s Death With Dignity Act. Her name was Jane Lotter, and last week, in The Times, Michael Winerip wrote this of her last moments with her family, including her husband, Bob Marts: “On July 18, the couple and their two children gathered in the parents’ bedroom. Ms. Lotter asked to keep in her contact lenses, in case a hummingbird came to the feeder Mr. Marts had hung outside their window. The last song she heard before pouring powdered barbiturates, provided by hospice officials, into a glass of grape juice was George Gershwin’s ‘Lullaby.’ Then she hugged and kissed them all goodbye, swallowed the drink and, within minutes, lapsed into a coma and died.” No paramedics. No arrest. No need.