Death with dignity quest personal for Barbara Mancini

Lisa Strand, FFRF operations director, introduced speaker Barbara Mancini on October 24, 2014, at FFRF’s national conference in Los Angeles: How many of you caught our next speaker on “60 Minutes” last weekend? Yes, she tells a compelling story. Barbara Mancini is an FFRF member who lives in Philadelphia with her husband and two daughters. She’s going to tell you what happened last year when she was charged with aiding the suicide of her very elderly father. Her supposed crime: handing him his prescribed morphine.

We at FFRF didn’t realize all of this was going on until Barbara contacted us earlier this year about the “60 Minutes” interview. Many freethinkers are strong supporters of end-of-life choice. We’ve seen the organized religious opposition to humane common-sense reforms that enable individuals to make choices to die on their own terms, not religiously dictated terms. We’re pleased that Barbara is here to discuss her prosecution, how religion intruded in her criminal case and what needs to be done to ensure death with dignity and rational policies guiding end of life choices. By Barbara Mancini James Baldwin famously said,

“Not everything that is faced can be changed, but nothing can be changed until it is faced.” Everyone here today strongly believes in the separation of church and state. We don’t want a religious overlord telling us how we must live. Nor do we want a pious crusader telling us how we must die.

I stand here today as an example of what can happen when laws are taken to extremes, and how religion can interfere with justice. In February 2013 I was arrested and prosecuted on the charge of aiding the attempted suicide of my terminally ill 93-year-old father.

Instead of having the peaceful and dignified death at home that he hoped for, he died after prolonged suffering and being subjected to exactly the medical treatment that he specified in his written advanced directives that he never wanted.

The circumstances and the politics that allowed this to happen could certainly happen again. My story is a cautionary tale. My dad, Joe Yourshaw, was one of 12 children born into a first-generation immigrant family. He was a decorated World War II veteran, and after the war he worked hard to establish his own business. He was a contractor and he did heavy excavation work. He married my mother and together they raised four children.

My father could build anything and fix anything. My mom will say she never had to call a repair person for anything until the last year of my father’s life. He was independent, strong-willed and had focused convictions about how he wanted to live.

He had a number of medical conditions—diabetes, high blood pressure, heart and kidney disease, arthritis and he had a stroke. At the age of 92 he made the decision to stop taking the medicines that treated these conditions. Why? They weren’t helping the quality of his life, which was getting worse over time. He discussed this decision with my family, his doctor and with the full knowledge that this decision would likely hasten his death. We all agreed to respect his wishes.
In February 2013 I was a regular person. I’ve been married for 20 years, I have two teenage daughters, a dog and two cats. I work as an ER nurse. My husband and I do volunteer work in our community.

My parents lived in Pottsville, Pa., a two-hour drive from my home in Philadelphia. I would speak on the phone with them several times a day. As dad’s health worsened, I visited frequently. So I had a very busy but private life. Not even a Facebook page. If you search for my name now, you will get millions of results.
At 93 my father was terminally ill. He enrolled in home hospice care and was having significant pain. As a nurse, I know that pain and other distressing symptoms often get worse as a person nears death. My father asked me to hand him his pain medicine. It was a partly filled 1-ounce bottle of liquid morphine. When I passed the bottle to him, he removed the cap and he quickly consumed what was left. Was this to relieve his severe pain or his attempt to end it all? Only he knew that answer.

A hospice nurse arrived a short time later and I explained that dad had drunk his morphine. He was drowsy but not unconscious. The nurse and her supervisor insisted that he be taken to the ER to be treated for an overdose.

My father’s written end-of-life directives specified that he wanted no life-prolonging treatment. I was his legal health care proxy. He had a standing do-not-resuscitate order. He was adamant that he never wanted to go to a hospital. I tried in vain to assure that his wishes were upheld.

The hospice called 911 and police and paramedics arrived. Against my father’s expressed wishes, he was taken to the ER to be treated and I was arrested then and there in the house.

The paramedics asked my father if he was having any pain, and for the very first time he said “no.” I was charged with aiding an attempted suicide. It’s a second-degree felony in Pennsylvania. Conviction carries up to 10 years in prison.

The police captain who arrested me told me I no longer had any say in what happened to my father. In my presence, he spoke on the phone to the ER doctor and told the doctor that if my father died, things would go much worse for me. That information was relayed to my 84-year-old mother, who was put in the position of having to choose between honoring her promise to my father or helping me. So my mother gave consent for the hospital to treat my dad.

Two hours after arriving in the ER, my father was given a medicine to reverse the effects of the morphine. He was furious that he’d been brought to the hospital and knew I was in trouble. He shouted repeatedly, “Don’t hurt Barbara. Don’t let them hurt Barbara.” My dad suffered tremendously, not only from his treatment in the hospital but also from the anguish of knowing that I was being accused of helping him end his life. He died four days later from pneumonia, not from a morphine overdose.

The Pennsylvania attorney general began a year-long zealous prosecution of me. I was placed on unpaid leave from my job. The prosecutor had the court put a gag order on me. I incurred over $100,000 in legal fees. The emotional and financial burden on my family and me was enormous.

My case received widespread media coverage—local, national, even international. The reaction was always the same: near universal shock and outrage, with many writers urging the attorney general to exercise prosecutorial discretion and drop the charge. Not one opinion writer supported the decision to prosecute.
It created a lot of sympathy for my father and me, but it also raised very legitimate questions among the dying and their caregivers, who are now asking, “Can they do this to us, too?”

Exactly one year after my father died, a judge ruled that the case had no merit. The charge was dismissed without any apology or recognition of what they’d put us through. We were left to pick up the pieces of our lives. The question that everyone has is, “How could this happen?” There are four elements that I believe came together to create this ordeal.

Why it happened

FIRST: Failure on the part of Hospice of Central Pennsylvania. My father was in home hospice care for two weeks with no medicine for pain. I called the hospice and asked them to prescribe morphine, which is reasonable and appropriate. Morphine is the most commonly used medicine to treat end-of-life pain. In fact, the same hospice had provided my father with morphine on a prior enrollment six months earlier.

That phone call was later used as evidence against me. The prosecutor said it showed that I was intending to help my father end his life. I didn’t know at the time that I made the phone call that morphine had been ordered for my father two weeks earlier and the hospice withheld it.

They later stated that they did that because my father said he didn’t want to take any medicine. I agree that he did not want to take any medicine that he thought would prolong his life, but he was taking lots of Tylenol and Motrin for pain.

The hospice used this phrase repeatedly in their documentation about my father: “comfortable despite pain.” I defy anyone to define that. My family and I vigorously dispute that characterization of how my father felt. In court my attorney asked the hospice supervisor if my father had the right to have as much medicine as he needed to relieve his pain. Her answer, “that is not a stated right.” The same supervisor also testified that my father should not receive any more than a very low dose of morphine at any given time. This attitude guaranteed that my father would suffer until the very end. And it contradicts what the United States Supreme Court ruled in two landmark cases in 1997. The majority opinion in both of these cases said that, “terminally ill patients have the right to as much medicine as they need to relieve their pain, even if it advances the time of death.” Incredible as this seems, either the hospice supervisor didn’t know this, or she knew it and disagreed with the ruling. 

THE SECOND ELEMENT: The law. The state statute that criminalizes “aiding a suicide” is vaguely written. The problem with a vague law is that it’s left open to interpretation. The attorney general interpreted it to mean that providing a dying man his legally prescribed medication rose to the felony level of “aiding a suicide.”
Clarence Darrow, who was way before his time, said it best, “I know that every step in the progress of humanity has been met and opposed by prosecutors.”

THE THIRD ELEMENT: Criminal justice in the United States. Once an arrest has been made, the goal is conviction. In my case, there was minimal investigation done of the supposed crime. The prosecutor relied on untrue statements by the hospice and the police. They possessed records that discredited what witnesses said and barely looked at them.

One example: A hospice witness testified that my father had never been on a narcotic before. It was this same hospice that provided him with morphine on a prior enrollment. When confronted in court with the evidence that my father had actually been prescribed a much higher dose of morphine prior to my ever making a phone call, the prosecutor told the judge that he was unaware of that information, and if true it was completely inconsistent with the testimony of his witnesses.
Yes, it was. It was right there in the hospice record. It contradicted what his witnesses said and he never bothered to read it. Did this end my prosecution? No, it continued for another four months, until a judge threw out the charge in a scathing 46-page opinion. You have to keep in mind that in the U.S., over 90% of criminal cases are settled through plea bargains. Tremendous pressure was placed on me to waive my preliminary hearing and work out a plea deal. It’s so much easier for the prosecutor and they still get to count it as a conviction.

Keep in mind that prosecutors are elected officials who like to tell voters that they’re tough on crime and have a high conviction rate. Most people who are charged with crimes don’t have the resources to fight that pressure to plead. I was very lucky to have an excellent criminal defense attorney who fought this unjust charge.
FOURTH: The admixture of politics and religion. Who wanted this case prosecuted? It was the police, the attorney general and the Schuylkill County coroner, David Moylan. Moylan made the determination that my father died from morphine overdose or toxicity and ruled that the manner of death was homicide.
Homicide. I knew that my father died of pneumonia and later had two independent experts evaluate his records. One of them was a forensic toxicologist. They both agreed that he didn’t die of morphine toxicity. To quote, “This was not a lethal level of morphine by any means.”

A few weeks after releasing my father’s death certificate, Moylan announced he was running for Congress on a sanctity-of-life platform. He was asked in an interview why he decided to run. Here’s what he said: “It just boiled down to one primary issue, and it’s one I feel strongly about — the sanctity of human life. It’s so important to defend human life from conception to natural death.”

Moylan has said this publicly, “I am a pro-life coroner.” It’s pretty funny, but wait. He’s also said this, “It’s very important that every decision you make as a coroner to determine the cause and manner of death [asks] how does it affect the sanctity of life? I’ve been doing that for the last year and a half.”

No mention of evidence in that. He won the Republican primary for the seat in Congress, and he’ll be running in the general election in a couple of weeks. [He lost 57% to 43% to the Democratic incumbent.]

Here’s an interesting point. In a brief to the judge, the attorney general said, “The commonwealth has never argued that the defendant was responsible for Mr. Yourshaw’s death on Feb. 11, 2013.” Considering that he and the coroner were on the same side of this prosecution, that’s a pretty big difference to reconcile.
Now, you may think that this coroner is some unsophisticated rube, but I want to tell you about him. He’s a graduate of MIT and Georgetown University School of Medicine. He’s a physician with a successful practice in radiation oncology. His position as coroner gives him the power to influence what happens to a person’s livelihood, liberty and even an accused person’s life. And he is attempting to increase his power and sphere of influence by running for Congress. Does this scare you? It should.

Death with dignity

Does anyone here think this could happen again? Here’s what the attorney general had to say after the judge dismissed my case: “If the citizens of the commonwealth disagree with an existing statute, it is incumbent upon the people to work with the General Assembly to amend the law. Until such amendment occurs, it is the legal responsibility of prosecutors to enforce the law as it currently exists.”

Now you know why I’m an activist. The Oregon Death With Dignity law is progressive. It contains significant safeguards and it allows people some choice at the end of their lives. Sadly, most of us do not have that kind of choice.

The most vocal and well-funded opponent of death with dignity is the Catholic Church. My case illustrates the extreme other side of what can happen. I’d like to leave you with three points today.

First, good hospice care is essential, and some hospices fail to provide good care. Second, this could happen again, even to you or someone you love. And third, the laws across the nation need to be changed. We need death with dignity in all states. I urge everyone here today to do something to help affect that change.
I am currently working with an organization called Compassion and Choices, a national end-of-life advocacy organization. Currently, for all of you Californians, they are mounting a big effort in this state to help make death with dignity legal.

My father died a terrible death, needlessly and tragically. That will always haunt me. I’m speaking out to somehow make it right for him, my dad. I am an activist so no other person will have to experience the trauma that came to be known as the Barbara Mancini case. I’d like to close with the wise words of Dr. Martin Luther King Jr.: “An injustice anywhere is a threat to justice everywhere.”

Question and answer

Q. I applaud what you have done and want to ask what consequences has the hospice faced with the outcome of this case? As a fellow nurse, a nurse that also took care of her dying father at home, it really makes me scared that my fellow nurses would not know the law and would behave in such an unconscionable manner.

A. First, I want to say that you will never know what the biases or values are of the people who are giving you hospice care, so you need to arm yourself with enough information to be a strong advocate for yourself. The only consequence that I know of at this date is that the hospice has suffered bad publicity.
Q. We’re going through this debate in Connecticut. Our problem, however, is less the religious lobby. The bigger problem for us seems to be the disability lobby. I’m curious if that had any affect in Pennsylvania?

A. Other opponents are the American Medical Association and California Medical Association, some disability rights groups and hospices. I know the disabled people feel like they might be discarded, but they don’t know what this law says. There are strict safeguards. It has to be initiated by the person who has received a diagnosis of a terminal illness from two independent physicians. So if someone’s trying to get rid of a family member, they can’t do that.
There has been no case of abuse of this law in the almost 18 years that it’s been in existence in Oregon. I understand the concerns of the disabled, but they are addressed in the law.

Q. I can’t believe that hospice did that, because their narrative seems to be about dying with dignity and in comfort. They’re about comfort care, so this surprises me very much.

A. Well, you know now that not all of them carry that out.

Q. How do I determine who is to be trusted?

A. There is no database or ranking to help you with that decision, so you must do your homework. If you know the law, that gives you a leg up. Compassion and Choices also has an end-of-life advocacy counselor who can guide you with questions to ask when you interview a hospice. That’s something you need to do.

A. Do you know Washington state’s law? How would you compare it to Oregon’s?

Q. My understanding is that it’s modeled pretty much after Oregon’s. Thank you, it was a privilege to be here.

Freedom From Religion Foundation