Department for Community Based Services

Standards of Practice Online Manual

4.27.5 Ending Use of Life Support Systems

Cabinet for Health and Family Services

Department for Community Based Services
Division of Protection and Permanency
Standards of Practice Online Manual
Chapter:
Chapter 4-Out of Home Care Services (OOHC)
Effective:
1/30/2018
Section:
4.27.5 Ending Use of Life Support Systems
Version:
4

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Legal Authority/Introduction

LEGAL AUTHORITY:

Procedure

1.The SSW or other Cabinet representative follows the procedures below, when the attending physician has determined that the child has no chance of survival without continued life support or if a do not resuscitate (DNR) order is recommended:

  1. The SSW provides the following information to the medically complex liaison during their consultation:
    1. Copy of the current custody order;
    2. Diagnosis of the child;
    3. Medical status of the child; and
    4. A letter from the physician supporting their medical recommendations.
  2. The medically complex liaison forwards the above information to the Medical Support Section; and
  3. The Medical Support Section submits the custody order and the letter from the physician to the Director of the Division of Protection and Permanency or designee, and also provides a copy to the Office of Legal Services.

If the child is in the custody of the Cabinet and parental rights are intact: 

  1. The parent is the only person who has decision making authority regarding the decision to end use of life supports;
  2. The SSW immediately notifies the parents, and (through supervisory channels) the Director of the Division of Protection and Permanency or designee and DJJ, if there is joint custody;
  3. The committing court does not have the authority to order the cessation of life support systems even if the parent’s whereabouts are unknown.
  4. The Cabinet may not request or consent to the cessation of life support systems.  If the parents do not agree to the cessation of life support systems for their child, their decision must be upheld.  Parents are the only individuals with decision making authority.
  5. The Cabinet should make every effort to locate the parents to discuss cessation of life support systems regarding their child.  In situations where the parents cannot be located, the Cabinet may not consent to cessation of life support systems.  The child's medical state must remain the same.

If the child is in the custody of the Cabinet and parental rights have been terminated: 

  1. The SSW completes the Do Not Resuscitate Checklist for Worker (found in the Steps to Obtain a Do Not Resuscitate (DNR) Order or Termination of Life Support document) and submits it to the medically complex liaison, who in turn, forwards it to the Medical Support Section.
  2. The SSW immediately notifies the Medical Support Section, and (through supervisory channels) the Medical Support Section informs the Director of the Division of Protection and Permanency (DPP) or designee and the Office of Legal Services.
  3. The director of DPP or designee, consults with the DCBS commissioner and the Cabinet secretary regarding whether to petition the court regarding the request to order cessation of life supports.
  4. The SSW or Cabinet representative petitions the court when approval by the secretary is granted.  1
  5. The SSW or other Cabinet representative follows additional regional guidelines, as appropriate.

Practice Guidance

  • The director of DPP or designee submits the information from the treating physician and the custody order to the commissioner.
  • The commissioner submits the information from the treating physician and the custody order to the Cabinet secretary.
  • The secretary:
    • Reviews all submitted information;
    • Approves or denies the motion by the court after consultation with the Office of Legal Services; or
    • Objects to a motion in court filed by the hospital, physician, etc. requesting a DNR order or discontinuance of life support.
  • If the secretary approves the motion, the Office of Legal Services advises the regional attorney to seek a court order or indicate the Cabinet’s position on any motion filed by a hospital, doctor, etc.
 

Footnotes

  1. A court order is the only permissible authorization for discontinuance of life support systems. 

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