Ending Life

The following is a script of "Ending Life" which aired on October 19, 2014, and was rebroadcast on July 19, 2015. Anderson Cooper is the correspondent. Andy Court, producer.

Should doctors and family members be allowed to help terminally ill people end their own lives rather than succumb to the last ravages of disease? The question has been the subject of a fierce and long-running, state-by-state battle. In the vast majority of states, the practice is currently not allowed, or else it's unclear and quite possibly illegal.

Our story tonight is about a woman who was prosecuted for allegedly helping her 93-year-old father kill himself. Barbara Mancini lives in Pennsylvania. As we first reported last year, her father was terminally ill and in pain and had repeatedly said he wanted to die. One morning while she was caring for him, Mancini says he asked her to hand him his bottle of morphine.

Barbara Mancini: He asked me to hand him the bottle and I did. I had the dosing syringe in my hand. He took the cap off and he drank what was remaining in the bottle.

Anderson Cooper: Could you have stopped him?

Barbara Mancini: I could have, I think. I mean he did it pretty quickly. But no, I didn't try to stop him.

This is Barbara Mancini and her father Joe Yourshaw in happier times, at Barbara's wedding in 1994. Yourshaw had served in Europe during World War II and earned a bronze star in the Battle of the Bulge. Barbara had always known him to be industrious and strong-minded. He was active well into his eighties. But in 2013, he was 93 and suffering from kidney disease, cardiovascular problems, and a host of other ailments. His medical records say doctors expected him to live "six months or less" and he was telling anyone who'd listen he wanted to die.

Barbara Mancini: He had very focused convictions about how he wanted to live. And being independent was a big part of that.

Anderson Cooper: He didn't want to wind up infirm in a hospital bed on a...

Barbara Mancini: No.

Anderson Cooper: ...a feeding tube

Barbara Mancini: Absolutely not. He was adamant that he never wanted to be in a hospital.

He put his wishes in writing and made Barbara his health care proxy. He stopped taking medications that might prolong his life and enrolled in a home hospice program that prescribed small doses of morphine he could drink to ease his pain. It was in February 2013, at his home in Pottsville, Pennsylvania, that Barbara says he asked her to hand him that bottle of morphine.

Anderson Cooper: What'd you think when you saw him drink it?

Barbara Mancini: I said, "Well, I think you just drank a lot of morphine there." And he said, "I want to go to sleep." And I just sat down next to him. And I held his hand. And he laid back and we started to talk.

Anderson Cooper: Did part of you think, "This is him saying goodbye"?

Barbara Mancini: Yes.

Anderson Cooper: Did you think at all about calling a hospital or...

Barbara Mancini: No.

Anderson Cooper: ...calling a doctor?

Barbara Mancini: I would not have done that because it was expressly against his wish. And I promised him I would honor his wishes.

She did tell a hospice nurse who visited the house that morning what had happened, and the hospice called the police. An officer soon came to the door.

Barbara Mancini: He told me I no longer had any say in what happened to my father.

Anderson Cooper: And he was taken to the hospital.

Barbara Mancini: He was.

Anderson Cooper: What happened to you?

Barbara Mancini: I was arrested on the spot.

Anderson Cooper: Did they tell you why you were under arrest?

Barbara Mancini: The police captain said I was being arrested for aiding a suicide.

Anderson Cooper: What's the penalty for that?

Barbara Mancini: Up to 10 years in prison.

Barbara Mancini believes that what happened that morning should not be against the law, and in some states it isn't.

[Woman: We love you. We love you, Rog.]

If he'd lived in Oregon, Joe Yourshaw might have been able to end his life as this man did, as captured in a 2011 documentary.

[Woman: You have the right to change your mind.]

[Man: My mind's not changing.]

This lethal potion of barbiturates was legally prescribed after two doctors certified he was terminally ill and mentally competent. Because all the requirements of Oregon's law were followed, no one involved was in danger of prosecution, even though some of them helped him kill himself.

[There's your merchandise.]

More than 800 people in Oregon have used lethal prescriptions to end their lives since that state enacted its "death with dignity" act 18 years ago. Washington and Vermont now have similar laws. In Montana and New Mexico, courts have ruled it's legal under existing law. Everywhere else, surveys suggest, the practice goes on very quietly to keep physicians and caregivers out of trouble.

Barbara Coombs Lee: What happened to Barbara Mancini was rare, but the risk of what happened to her pervades every bedside of every dying individual.

Barbara Coombs Lee is president of Compassion & Choices, one of the nation's largest advocacy groups on end-of-life issues. She helped write Oregon's "death with dignity" act, and believes every state needs a similar law. Without it, she argues, doctors still write lethal prescriptions but they do it in secret, without any standards.

Barbara Coombs Lee: Doctors often write prescriptions for life ending medication for each other. Just as they write prescriptions for life ending medications for their patients with winks and nods.

Anderson Cooper: And it shouldn't be done with winks and nods?

Barbara Coombs Lee: It should be a transparent, open process. That's how you make a practice safe.

There are, of course, all sorts of objections - some religious, some moral, and some from doctors themselves.

[Dr. Ira Byock: Anything we can do to just make this day a little bit better for you?]

Dr. Ira Byock is a Dartmouth professor and head of the Providence Health System's Institute for Human Caring. He's been nationally recognized for his efforts to provide terminally ill patients with better care. But he is strongly opposed to laws like Oregon's.

Dr. Ira Byock: There's certain things that people aren't supposed to do to one another as absolutes. They are not okay. Doctors killing patients is not okay.

Anderson Cooper: But shouldn't people have the ability to determine when their life is no longer worth living?

Dr. Ira Byock: You know, when a physician is involved in a suicide, it's a social action. And if you want to look at the societies like Belgium and Netherlands, well, nowadays people who have just lost interest in living, or are clinically depressed, are being euthanized legally.

[Reporter: Is there anything you can say, Barbara?]

Barbara Mancini was released on bail, but she was forced to take an unpaid leave from her job as an ER nurse.

The case against her was complicated by the fact that her father did not die right away when he got to the hospital. His medical records indicate he "responded well" to a drug that reversed the effects of the morphine and he "awoke" in the ER.

Barbara Mancini: My mother and my sister-in-law were with him and they said they had never seen him so angry in his entire life. He pulled out his IV.

Anderson Cooper: He pulled out his own IV.

Barbara Mancini: Yeah, he apparently pulled off the wires for the heart monitor and tried to get up and leave.

Four days after being taken to the hospital, Joe Yourshaw died. Though his death certificate lists "morphine toxicity" as the primary cause, hospital records suggest a number of other possible causes including "aspiration pneumonia," and "failure to thrive." The records also show that because of his daughter's arrest, Yourshaw's family allowed the hospital to provide medical treatment he specifically said, in his living will, he didn't want. Barbara Coombs Lee says studies in medical journals indicate that's common, even when there is no arrest.

Barbara Coombs Lee: I think most people don't realize that an advanced directive, the paper that we fill out and have other people sign as witnesses, it can't mandate. It can't require a doctor or a health care provider to do anything or not to do anything.

Anderson Cooper: I think most people think the complete opposite?

Barbara Coombs Lee: Actually in order for those wishes to have any force, they have to be reduced to a medical order.

But only two states have well-established systems to ensure that a medical order regarding life-sustaining treatment will be respected throughout the health care system. In other states, there's no guarantee.

Barbara Mancini's court case dragged on for months. Though Compassion & Choices helped pay some of her attorneys' fees, the legal bills mounted. And so she says did the stress on her family.

Anderson Cooper: Did you feel that you had aided a suicide?

Barbara Mancini: No, I didn't. I felt like what I did was hand my father his medicine. Now he didn't tell me, "I'm going to kill myself today." He asked me for the medicine.

Anderson Cooper: You think if Pennsylvania had a law like they have in Oregon, things would've been different?

Barbara Mancini: I do. And I also feel that he should have had the option if he wanted it.

"I think that this case is emblematic of how we are failing elders, chronically ill people, vulnerable people in America."

But Dr. Byock, who reviewed Joe Yourshaw's records at our request, questions whether Yourshaw would have needed a "death with dignity" law to end his life if he had simply received better end-of-life care from his hospice.

Dr. Ira Byock: If I was his family, I would have been livid.

Anderson Cooper: Why?

Dr. Ira Byock: They were just doing the regulatory minimum for Mr. Yourshaw. And they weren't really addressing his suffering to the extent it needed to be.

In a statement, the Hospice of Central Pennsylvania said, "by law we are unable to comment on this specific case," but, "the care we provide... greatly exceeds the regulatory minimum..." Asked why it called the police to the Yourshaw home, the hospice said its nurses "must obey the laws" and state law "makes it a crime for someone to aid another in committing suicide."

Hospice records reveal Joe Yourshaw to have been a difficult patient, who at times refused to take any medication. But the records also show Yourshaw repeatedly told hospice workers that he suffered from "pain all over" and felt that "by living he is more of a burden to his family."

Dr. Ira Byock: I think that this case is emblematic of how we are failing elders, chronically ill people, vulnerable people in America.

Anderson Cooper: Failing how?

Dr. Ira Byock: In so many ways. We are, you know, not treating people's suffering. We are making them feel undignified. Ask any boomer who's cared for their parents. They'll tell you that even for those of us who are doctors and nurses, it's really, really hard to get the basics of care for your frail loved one met.

Anderson Cooper: Barbara Mancini would say, well, if Pennsylvania had the kind of laws that Oregon now has, which would have allowed her father to get some medicine that could have ended his life, whether he chose to use it or not, that would have at least given him a sense of peace.

Dr. Ira Byock: So what we're saying to Mr. Yourshaw is, "We're not going to treat your pain. We're not going to train your doctors to counsel you. We're going to basically ignore you. But don't worry, because if the time comes when you're feeling hopeless, we can write that lethal prescription. In what world is that a progressive, positive development?

Anderson Cooper: Is it possible that your father swallowed that morphine because he was in a lot of pain?

Barbara Mancini: Yes.

Anderson Cooper: And he didn't want to be a burden to your family rather than a real desire to end his life?

Barbara Mancini: That certainly is quite possible.

Anderson Cooper: Well is that an argument for better end-of-life care?

Barbara Mancini: Absolutely.

Anderson Cooper: As opposed to, you know, death with dignity acts or...

"There are some nights I lie awake in bed and I just relive this whole thing."

Barbara Mancini: I don't know why better end-of-life care and death with dignity can't coexist. Why not?

A year after Barbara Mancini was arrested, a state judge dismissed the charges against her, ruling that the prosecution's case "appears to have been based on little independent investigation" and "significant hearsay."

[Barbara Mancini: Good afternoon. My name is Barbara Mancini...]

Last year, Mancini left her nursing job to work with Compassion & Choices, encouraging other states to pass laws similar to Oregon's. She's fighting for a cause now, but says she's also struggling to come to terms with what happened to her father

Barbara Mancini: There are some nights I lie awake in bed and I just relive this whole thing. And less of it has to do with what happened to me. More of it has to do with picturing him lying there in that ER crying out, knowing what I read in the hospital record.

Anderson Cooper: The way he died haunts you?

Barbara Mancini: Yes. Because the way his life ended was exactly the way he didn't want it to end. With no control, in pain, having things done to him. And I feel terrible about it.