Pa. nurse's assisted suicide case hits at heart of national debate
POTTSVILLE — From the narrow porch of her row house, standing with her pit bull Bella at her side, Audrey Artz pondered the thought of helping a terminally ill relative take his life.
No, she couldn't do that, she said.
Artz, 74, a former waitress, knew about that real-life drama playing out a few blocks from her house in the Schuylkill County Courthouse, where lawyers for Philadelphia nurse Barbara Mancini asked a judge to dismiss charges of assisted suicide for her handing liquid morphine to her father, Joseph Yourshaw, in his Pottsville home.
“For her to give that to him and say, ‘Here,' I couldn't do that,” Artz said.
Her neighbor, Glenda Deutsch, 73, was more sympathetic toward Mancini: “As a nurse, she saw people suffer all her life.”
The Mancini case resonates beyond this town of about 14,000 people in Pennsylvania's once-abundant anthracite coal region, reaching to the heart of ongoing national debate about how and when dying patients can receive assistance to end their lives.
The criminal case against Mancini, 57, is complicated.
The morphine was legally prescribed, her attorney Frederick Fanelli argued last week, and Yourshaw, 93, “being of sound mind, consumed that morphine.”
Taken by ambulance to the hospital, he lived for four more days, according to court records. Hospital personnel gave him more morphine. He had heart disease, kidney failure and other complications.
Federal law and hospice regulations allowed Yourshaw to administer his doses, and permitted caregivers and family members to give him pain medication, Fanelli said.
The State Attorney General's Office argued that Mancini intentionally “aided or solicited” Yourshaw to commit suicide. Senior Deputy Attorney General Anthony Forray cited testimony from a preliminary hearing at which Pottsville police Capt. Steve Durkin said Mancini told him that her father wanted to die and she gave him morphine.
Mancini reportedly told a hospice supervisor in a phone call that she “had fulfilled his wish,” Forray argued in court papers.
Judge Jacqueline Russell did not rule immediately on whether the case goes forward. The charge of assisted suicide is a felony.
End-of-life questions are likely to arise more often as millions of baby boomers age, said Alan Meisel, a University of Pittsburgh law professor with the university's Center for Bioethics and Health Law. That generation spanned 1946 to 1964, when more than 76 million babies were born in the United States.
“Many of us have dealt with those issues with our parents,” he said.
Four states have some type of law described by advocates as “aid in dying” statutes. Ore-gon's law, which took effect in 1988, was the first. It provides for physician-assisted suicide. Montana, Washington and Vermont approved laws within the past five years, Meisel said.
“It's very important to realize the Mancini case, if it were in Oregon, wouldn't have been covered by the law,” he said.
Meisel believes “there is a slow movement toward legalization. My guess is in the next 25 years, we'll see a fair number of states adopting a variation of the Oregon law.”
A bill pending in the Pennsylvania Senate would enable a terminally ill patient to request in writing a dose of lethal medication from a physician. Only the doctor could administer the drug — in front of two witnesses, one of them a relative. The Senate Judiciary Committee is reviewing the “death with dignity” bill by Sen. Daylin Leach, D-Montgomery County.
The argument in Mancini's case pits the state's interest in preserving life against whether a terminally ill patient can take a lethal dose of medication with assistance.
A group called Compassion & Choices in Denver filed a friend of the court brief to support Mancini, arguing the “trumped-up case” has broad implications, spokesman Sean Crowley said.
“Barbara Mancini is Everywoman,” Barbara Coombs Lee, the group's president, said. “Women across the country are in the same situation. It's not a crime to hand medication to a dying patient, even if it hastens death.”
Lee, a former emergency room nurse, believes Attorney General Kathleen Kane could use prosecutorial discretion in this case.
“These decisions are very, very personal,” Lee said.
Joe Peters, a spokesman for Kane, said her office took the case because the Schuylkill County district attorney had a conflict of interest. Peters said prosecutors had no choice but to follow the law.
“Continued prosecution of Barbara Mancini will have a chilling effect on millions of other families who fear that providing home hospice care for their dying relatives could put them in prison,” Crowley said. “This outcome would be tragic.”
But Michael Ciccocioppo, executive director of Pennsylvania Pro-Life Federation, said it is “fundamentally wrong” to help someone commit suicide, even if the person is dying and in pain. A former hospital administrator, Ciccocioppo said pain can be managed. When he worked at Holy Spirit Hospital, “pain control and management” was a priority.
“The state of Pennsylvania has a compelling interest in preventing people from doing that,” he said about suicide. “You're a citizen of this state. Where would you draw the line if certain people are allowed to commit suicide?”
The Pro-Life Federation reviewed Oregon records showing why people requested lethal doses of medication. The top reason was that they fear losing autonomy and ability to care for themselves. The second-most common reason was a fear of being unable to participate in things they once did.
“You have to go to number six before you find fear of inadequate pain control,” Ciccocioppo said.
Mancini cannot talk about her motivations because of a court-imposed gag order on those involved in the case. She spoke briefly before her hearing about “the terrible year” she and her husband, Joe, have experienced.
Joe Mancini works two shifts as a paramedic to make up for lost income while she remains on unpaid leave from a hospital, and their legal bills are piling up, Crowley said.
Mancini's mother, 84, is “suffering great stress,” and Mancini worries about the case's effects on her two teenage daughters, he said.
Brad Bumsted is Trib Total Media's state Capitol reporter. Reach him at 717-787-1405 or firstname.lastname@example.org.