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Fitzgerald: Cautionary tale for boomers caring for dying parents

Updated: October 1, 2013 6:35AM



A legal ruling this month from a courtroom in rural Pottsville, Pa., could impact tens of millions of baby boomers nationwide who are caring for their aging and dying parents. This relatively obscure decision could chill good end-of-life medical care and diminish legal options nationwide.

On Aug. 1, a Schuylkill County magistrate ordered a Philadelphia nurse, Barbara Mancini, to stand trial in the February death of her terminally ill, 93-year-old father, Joe Yourshaw.

Pennsylvania Attorney General Kathleen Kane’s office charged Mancini, 57, with assisted suicide for allegedly giving her father a larger dose of his prescribed morphine, which he consumed. The attorney general’s office is handling the case at the request of the Schuylkill County district attorney because of a potential conflict of interest.

Mancini had relieved her mother of caregiving duties for her father, who was in home hospice care as his death approached. Yourshaw had made medical decisions to ensure that he did not experience a prolonged, painful death. He completed his advance directive and designated his daughter as his medical surrogate to carry out his wishes if he were unable to do so.

Yourshaw stopped taking all medication and stated he wanted no medical intervention. What he wanted was to die at home in peace. What he and his family got was anything but peaceful.

All parties in this outrageous criminal proceeding seem to agree that Yourshaw consumed a large dose of the morphine prescribed by a hospice physician to relieve his chronic, severe pain. Later that day, a hospice nurse checked on him, and when Mancini told her she had given Yourshaw extra morphine, the nurse called her supervisors, who called 911.

What happened next should disturb every American. Despite Yourshaw’s advance directive and Mancini’s instruction, as his attorney-in-fact for health care, to refrain from medical intervention, EMTs took Yourshaw to a hospital.

And then police arrested Mancini, who was charged with assisted suicide, a felony that carries a maximum penalty of 10 years in prison. The hospice nurse told police that Mancini had told her that she tried to end her father’s life, but Mancini denied that, saying she only tried to relieve his pain.

When hospital staff revived Yourshaw, he expressed anger at being removed from his home and became more furious upon learning that his daughter was in legal trouble. He died four days later in the hospital. Imagine, a dying man’s last days are diminished by his worry over his daughter’s arrest for the supportive and respectful way she cared for him.

This case has great resonance on a personal level. Fifteen years ago this month, I was that loving daughter, supporting my mother as my father, a decorated Vietnam veteran, was dying. I learned much that week, but the most searing lesson was that end-of-life decisions are the most important and personal decisions that families face.

These decisions have immediate implications for the sick and dying. And they have long-term implications for those who live on. With loving family in attendance there is no need, nor space, for government at the bedside of a dying person.

Joe Yourshaw was very old and terminally ill. He had end-stage diabetes, heart and kidney failure and arthritis. Maybe his agony was so great, he longed to die. Where is the public interest in constructing a criminal case from this scenario? How will society benefit from imprisoning Barbara Mancini?

This case could be the bellwether for my generation. Millions of families across America are facing end-of-life decisions every day, as we baby boomers care for our parents, including members of the “greatest generation,” World War II veterans like Yourshaw.

The story resonates as we ourselves age. Do the 75 million-plus boomers need to fear the long arm of government literally reaching into our living rooms to seize authority for our medical decision?

Attorney General Kane should take a similar principled stand in this case and drop the criminal prosecution of Mancini. It would be appropriate because the U.S. Supreme Court in 2009 ruled that dying patients can receive as much medication as they need to relieve their suffering, even if it advances the time of death.

Yourshaw’s family was aggrieved by what happened to him against his wishes six months ago. They are traumatized by what’s happening to his daughter today.

Gwen Fitzgerald is director of communications and marketing for Compassion & Choices, the nation’s oldest and largest nonprofit organization working to improve care and expand choice at the end of life.



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