OKDHS.org - OAC 340:75-13-81. Withdrawal of life support, withholding or withdrawal of hydration and nutrition, resuscitation efforts, and organ donation

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340:75-13-81. Withdrawal of life support, withholding or withdrawal of hydration and nutrition, resuscitation efforts, and organ donation

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Revised 5-11-06

(a) Decisions for a child in OKDHS custody. When a child is in the legal custody of Oklahoma Department of Human Services (OKDHS), regardless of custody status, the court must be involved and make any decision regarding:

(1) withdrawal or withholding of life support systems;
(2) hydration;
(3) nutrition; and
(4) approval of a Do Not Resuscitate Order. • 1

(b) Withdrawal of life support. Any medical procedure or intervention administered to a child in OKDHS custody that serves only to prolong the process of dying or maintain the child's condition of persistent unconsciousness is considered life-sustaining treatment. This does not include the administration of medication or the performance of any medical treatment deemed necessary to alleviate pain or the normal consumption of food and water. The withdrawal of life support systems is generally considered only for a patient who suffers from an incurable and irreversible condition, death within six months, or who is persistently unconscious, per Section 3101.1 et seq. of Title 63 of the Oklahoma Statutes (63 O.S. § 3101.1 et seq.).

(c) Withholding or withdrawal of hydration and nutrition. Hydration and nutrition may be withheld or withdrawn only if the impending death would result from the underlying terminal illness or injury and not from dehydration, starvation, or both, per 63 O.S. § 3080.1.

(d) Resuscitation efforts. A Do Not Resuscitate Order is an order issued by a licensed physician that cardiopulmonary resuscitation must not be administered. Cardiopulmonary resuscitation includes those measures used to restore or support cardiac or respiratory function in the event of cardiac or respiratory arrest. As a result of such an order for a child in OKDHS custody, no efforts are made to restore or support the cardiac or respiratory system.

(e) Organ donation. 63 O.S. § 2203 outlines who may request and receive donated organs and who may supersede OKDHS in the decision of organ donation for a child in OKDHS custody at the time of death. OKDHS may:

(1) consent to the donation of organs of a child who was in permanent OKDHS custody; and
(2) not consent to the donation of organs of a child who was in any other custody status at the time of death.

INSTRUCTIONS TO STAFF 340:75-13-81

1. Procedures for a child in OKDHS custody. When the child is in Oklahoma Department of Human Services (OKDHS) custody and suffers from an incurable and irreversible condition, medical providers may ask Child Welfare (CW) staff for a decision regarding whether to withhold or withdraw the child's life support systems, hydration, or nutrition, or authorization for a Do Not Resuscitate Order.

(1) When the child is in:
- (A) emergency or temporary OKDHS custody, the child's CW worker informs the district attorney (DA) and child's parent(s) and attorney of the attending physician's request or recommendation and of the need for a court hearing; or
- (B) permanent OKDHS custody, the child's CW worker informs the DA and child's attorney of the attending physician's request or recommendation and of the need for a court hearing.
(2) The CW worker:
- (A) does not rely on an oral report or recommendation from the attending physician; and
- (B) provides the DA a written report or recommendation from the physician that may include:
  - (i) the child's:
    - (I) medical condition;
    - (II) prognosis;
    - (III) quality of life;
    - (IV) alternatives, if any; and
    - (V) life expectancy with and without life support, nutrition, or hydration; and
  - (ii) a Do Not Resuscitate Order.
(3) The DA may request a hearing with notice given to the parties and OKDHS. The court makes the decision regarding whether to withhold or withdraw life support systems, hydration, or nutrition, or approve a Do Not Resuscitate Order.

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