I. End of Life Medical Decisions

If a child in DFPS conservatorship has been diagnosed with an “irreversible condition” or a “terminal condition” and medical professionals suggest withholding or withdrawing life-sustaining treatment, the regular process for medical consent does not apply and the caseworker and supervisor must follow the procedures outlined below. However, any party may seek court intervention at any time if all parties do not agree on a course of action or if any party is concerned about the child’s rights.

If parental rights have not been terminated and the child’s attending physician recommends end-of-life care, the parents have the authority to make the end-of-life decisions even if DFPS has Temporary Managing Conservatorship or Permanent Managing Conservatorship. DFPS staff or other Medical Consenters do not have the legal authority to consent in these circumstances.

If parental rights have been terminated as to both parents, or the parents are deceased and the attending physician recommends end-of-life care, the caseworker and supervisor must:

•   Obtain a written statement from the attending physician certifying that the child has a terminal or irreversible condition and that the physician recommends withholding or withdrawing life-sustaining treatment;

•   Request a second opinion or a review by a hospital medical or ethics review board if there are any concerns regarding the recommendation of the attending physician;

•   Confirm that there is no relative, fictive kin, or other individual with possessory or custodial rights. If one is available, that person must be consulted for end-of-life decisions if possible;

•   Notify and discuss the recommendation with the program director, regional director, regional attorney, attorney representing DFPS, the child’s attorney ad litem, guardian ad litem, CASA (if applicable), and any other legal party to the case; and

•   Notify and consult with the local court.