2. “DNR” DO NOT RESUSCITATE WITHHOLDING OR WITHDRAWING LIFE SUSTAINING TREATMENT Withhold Refrain from applying life support Withdraw Disconnect life support previously applied

3. “LIFE SUSTAINING TREATMENT” § 166.002(10) TEXAS HEALTH & SAFETY CODE "Life-sustaining treatment" means treatment that, based on reasonable medical judgment, sustains the life of a patient and without which the patient will die. The term includes both life-sustaining medications and artificial life support, such as mechanical breathing machines, kidney dialysis treatment, and artificial nutrition and hydration. The term does not include the administration of pain management medication or the performance of a medical procedure considered to be necessary to provide comfort care, or any other medical care provided to alleviate a patient's pain.

4. Before a DNR is considered……….. A written statement from the attending physician certifying that the child has a terminal or irreversible condition must be obtained with the physician recommending withholding or withdrawing life-sustaining treatment

5. “TERMINAL” § 166.002(13) TEXAS HEALTH & SAFETY CODE an incurable condition caused by injury, disease, or illness that according to reasonable medical judgment will produce death within six months, even with available life-sustaining treatment provided in accordance with the prevailing standard of medical care.

6. “IRREVERSIBLE CONDITION” § 166.002(9) TEXAS HEALTH & SAFETY CODE means a condition, injury, or illness: (A) that may be treated but is never cured or eliminated; (B) that leaves a person unable to care for or make decisions for the person's own self; and (C) that, without life-sustaining treatment provided in accordance with the prevailing standard of medical care, is fatal.

7. When Parents Retain Their Rights Parents decide on the DNR DFPS DOES NOT have legal authority to consent

8. Inform the parents of the recommendation for a DNR Arrange for the parents to discuss recommendation with physician directly Inform the attorney representing DFPS, the AAL/GAL, & DFPS Regional Attorney about parent’s decision DFPS Caseworker Responsibility When Parents Retain Their Rights

9. If Parents Consent: Parents execute the DNR Order and sign documents If Parents Refuse to Consent: DFPS takes no further action If Parents Cannot be Located: DFPS required to notify all parties including DFPS Regional Attorney Attorney representing DFPS may request a GAL to explore child’s best interest Once parent/GAL makes decision, DFPS to inform all parties whether DNR was executed

10. Arrange for review by committee (hospitalized children) or Infant- Care Review/Ethics committee arrange for a second medical opinion if necessary to ensure objectivity Notify the Court When Parents Lose Their Rights or Are Deceased

11. If Court Wishes to be Involved, DFPS: Presents situation to courtInvolves AAL/GAL Complies with Court’s directive If Court Does Not Wish to be Involved, DFPS: Notifies Court of final decision