HF4568

Purpose

This bill sets new rules for when lifesustaining treatment is considered for unemancipated minor patients. It aims to protect parental involvement in decisions about resuscitation and related care, establish a formal process for notifying guardians, and create safeguards around when and how life-sustaining treatment can be used or withheld.

Main Provisions

• Short title and definitions
  • Establishes the act's short title (Simons Law) and defines key terms, including:
  • Order not to resuscitate (DNR/DNAR/AND and similar terms)
  • Lifesustaining treatment
  • Artificial nutrition and hydration
  • Reasonable medical judgment
  • Unemancipated minor (a minor not married and not in active military service)
• Notification before resuscitation-withholding decisions
  • Before instituting an order not to resuscitate or similar orders for an unemancipated minor, at least one parent or legal guardian must be notified both orally and in writing.
  • The notification must include details required by the act, and there is a 48-hour waiting period after notification before the order can be implemented, unless a health care provider determines urgency justifies proceeding sooner.
• Transfer and continuation of care
  • If a parent/guardian requests a transfer during the 72 hours of trying to contact them and the 48-hour waiting period, the hospital must continue lifesustaining treatment and artificial nutrition/hydration for at least 15 days if notice requirements are met.
  • The hospital must help with the transfer and must provide access to the minor’s medical records to designated providers.
  • If a transfer cannot be arranged within 15 days, an order not to resuscitate or similar order may be instituted.
  • If a transfer is possible, the parent/guardian may seek another medical opinion or choose a different facility; the attending provider must not hinder such efforts.
  • The party requesting transfer may request immediate access to medical records for those arranging the transfer.
• Role of guardians and courts
  • Parents/guardians may revoke prior consent for a DNR-like order orally or in writing, and revocation takes precedence over earlier consent.
  • Courts generally cannot require withdrawal of lifesustaining procedures over a parent/guardian’s objection, except in very specific life-ending scenarios (e.g., destruction of circulatory/respiratory functions and the entire brain, including the brain stem).
  • For a child under juvenile court jurisdiction, a guardian ad litem must be appointed to act in the child’s best interest before medical decisions that would withhold treatment and likely cause death are ordered; the Department of Children, Youth and Families cannot be appointed as guardian for those purposes.
  • Relative caregivers can have the same authority as a parent/guardian if the child is not under juvenile/family court jurisdiction.
• Legal remedies and reporting
  • A parent/guardian/relative caregiver/sibling/grandparent may sue for death or injury of an unemancipated minor if a DNR or withholding order was violated or delayed.
  • Mandatory reporting: health care workers must report failures to comply with the requirements; professional boards may suspend or revoke licenses for failure to enforce the provisions.
• Limitations and safeguards
  • Health care providers are not required to give or continue treatment that is medically inappropriate or would create greater risk, harm, unnecessary pain, or suffering.
  • Providers are not required to continue CPR/ventilation beyond what reasonable medical judgment determines to be beneficial.
• Policy disclosures
  • Providers must disclose, upon request, policies relating to resuscitation or lifesustaining measures, including policies about measures deemed not beneficial or futile.
• Severability
  • If part of the law is unconstitutional, the rest remains in effect.

Significant Changes to Existing Law

• Introduces mandatory parental/guardian notification and a 48-hour waiting period before implementing a DNR-like order for unemancipated minors, with urgency-based exceptions.
• Establishes a formal, time-bound transfer process and a minimum continuation period (15 days) of life-sustaining care if a transfer is being arranged.
• Expands guardianship and guardian-ad-litem requirements in cases where withholding treatment could end a child’s life, limiting who can be appointed as guardian for such decisions.
• Provides a framework for revocation of consent and protection against court-ordered withdrawal of lifesustaining care without appropriate guardianship actions.
• Creates statutory remedies, mandatory reporting, and potential professional discipline for violations of the new requirements.
• Requires explicit disclosure of resuscitation policies to patients, guardians, or prospective patients.

Terminology and Phrases to Note

• Order not to resuscitate (DNR, DNAR, AND, do not resuscitate, etc.)
• Lifesustaining treatment
• Artificial nutrition and hydration
• Reasonable medical judgment
• Unemancipated minor
• Do not resuscitate / do not attempt resuscitation
• Allow natural death
• Transfer process and transfer request
• Guardian ad litem
• Juvenile court / family court
• Department of Children, Youth and Families
• Revocation of consent
• Donotresuscitate / donotattempttoresuscitate
• Policy disclosures
• Mandatory reporting
• Severability

Relevant Terms unemancipated minor; order not to resuscitate; lifesustaining treatment; DNR/DNAR/AND; artificial nutrition and hydration; reasonable medical judgment; parental/guardian notification; 48-hour waiting period; 72-hour contact period; transfer; guardian ad litem; juvenile/family court; Department of Children, Youth and Families; revocation of consent; mandatory reporting; policy disclosures; severability; life-ending procedures.