Aided-Suicide Case Dismissed, After 1 Year!!!!

Philadelphia Inquirer, Sunday, February 15, 2014, Page A2, "STAFF REPORTS/HEALTH CARE"

With aided-suicide charge rejected, daughter recounts ordeal

"It made me feel like I lived in a country where Vladimir Putin is president."

MICHAEL VITEZ, INQUIRER STAFF WRITERPublished Sunday, February 16, 2014, 1:09 AM

Family photo

Barbara Mancini in 1992 with her father, Joseph Yourshaw. Mancini, a nurse, had been accused of assisted suicide in his death.

Barbara Mancini, speaking out for the first time, described the afternoon when she was arrested for assisted suicide, and when her father was revived against his wishes, as "a surreal nightmare."

"I just couldn't believe it," she recounted Wednesday, the day after a Schuylkill County judge dismissed the yearlong case against her. "It didn't seem like this could possibly be happening to me or to him. Absolutely the worst thing in the world."

Schuylkill County Judge Jacqueline Russell said the attorney general's case rested on conjecture and lacked evidence. An agency spokesman said it was reviewing the decision and would comment Tuesday on whether it planned to appeal.

Mancini was an emergency-room nurse for 20 years at Lankenau Medical Center in Wynnewood until she lost her job after the arrest. The hospital said Thursday that she could have it back, though Mancini, who lives in Roxborough, said she wanted to make sure the offer was good even if the attorney general appealed.

"It made me feel like I lived in a country where Vladimir Putin is president," Mancini said of her prosecution, which drew international attention. "This is what you think happens in Russia, that you get arrested on trumped-up charges and prosecuted for political reasons."

So what happened on that day, Feb. 7, 2013?

What is well documented was that her father, Joseph Yourshaw, 93, had no quality of life and wanted to die.

On the day of his hospice admission, Jan. 17, 2013, nurse Barbara Cattermole wrote in a progress note: "Most important to patient now: wants to die."

He suffered from diabetes and high blood pressure, which had led to a stroke and heart disease. He was in kidney failure and had refused dialysis, refused all treatments.

Repeatedly noted on hospice records were that he had a living will, a "Do Not Resuscitate" order, wanted to die at home, and that Mancini had his power of attorney to make decisions if he could not make them.

The prosecution argued - based on testimony at the preliminary hearing by hospice staff - that Mancini had pushed hospice to prescribe morphine for her father when he didn't want it.

Mancini spent the last five months poring over his hospice and medical records, and reached the opposite conclusion, that Hospice of Central Pennsylvania failed to treat his pain and keep him comfortable.

"I believe if this hospice had not failed my father," she said, "he would not have been so desperate."

The hospice and its nurse did not respond Friday to calls.

On Feb. 6, Yourshaw fell in his Pottsville home. He was in such pain that night, his wife and son couldn't even remove his clothes.

"My mother was in tears when she called me that night," Mancini said.

When Mancini arrived on the morning of the 7th, her father was still sleeping. He was routinely sleeping 16 to 18 hours a day - also noted in hospice records - common for a person near the end of his life.

Mancini's mother needed a break, and went to lunch with a friend. Yourshaw woke after a while. Normally, he wore a Depend, but had been in too much pain to let his family put one on. When he woke, he was wet.

"I told him we had to get him out of those wet clothes," Mancini recalled. "He let me do it, which was the first time I ever changed my father. That wasn't easy for him. I helped him to the commode, which was right next to the bed. He was in a lot of distress. Then he wanted to get back into bed. And asked me to bring him his medicine, his morphine.

"I brought it in from the kitchen, and I handed it to him."

The morphine that hospice prescribed, Roxanol, came in a concentrated liquid, in a bottle smaller than a shot glass. A dose was a few drops on the tongue.

"He took the cap off and he drank it," Mancini continued, "and I said, 'Ooo, I think you might have just drank a lot of morphine there.' He said, 'I just want to go to sleep.'

"He didn't say, 'I want to die.' Well, every day he said he wanted to die. He didn't say, 'I just drank that to kill myself.'

"I just sat there and held his hand," she said. "And then we just started talking. He liked to talk about World War II. [Yourshaw fought in the Battle of the Bulge.] He stayed awake for quite some time. That's a rapid-acting morphine, but it didn't work rapidly on him. I don't know if he'd developed a tolerance."

The prosecution alleged the bottle was nearly full, a lethal dose, all part of the conspiracy to end his life. Mancini said she had no idea how much was in the bottle. "I held his hand, and he got sleepy and sleepy. He was never unconscious. I would say he was lethargic."

At that point, the phone rang. Because Yourshaw had fallen the day before, Cattermole wanted to see him and could be there  in 15 minutes. Mancini said fine.

"When she came in," Mancini recounted, "I said, 'I want to tell you something.' I told her he drank what was left in the bottle. I thought she should know. She looked worried. She checked him out. I guess she thought he was going to die then. She listened to his lungs, looked at pupils.

"She said, 'Do you mind if I do Reiki treatment to help him pass?' I assume she meant help him die. I said OK.

"She put her hands on his head, and his shoulders, hips, and she's waving her hands over him. I'm guessing it took like 10 minutes. She did this whole thing."

Mancini said Cattermole then told her that she was likely going to be there awhile, that she better go outside and make some calls, cancel her other appointments.

"She was calm, and I was calm," Mancini said.

Cattermole went outside and called her supervisor. "She came back in," Mancini said, "and told me, 'He has to go to ER to be treated for an overdose.'

"I felt like someone did this to me," said Mancini, pretending to stab herself in the heart. "Then I got really upset," she said. "Really upset."

"I said to her: 'He's suffering. He wants to die.' Now, I didn't say he did that to die. I said he's suffering and wants to die. He has a living will. He doesn't want to do that. She told me I didn't have a choice. I started to cry. I was yelling at her. She told me that she had to report it. I told her, 'I'm not going to let you take him.' "

Cattermole called supervisor Barbara Woods and handed Mancini the phone. Woods "insisted that he had to go to the ER, that they were calling 911. I lobbed a lot of F-bombs at her," said Mancini.

Then: "I threw the phone against the wall."

"I don't erupt like this," Mancini said. "I never imagined that a hospice would invalidate my father's end-of-life wishes. And he was adamant. He made me promise he'd never go to the hospital."

Cattermole's version at the preliminary hearing was much different. She said Mancini told her she had fulfilled her father's wish and asked for more morphine to finish the job.

"That never happened," Mancini said. "Never. I never said, 'I fulfilled his wish.' I never asked for more morphine. I did say, 'This morphine never relieved his pain.' "

Her father, she said, was never unconscious. He was able to track Cattermole's finger with his eyes, and when the ambulance crew asked him whether he was in any pain, she said, he replied no. She laughed at the irony there. "That was probably the first time he wasn't in pain."

Yourshaw was taken to Pottsville Hospital and revived with Narcan at 3:45 p.m. He was immensely agitated, records show. His first words, and repeated words, were: "Don't let anyone hurt Barbara."

Mancini believes he had been alert enough at home to observe the shouting and screaming.

Mancini was arrested on the spot. Fingerprinted, arraigned, released on $100,000 bail. Never again allowed to be alone with her father. He died in the hospital four days later - ironically after being given morphine by the hospital. Mancini wept once during the long interview, when describing how her father suffered in the hospital at the end and went to his grave so worried about her.

"I think, in time, I'll be able to move on from this," she said, "but he doesn't get to do over his death. He will always have had a horrible, painful death. And there's nothing I can do about it."

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mvitez@phillynews.com 215-854-5639 @michaelvitez

Pa. case fuels debate on assisted suicide

Barbara Mancini and lawyer Fred Fanelli. Mancini faces charges for giving her father morphine he used to kill himself. (MICHAEL BRYANT / Staff Photographer)

MICHAEL VITEZ, INQUIRER STAFF WRITER

POSTED: Wednesday, October 23, 2013, 2:01 AM

If she lived in Oregon, Washington state, or Vermont, Barbara Mancini could have handed her terminally ill father the morphine he wanted, and there the story would have ended.
But in Pennsylvania, it was just the start of a legal saga that has refueled the national debate over assisted suicide and cast the 57-year-old Philadelphia nurse as either a compassionate daughter comforting a dying man, or a criminal enabler in his death.
Under the state penal code, "a person who intentionally aids or solicits another to commit suicide is guilty of a felony."
Mancini was arrested Feb. 7 and so charged. Conviction could mean up to 10 years in prison.

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In a hearing two weeks ago, state Senior Deputy Attorney General Anthony Forray said that Mancini pressured a hospice to prescribe morphine for her father, that she handed him the drug believing it would kill him, and asked for more when it didn't.
Mancini's lawyer, Fred Fanelli, said she acted out of love in giving Joseph Yourshaw, 93, of Pottsville, the morphine upon his request. Fanelli also contended that what Mancini did was legal even under Pennsylvania law, because Yourshaw did not need her help - he could have obtained the morphine himself - and his intention when he took it is unknown.
Laws that went into effect in Oregon 15 years ago, in Washington state four years ago, and in Vermont this year would allow actions like Yourshaw's and Mancini's. So would current bills in Pennsylvania and New Jersey. Both are patterned after Oregon's law, which says that if two doctors deem a terminally ill person mentally competent, he or she has the right to be prescribed a lethal drug dose. A daughter could pass it to her father without fear of penalty.
In Pennsylvania, and in this case, the issue is intent: Did Mancini hand Yourshaw the morphine knowing he would end his life? Or did she do it so he could ease his pain?
In Oregon, that distinction is not important.
Perhaps the most telling aspect of that law is how few take advantage of it.
Among the 32,000 Oregonians who died last year, 77 ended their lives after legally obtaining lethal doses; 38 others got drugs but didn't use them.
Yourshaw was under hospice care, with end-stage diabetes, renal failure, and heart disease, when he drank the morphine Feb. 7. Against his daughter's wishes, a hospice nurse called police, and Mancini was charged that day with aiding a suicide. Yourshaw was revived at a hospital, only to die four days later.
Mancini has been suspended from her job in the emergency room of a local hospital. Her legal fees have topped $90,000, said her husband, Joe.
Supporters of Oregon's statute say that laws against assisted suicide, such as Pennsylvania's, were not intended for cases like Mancini's. They apply to putting guns in the hands of unstable people, or bullying teens into killing themselves.
"Joe Yourshaw wasn't suicidal, even if he did intend to advance the time of death," said Barbara Combs Lee, who led the effort in 1997 to pass the Oregon law and founded the advocacy group Compassion & Choices.
"That's a rational end-of-life decision: I'm dying. My only choice is how long the process goes on, what it feels like for me, and what memories I leave my loved ones."
Opponents of Oregon-type laws argue that doctors should save lives, not help end them with lethal prescriptions.
In 1997, the Supreme Court unanimously ruled that Americans do not have a constitutional right to assisted suicide. But, Chief Justice William H. Rehnquist wrote, "it is widely recognized that the provision of pain medication is ethically and professionally accepted even when the treatment may hasten the patient's death."
Justice David Souter concurred that terminally ill patients may take medication "to alleviate pain, even when the medication is so powerful as to hasten death and the patient chooses to receive it with that understanding."
In 2006, the justices upheld Oregon's law and urged states to serve as laboratories.
"It's quite moving when you look at the evidence in Oregon," said State Sen. Daylin Leach (D., Montgomery), who introduced a bill like Oregon's. "There has not been a single case of demonstrated pressure or fraud. Look what happened. People get the medication, and . . . often they don't wind up taking it. Knowing that if it gets too bad, they have a way out is all they need."
His bill, however, "isn't going anywhere right now," he said. And until it does, "situations like this will continue to happen."
A similar bill introduced in New Jersey by Gloucester County Assemblyman John J. Burzichelli has cleared the health committee and is "working its way through the process," he said Tuesday.

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mvitez@phillynews.com
215-313-3518
@michaelvitez

Read more at http://www.philly.com/philly/health/20131023_Pa__case_fuels_debate_on_assisted_suicide.html#eCG7BtEgVfvPouP4.99

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.