## Facts

- Jane Doe, a 13-year-old child, suffered lifelong medical problems and was hospitalized after a choking episode; her condition deteriorated into stupor/coma with progressive neurological decline.
- Physicians believed she had a degenerative neurological disease and multiple systemic illnesses; she required ventilatory support, and later tracheostomy and gastrostomy tubes.
- Physicians discussed a do-not-resuscitate (DNR) order and later possible de-escalation of life-sustaining treatment due to continued decline.
- Jane’s mother supported a DNR and at times supported de-escalation; Jane’s father opposed a DNR and objected to limiting treatment.
- The hospital’s bioethics committee reviewed the case and recommended supporting the mother’s request for a DNR and de-escalation.
- The hospital filed a declaratory judgment action seeking judicial direction on whether it could implement a DNR and/or de-escalate treatment in light of the parents’ disagreement; it did not seek termination of parental rights.
- The trial court found the hospital had standing but enjoined implementation of a DNR or de-escalation unless both parents agreed.

## Issues

1. Whether a hospital facing conflicting parental directions about end-of-life care for a minor may seek declaratory relief to clarify its legal duties.
2. Whether Georgia law permits entry of a DNR order for a minor based on one parent’s consent when the other parent, also present and involved, objects.
3. Whether the trial court properly required two-parent agreement for both a DNR order and broader de-escalation of life-sustaining treatment.

## Decision

- The Supreme Court of Georgia affirmed that the hospital had standing to pursue declaratory judgment to resolve an actual, immediate controversy over prospective treatment decisions.
- The Court held that the governing Georgia statute for DNR orders for minors required consent of both parents when both are present and actively participating in the child’s medical decision-making.
- The Court affirmed the trial court’s result requiring two-parent concurrence for a DNR under those circumstances.
- The Court reversed or modified in part to clarify the scope of relief as to treatment de-escalation, distinguishing the statutory DNR requirements from broader treatment-limitation decisions.

## Legal Principles

- A hospital may use declaratory judgment to obtain judicial guidance when legal duties are uncertain and parental directives conflict regarding a minor’s life-sustaining treatment.
- When a statute prescribes procedures for a minor’s DNR order, courts must apply the statutory conditions as written.
- Under Georgia law at the time, if both parents are present and actively participating, a DNR for a minor requires agreement of both parents; one parent’s objection prevents implementation absent other lawful authority.
- Disputes over continuing or limiting aggressive treatment for a terminally ill child do not, without more, constitute parental abuse or justify bypassing statutory protections.
- A DNR order (withholding CPR during arrest) is legally distinct from other decisions to withdraw or reduce ongoing life-sustaining interventions; the latter must be evaluated under general law and the child’s best interests rather than treated as automatically governed by the DNR statute.

## Conclusion

The court permitted the hospital to seek declaratory guidance but enforced the statutory requirement that both parents must consent to a minor’s DNR when both are involved, while clarifying that broader treatment de-escalation questions are not necessarily controlled by the DNR statute and require separate legal analysis.


In re Jane Doe, 418 S.E.2d 3 (Ga. 1992)