## Facts

- Christopher I., born in September 2001, became a dependent child after severe physical abuse by his father and the mother’s failure to protect.
- On December 17, 2001, Christopher was violently shaken and thrown against a crib, causing catastrophic neurological injury.
- Christopher remained hospitalized in intensive care from December 2001 and was comatose and ventilator-dependent.
- Physicians described him as in a persistent vegetative condition with no cognitive function; future medical treatment was expected to be futile.
- Six physicians testified at a four-day evidentiary hearing, including treating doctors and independent specialists.
- The medical evidence was essentially unanimous that Christopher was not medically or legally brain dead, but had no prospect of regaining consciousness or cognitive function, and ongoing life support would only prolong dying and expose him to complications and suffering.
- The mother petitioned to withdraw life-sustaining treatment; the father objected and sought continuation of life support.
- Minor’s counsel, after reviewing the medical evidence, supported withdrawal as in Christopher’s best interests.
- The juvenile court found by clear and convincing evidence that withdrawal of life-sustaining medical treatment, including ventilator support, was in Christopher’s best interests and authorized removal.
- The father appealed, challenging the juvenile court’s authority and the best-interests determination.

## Issues

1. Whether a juvenile court in a dependency proceeding has authority to authorize withdrawal of life-sustaining medical treatment for a dependent child over a parent’s objection.
2. What legal standard and burden of proof govern a decision to withdraw life-sustaining treatment for a dependent child lacking capacity.
3. Whether substantial evidence supported the finding, under the clear and convincing evidence standard, that withdrawal was in the child’s best interests.

## Decision

- The Court of Appeal affirmed the juvenile court’s order authorizing withdrawal of life-sustaining medical treatment.
- The juvenile court had authority, within dependency jurisdiction, to make fundamental medical decisions for a dependent child in state custody, including withdrawal of life support when warranted.
- The juvenile court correctly applied a best-interests-of-the-child standard and employed a clear and convincing evidence burden given the seriousness of the decision.
- Substantial evidence supported the best-interests finding, including unanimous expert testimony that Christopher was permanently unconscious with no chance of cognitive recovery and that continued intervention was medically futile and burdensome.
- The lack of formal brain-death status did not bar withdrawal where the evidence showed a permanent vegetative state and futile, invasive treatment.
- The proceedings provided adequate safeguards, including a multi-day evidentiary hearing and participation by counsel for the parents, the agency, and the child.

## Legal Principles

- In dependency proceedings, the juvenile court’s paramount obligation is the child’s welfare; when the state has assumed protective custody, the court may make medical decisions necessary for the child’s care, including end-of-life decisions.
- Withdrawal of life-sustaining treatment for a dependent child lacking capacity is governed by the child’s best interests, assessed through medical prognosis, burdens of treatment, likely pain and complications, and the child’s dignitary interests.
- Because termination of life-sustaining treatment is exceptionally grave, a clear and convincing evidence standard may be required and satisfied through strong, consistent expert medical testimony and a developed evidentiary record.
- Parental preferences are relevant but not controlling when the child is a dependent and parental rights have been curtailed by abuse or failure to protect; the child’s interests may outweigh a parent’s demand for continued treatment.
- Legal permissibility to discontinue life support does not depend solely on a finding of brain death; it may be authorized where the patient is in a permanent vegetative state and continued treatment is futile and burdensome.

## Conclusion

The court upheld an order permitting withdrawal of ventilator support for a dependent infant in a permanent vegetative state, holding that the juvenile court had authority to decide the issue and that clear and convincing evidence supported the determination that withdrawal was in the child’s best interests despite the father’s objection.


In re Christopher I., 131 Cal. Rptr. 2d 122 (Cal. Ct. App. 4th Dist. 2003)