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Health & Fitness

August 2013 - Pennsylvania's Bizarre Assisted Suicide Case

Pennsylvania has been making national news following the indictment against a 57 year old Schuylkill County nurse, Barbara Mancini, who allegedly she assisted her 93 year old father, Joseph Yourshaw, to commit suicide. Although  Oregon, Washington, Montana, and Vermont have laws permitting assisted suicide, it is still a crime to do so in Pennsylvania. Our Crimes Code Section 2505 define it as a second degree felony (the same as involuntary homicide) if it results in death. The U.S. Supreme Court has already stated there is no such thing as a constitutional right to die, and the state has an overriding interest to protecting its citizens  But, the Court said “that a patient has the right to use as much medication as they need, even if it hastens the time of death.”

When we draft an advance medical directive in our office, every document contains a clause wherein the drafter may choose to have drugs administered to relieve pain, even if it shortens life. Many clients seem to choose that option but others, including Catholic clients and those who want to be used as a subject to advance medical research, do not. The drug of choice to reduce pain is morphine, It can reduce pain yet may cause death if too much is administered. Hospice workers are excellent at determining the correct dosage. However, it is illegal to increase the dosage for the sole purpose of causing death rather than relieving pain. There have been cases where a medical worker complained about a co-worker giving too high a dose, resulting in criminal prosecution against the worker administering the drug. That is exactly what happened here… the hospice worker found out about the morphine given to the patient by his daughter, and called the police. The police arrested the daughter who allegedly administered the lethal dose, and brought the hospice patient to the hospital to revive him.

If convicted of the crime, the maximum penalty for Ms. Mancini is ten years. If this is her first offense, the optional sentencing guidelines call for a sentence between 3 and 9 years.

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Yet, this is not an open and shut case. The Ms. Mancini, admits that she gave the morphine for her father, but denies it was for the purpose of killing him. Her father was a hospice patient suffering from diabetes. He reportedly stopped taking any medication in 2011 and began to eat a diet that would be expected to worsen uncontrolled diabetes. In January of this year he reportedly told his family he wanted to die. After it was discovered he took the entire vial of morphine, the patient was taken to the hospital and given an antidote for opiate overdoses. He recovered and reportedly raised hell with everyone for reviving him and for picking on his daughter who tried to help. Yet he died four days later. The defendant and her attorney state it’s not plausible that the death was caused by the overdose if he died four days later after becoming conscious again.

The standard of proof at a preliminary hearing which took place earlier this month is only whether there is enough evidence to hold the case over for trial. The question is: “if everything the complainant witness says is true, does that constitute a crime?” As you might expect, nearly every case is held over for trial. Only at trial will the judge or jury determine if all the facts alleged are true, and whether there is enough evidence to support them.

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Normally this case would be tried by the local district attorney. In this case there was a conflict of interest (the nurse may have assisted the D.A.’s office in another matter earlier) and so the D.A. asked the state Attorney General to take over the case.

Another interesting fact about this case is the intervention of groups such as “Compassion and Choices” and their effort to organize people to write letters to the Pennsylvania Attorney general to drop the case.   

I originally posted this story yesterday, but withheld it after a conversation with my wife, a gerontological nurse practitioner who is quite familiar with hospice. She informed me the story may be misleading to readers as everyone else is reporting it. First, she asked, where did the extra morphine that was administered come from? Morphine is a controlled substance and some doctor must have written the prescription. "It is most likely," says my better half, "that the daughter was given the morphine to administer after the hospice nurse left, and she had every right to have it in her possession."  Another issue is whether anyone performed an autopsy because the father may have just as likely gone into a coma if he was not treating his diabetes, either before or after the hospital admission. Another issue, it is very rare for a diabetes patient to want to die, it is such an easily controlled illness, so the mental state of the patient is questionable. And finally, it is posible that when the hospital staff realized they had been trying to revive a patient who was on hospice to begin with, they may have simply let him die four days later rather than continue medical interventions. All of these issues will be explored at trial, so stay tuned. 

Ignoring the bizarre nature of this case, what do you think? Should be change the law to allow assisted suicide in Pennsylvania? Do you think that suicidal wishes are merely symptoms of treatable depression? What would you put in your advance medical directive or living will?

Stay well until the next post.

Bob Gasparro

Bob Gasparro is an Elder Practitioner (accountant and attorney). He can be reached at Robert.Gasparro@lifespanlegal.com or (484) 297-2050. Comments to this post, and ideas for future posts are welcome. 

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