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 (TMC) or permanent managing conservatorship (PMC). CPS staff or other medical consenters do not have the legal authority to consent in these circumstances.

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 about the attending physician's recommendation. The hospital decides whether to convene a review committee;

  •   inform the parents of the child's medical condition and the recommendation of the attending physician and any hospital medical or ethics review board (if applicable);

  •   arrange for the parents to discuss any recommendation with the attending physician directly (by phone or in person); 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.

Staff must ensure all parties are informed of the decision once a decision has been made.