SF4790

Purpose

• Establishes a formal framework for providing or withholding lifesustaining treatment for unemancipated minor patients, including orders not to resuscitate and related care decisions, while clarifying roles, notification duties, and protections for families and providers.

Key Definitions and Concepts

• Order not to resuscitate (DNR/DNAR): A health care provider’s order that resuscitation measures will not be provided if the patient experiences cardiopulmonary cessation.
• Lifesustaining treatment: Medical care intended to sustain the patient’s life, including resuscitation and artificial nutrition and hydration.
• Unemancipated minor: A minor who is not married and not in active military service (including a live-born infant from birth). Excludes minors who have a child and manage their own finances in certain situations.
• Reasonable medical judgment: The standard of care used by a reasonably prudent health care provider familiar with the patient’s case and treatment options.

Main Provisions

• Notification and consent before lifesustaining decisions

  • Prior to instituting an order not to resuscitate or to withhold lifesustaining treatment (including artificial nutrition and hydration), at least one parent or legal guardian must be notified, when reasonably available.
  • Notification must be given orally and in writing, unless urgency requires oral notice only.
  • A minimum 48-hour waiting period after notice before implementing certain orders, unless the medical urgency requires otherwise.
  • If only one parent/guardian is contacted, efforts to notify the other must be documented in the patient’s medical record.

• Transfer and continuation of care

  • A parent/guardian may request a transfer to another facility within 48 hours of notice.
  • During the 72 hours to contact a parent/guardian and the 48 hours to decide on transfer, the hospital must continue lifesaving treatment and artificial nutrition/hydration for at least 15 days if a transfer is requested and notice requirements are met.
  • Hospitals must assist in the transfer process and must not hinder the parent/guardian’s ability to obtain additional medical opinions or to transfer care.
  • If transfer cannot be arranged within 15 days, a decision to withhold or institute certain orders may be made.

• Revocation and authority of guardians

  • A parent/guardian may revoke previously given consent for an order not to resuscitate or similar orders orally or in writing; revocation is recorded in the medical record.
  • Courts generally cannot force withdrawal of lifesustaining treatments over a guardian’s objection unless critical life-ending conditions exist; juvenile/family court processes require a guardian ad litem to protect the child’s best interest.
  • Relatives who are caregiver or guardian have the same authority as a parent/guardian if the child is not under juvenile/family court jurisdiction.

• Safeguards and enforcement

  • Legal action may be brought by a parent/guardian/relative caregiver/sibling/grandparent if a do-not-resuscitate order is violated or delayed.
  • Mandatory reporting: any health care practitioner or hospital/clinic employee aware of noncompliance must report to the appropriate state law enforcement agency; professionals may face license suspension or revocation for failure to comply.
  • Limitations: providers are not required to deliver or continue treatment that is medically inappropriate or would cause undue harm, suffering, or risk to the patient.
  • Policy disclosures: providers must disclose policies about resuscitation and lifesustaining measures upon request.

• Policy and severability

  • Providers must disclose policies on resuscitation and lifesustaining measures when asked.
  • If part of the statute is found unconstitutional, the rest remains in effect (severability).

Significant Changes to Existing Law

• Introduces a formal notification requirement and 48-hour waiting period for orders not to resuscitate or to withhold lifesustaining treatment for unemancipated minors.
• Establishes a structured transfer process with specific timelines (including a 15-day continuation window during transfer discussions).
• Codifies guardianship and guardian ad litem roles, including limits on court authority to override parental/guardian decisions except under defined life-ending circumstances.
• Adds explicit protections for relatives and caregivers with authority to make medical decisions for unemancipated minors under certain conditions.
• Creates stronger enforcement mechanisms, including mandatory reporting and potential licensure consequences for noncompliance.

Relevant Terms

• order not to resuscitate (DNR, DNAR, Do Not Resuscitate, Do Not Attempt Resuscitation)
• resuscitation
• lif esustaining treatment
• artificial nutrition and hydration
• unemancipated minor
• reasonable medical judgment
• parent or legal guardian
• guardian ad litem
• transfer of care
• notification (oral and written)
• 48-hour notice
• 72-hour contact window
• 15-day continuation period
• revocation of consent
• juvenile/family court
• relative caregiver
• mandatory reporting
• life-ending considerations
• policy disclosures
• severability