Caring Daughter or Murder Suspect?

If you're a friend or family member of a hospice patient, you could be facing a murder charge. That's the not-so-subtle message that Pennsylvania Attorney General Kathleen Kane is sending to dying patients and their families.
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If you're a friend or family member of a hospice patient, you could be facing a murder charge. That's the not-so-subtle message that Pennsylvania Attorney General Kathleen Kane is sending to dying patients and their families, described in the July 31 online edition of the Philadelphia Inquirer. So be warned.

Barbara Mancini didn't have the benefit of a warning back in February when she was caring for her father, Joe Yourshaw. No one told her that she might be charged with murder. And now one can only imagine that she's having second thoughts about being a dutiful daughter.

Yourshaw was 93 years old and lived in Pottstown, a small city on the outskirts of Philadelphia. He was dying of multiple medical problems and didn't want any more aggressive treatment. That's why he enrolled in hospice. Yourshaw's goal, apparently, was to live the rest of his life in his own home, with as much comfort and dignity as he could.

And it seems that his daughter Barbara was helping him to do just that. She's a nurse, and so she assisted with his medications and his personal care. In short, she did what she could to make sure that Yourshaw was able to live out the rest of his life on his own terms. She was doing exactly what we hope our friends and family members will do for us when we're nearing the end of life.

Then things changed.

On Feb. 7, Yourshaw apparently asked his daughter to hand him his prescription bottle of morphine, which she did. The details of what happened next aren't known yet, but Yourshaw's hospice nurse arrived on the scene shortly thereafter. She concluded that Barbara had helped her father try to end his own life.

Police were called, and Yourshaw was transferred to the hospital. Hospitals, remember, are where patients generally receive exactly the sorts of aggressive treatment that Yourshaw probably didn't want. That is, hospitals are exactly the sorts of places that people enroll in hospice to avoid.

We don't know what treatment Yourshaw received at that hospital. But we do know that it didn't work. At least, not for long. Yourshaw died four days later.

Now Barbara Mancini is being charged with murder for... what, exactly? For handing her dying father a bottle of pills that were appropriately prescribed and legally obtained? For being a good caregiver? For being a dutiful daughter?

I'm a hospice doctor in Philadelphia, and already I'm starting to get queries from patients and their families who have read the headlines about Joe Yourshaw's death. They want to know whether this could happen to them. And they want to know what they can do to avoid it.

I wouldn't be surprised if, over the next couple of weeks, some of my patients stop taking the opioid drugs like morphine that control their pain. They don't want to suffer unnecessarily, of course. But neither do they want to be the cause of sending a family member to prison.

Many of my patients already feel that they're a burden to their families. They're worried about the stress that their families are under, and they worry about their finances. Now, apparently, they need to worry that their husbands and wives and daughters will end up facing murder charges. That's just one more worry to place on the shoulders of people who are dying.

Of course, in most situations it's illegal to help someone end his or her own life. (The exception is under very specific circumstances that are defined by assisted suicide laws in states like Oregon.) But it's also morally wrong to withhold medication like morphine that is needed to treat pain and other forms of physical suffering.

So is Barbara Mancini a criminal? Or is she a good daughter? And, more to the point, do we really want a state Attorney General's office deciding how families should care for their loved ones? If we do, then perhaps the staff of the Attorney General's office could roll up their sleeves and help out. For instance, right now I'm taking care of an elderly man whose wife is too small and frail to move him out of bed. She relies on nurses and home health aides, but I'm sure she'd appreciate some extra help. So perhaps the Attorney General's office could send a couple of people out to give her a hand?

Of course there are details of Yourshaw's story that we don't know, and indeed that we'll never know. Perhaps there was more that what's being shared publicly. Perhaps Barbara Mancini really is a murderer.

But I doubt it. I take care of many patients like Joe Yourshaw. And I meet many loyal, caring family members like Barbara Mancini. These are people who are doing their best to cope with the emotional and physical and spiritual challenges of dealing with a serious, fatal illness. Family members in particular, find themselves thrown into a caregiving role without much warning, training, or guidance. And so they do the best they can.

I'm guessing that's what Barbara Mancini did. She did the best she could. And now there seems to be a good chance she's going to wind up in prison.

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