Summary
The Supreme Judicial Court of Maine held that the Department of Health and Human Services may make medical decisions for a child in its custody, but may not unilaterally approve a do-not-resuscitate directive over the parents’ objection without constitutionally adequate process. The court required notice, a hearing, and clear and convincing evidence that the DNR is in the child’s best interest. It vacated the judgment insofar as it interpreted the statute to permit approval of a DNR without a hearing and affirmed the judgment in all other respects.
Topics
Practice areas
Questions Presented
- Whether 22 M.R.S. § 4037 authorizes the Department, as custodian of a child under a protection order, to unilaterally approve a do-not-resuscitate directive over the parents' objection without constitutionally adequate notice and an opportunity to be heard.
- What procedural protections are required before the Department may obtain authority to issue a DNR for a child in its custody when the parents object.
- Whether the father's challenge to the aggravating-factor finding and cessation of reunification efforts was reviewable on appeal.
Holdings
- Section 4037 grants the Department authority to make ordinary medical decisions for a child in its custody, but it does not authorize the Department to unilaterally approve a DNR over the parents' objection without constitutionally adequate process.
- When a parent whose rights have not been terminated objects to a DNR for a child in Department custody, the court must provide reasonable notice, hold a hearing, and determine by clear and convincing evidence whether it is in the child's best interest to give the Department authority to issue the DNR.
- The court declined to reach the merits because an order ending reunification efforts under 22 M.R.S. § 4041(2)(A-2)(1) is interlocutory rather than a final judgment and therefore was not then appealable.
Key quotations
“The decision to withhold or withdraw life-sustaining treatment is a decision of such heightened magnitude that it cannot be said to be within the scope of ordinary medical decisions.” (903 A.2d at 337-38)
“Thus, due process requires that parents be afforded the same procedural protections before approval of a DNR for their child as they are afforded prior to the termination of their parental rights.” (903 A.2d at 338)
Factual background
Matthew W. was born on August 18, 2005, and remained in his parents' care until September 30, when they called 911 because he was not breathing. Doctors diagnosed acute respiratory decompensation, anemia, and severe intracranial hemorrhages that they characterized as shaken-impact injuries, with a grim long-term prognosis. The Department obtained custody through child-protection proceedings. Matthew's doctors initially obtained the parents' consent to a do-not-resuscitate directive, but the parents revoked that consent the next day, after which the Department unilaterally approved reinstatement of the DNR.
Procedural history
The Department petitioned for a child protection order after Matthew was hospitalized with severe brain injuries. The parents consented to a preliminary protection order, and the District Court later awarded custody to the Department. After the parents withdrew consent to a DNR directive, the Department unilaterally reinstated it, and the District Court ruled that section 4037 authorized that action. Following a jeopardy hearing, the court found Matthew in jeopardy, continued Department custody, and relieved the Department of reunification efforts with the father based on an aggravating-factor finding. The Supreme Judicial Court consolidated the parents' appeals, vacated the DNR ruling, and affirmed the judgment in all other respects.
Remand instructions
The District Court must conduct further proceedings consistent with the opinion. If a parent objects to a DNR, the court must provide reasonable notice, hold a hearing, and determine by clear and convincing evidence whether giving the Department authority to issue the DNR is in the child's best interest, considering the factors identified by the Supreme Judicial Court.