Pennsylvania case reopens debate on assisted suicide

PHILADELPHIA -- No one may ever know Barbara Mancini's intentions when she allegedly handed her dying 93-year-old father a bottle of morphine at his central Pennsylvania home.

Did she want to relieve his pain? Help him end his life? Both?

Joe Yourshaw died four days later at a hospital. That was after a hospice nurse making a call to check on Yourshaw arrived at the home a short time later and called 911, despite a "Do Not Resuscitate" order. In the interim, Yourshaw was given a drug antidote, awoke agitated over his hospitalization, and became upset when told his daughter might be in trouble, according to Mancini's supporters.

"Don't hurt Barbara," he cried, according to Compassion & Choices, a Denver-based group that supports "death with dignity" laws and has advocated for Mancini since her arrest in June.

A trim, silver-haired hospital nurse from Philadelphia, she is just the latest person caught in the cross hairs of the nation's assisted-suicide debate.

While Oregon, Washington, Montana and Vermont allow at least some types of assisted suicide, and another half-dozen states have considered it, most states ban the practice, and a small number of people are prosecuted in the U.S. each year.

"She told me that her father wanted to die and she gave him the morphine," Pottsville Police Capt. Steve Durkin testified at Mancini's preliminary hearing this month, when a judge in Schuylkill County upheld the assisted suicide charge.

Mancini, a 57-year-old wife, mother and daughter now is heading for trial, while supporters attack state Attorney General Kathleen Kane for pursuing the case. Yourshaw suffered from end-stage diabetes and heart problems before he died in February.

"This chilling precedent could impact tens of millions of baby boomers caring for their aging and dying parents," Compassion & Choices said in a news release.

If her case plays out like most, a judge or jury will sympathize with Mancini, and she will receive probation or community service, according to medical ethicist Art Caplan.

"Very few of them turn out to be anything other than motivated by love or concern, or mercy. But a few do," said Caplan, who therefore believes that authorities need to review such deaths for potential abuses. "They're checking to ... establish what really happened. Was it really because that's what her dad wanted, or was she just tired of visiting?" he said.

In 1994, the U.S. Supreme Court said patients who are dying and in pain have the legal right to receive prescribed medications "to alleviate that suffering, even to the point of causing unconsciousness and hastening death."

Some recent prosecutions around the issue include that of an elderly Connecticut man who told police he had cleaned a gun for his dying friend, and left it within reach before the friend killed himself. He received probation.

Barbara Coombs Lee, president of Compassion & Choices, called Mancini's case "much more ambiguous and benign."

"Even if the law and facts were crystal clear in this case -- and they're not -- juries engage in jury nullification. Or, the prosecutors could have their own internal guidelines, their own determinations about malice," she said.

She fears the case will lead dying patients to refrain from talking to loved ones about their wishes. Dr. David Cassarett shares her concerns, especially given the role of Yourshaw's hospice nurse, who is now a prosecution witness.

"I would hate to think that some patients and families wouldn't enroll in hospice," said Cassarett, the chief medical officer of Wissahickon Hospice, part of the University of Pennsylvania Health System.

"As a physician faced with somebody who wants or seems to want to end his life, my first thought is to engage in a discussion about what's going on and how we can help."

Mancini's lawyer, Frederick Fanelli, argued unsuccessfully this month that Yourshaw had a constitutional right to take enough medicine to ease his pain. Amid a gag order, he did not return a call for comment this week. Kane's office, which stepped in when the local prosecutor had a conflict, declined to comment Friday.

"You could argue, I guess, that this is the process that identifies potential (abuses)," Cassarett said, "but it's a lousy process."